By Kacey Heekin (2016)
Florida’s mental health system has remained significantly and chronically underfunded. Mental health expenditures across the United States have been relatively minimal in comparison to the prevalence of mental illness (according to the Substance Abuse and Mental Health Services Administration [SAMHSA], approximately 18.5% of adults in the U.S. currently experience any mental illness and 4.2% experience serious mental illness [SAMHSA, 2014]) and the severity of the consequences of an inadequate mental health system, but even so, mental health funding in Florida has been notoriously low.
State mental health agencies (SMHAs) are “the state government organizations responsible for planning, organizing, delivering, and monitoring critical mental health… services in each state… and SMHAs provide safety-net services to individuals with mental health… disorders… who lack insurance and/or have high levels of service needs” (SAMHSA, 2015). All of the data regarding SMHA expenditures contained in this issue brief have been obtained from the National Association of State Mental Program Directors Research Institute, Inc. (NRI).
SMHA Total and Per Capita Expenditures
Florida has long maintained one of the lowest per capita mental health expenditures inthe nation. According to the most recent available data, Florida has a SMHA per capita mental health services expenditure of $37.28, giving it a rank of 49th for mental health funding in the U.S.
Tables 1 and 2 show just how dire Florida’s mental health funding situation has become over the past decade, especially in comparison to the nation at large. In constant dollars, Florida’s SMHA total expenditure in 2012 was 33% lower than in 2002; in contrast ,the total expenditure for all SMHAs in the U.S. in 2012 was 8% greater than in 2002.
Figures 1 and 2 display the trends from Table 1 and demonstrate the differences in mental health expenditure trajectories between Florida and the U.S. as a whole throughout the past decade.
Expenditures by Type of Program
The largest proportions of SMHA expenditures are devoted to state psychiatric hospital inpatient services and community-based programs. Throughout the past 50 years, propelled by the deinstitutionalization movement, there has been a shift in the primary setting of mental health treatment from psychiatric hospitals to community-based centers. However, a lack of funding and support for community-based services during the process of deinstitutionalization has left many individuals without sufficient care and, often times, homeless and/or in emergency departments, jails, and/or prisons; this contributes to a vicious and economically draining cycle, whereby individuals with unmet mental health needs continuously interact with high-cost public services and yet never receive adequate treatment. Florida, particularly, has struggled with a huge and growing number of incarcerated individuals in need of mental health services.
Throughout the past decade, Florida has spent a disproportionately higher ratio of its mental health budget on state psychiatric hospital inpatient services to community-based programs in comparison to the rest of the U.S. In 2012, Florida focused nearly two times the percentage of its total SMHA expenditures on state psychiatric hospital inpatient services compared to the overall U.S. (i.e., 45% versus 23%) and a much smaller percentage of its total SMHA expenditures was devoted to community-based programs, again by comparison to the overall U.S. (i.e., 53% versus 74%). Tables 3 and 4 and Figure 3 show these trends. Florida currently has one of the highest rates of percentage of its mental health budget being spent on institutional care in the nation, thus reducing the amount of the budget that can be appropriated to community-based services.
The Future of Florida’s Mental Health System
Florida’s mental health service system has many inadequacies, especially the significant lack of funding for mental health services, insufficient investment in community-based mental health services, and a crisis of mental health care in the state’s correctional system. Since the state of mental health funding in Florida has remained dismal, it will be important to increase the focus on mental health research and policy initiatives designed to identify more cost-effective methods of providing mental health services. Coordination of care, development of integrated health networks, andcollaboration among researchers, mental health providers, consumers, advocates,criminal justice personnel, policymakers, etc., will also be critical. Ultimately though, expanded funding for mental health services in Florida and at the national level would be one of the most beneficial interventions and would improve overall societal well-being.