State needs one good system for mental health

Floridians with mental illness — and their families — are finally getting some respect from the Florida Legislature. But will it last?

The powerful Senate Health and Human Services Appropriations Subcommittee held a panel discussion on what’s ails the state’s mental health system on Tuesday, and at its close, Sen. Aaron Bean, R-Fernandina Beach, offered perhaps the most optimistic sign yet that reform is in the air.

“This could be the year that mental health gets the spotlight. Hopefully, help is on the way,” he said. It’s decades overdue. The committee’s panelists said it plainly: Florida doesn’t really have a mental health system. It has two disconnected layers: crisis centers and the criminal justice system.

The crisis centers can hold people considered a danger for three days, possibly longer, under the state’s Baker Act. But upon release, there’s rarely adequate follow-up care, so people are likely to wind up rearrested or recommitted in short order. This dysfunction has been costly. It has overburdened state hospitals responsible for restoring defendants to competency to stand trial. It has brutalized people with mental illness, and it has turned the police into a medical taxi service. Most officers lack the training to calm a person in the throes of crisis, or the mission to treat them with compassion and understanding. Too often, when they arrive on a 911 call, they escalate the situation, sometimes with tragic results.

Panelist T. Patterson “Patt” Maney, a county court judge in Okaloosa County since 1989, served on the Supreme Court’s task force on mental health. He noted that both drug courts and veterans’ courts — including here in Palm Beach County — have worked exceptionally well by giving offenders a second-chance alternative to prison. A mental health court fashioned in a similar way, in Miami, has saved money and lives. To work properly, mental health courts must have healthy, strong community services to support those being deferred.

“If you improve the community mental health care you would cut down on the cost of the revolving door of the psychiatric hospitals and the courts,” Maney stressed.

Another promising concept, launched in Orlando, relieves the police of social worker duties and has them deliver their detainee to a mental health and substance-abuse receiving center, where qualified specialists take over.

“What used to take two to four hours now takes an officer 10 minutes to drop the consumer off and get back on the street,” said Donna P. Wyche, of the Orange County Health Services Department.

The best news about Tuesday’s hearing is that lawmakers listened to the experts instead of the usual lobbyists. The last time the Legislature touched the state’s mental health system, it focused on dollars over people, and did real damage. It added a new layer of privatized bureaucracy called “managing entities” to process the state’s payments to mental health providers. No money was earmarked to hire them, so the managers siphoned off about 4 percent of the sparse state funds available for care.

The state grossly underpays the social workers and psychologists who see Medicaid patients. These providers haven’t had a raise in two decades, one speaker said, and so the services shrink a little each year. Staff turnover at community mental health centers is a terrible one-third per year, said Mike Hanson, president and CEO of the Florida Council for Community Mental Health.

Priorities matter. If Florida has millions for new stadiums, tourism marketing, for-profit charter school companies and “innovation incentives” for business, then it has real money to build an effective and efficient mental health system.