Two years ago, the Florida grand jury tasked with investigating school safety problems and other issues after the Parkland mass shooting issued a scathing report about the state’s mental health care system.
“To put it bluntly,” the report said, “our mental health care ‘system’ — if one can even call it that — is a mess.”
The grand jury found “deficiencies in funding, leadership and services” within the state’s “patchwork of interlocking, often-conflicting” sources of mental health treatment. The Florida Supreme Court impaneled the grand jury in 2019 at the request of Gov. Ron DeSantis after 17 people were shot and killed the year before at Marjory Stoneman Douglas High School.
At the time, Florida ranked last among states for its per capita mental health care funding, the grand jury said.
Soon, a state commission created last year will publish interim recommendations on how to reform Florida’s confusing and underfunded system.
The Commission on Mental Health and Substance Abuse’s initial findings must be sent to DeSantis and legislative leaders by Jan. 1. A final report is due next September.
The Tampa Bay Times asked a Department of Children and Families spokesperson for the initial report, but she said it’s still being finalized and will be published soon. She didn’t say when.
The commission discussed its proposed recommendations during public meetings earlier this year, providing some insight into what the report is expected to say.
Here are four takeaways.
Jail diversion programs
Typically, most people with mental illnesses “are no more dangerous than the general population,” said Steve Leifman, a judge in Miami-Dade County and a longtime mental health advocate.
But the criminal justice system has become the “de facto mental health system in America,” he said at an October meeting.
The Miami-Dade County jail, for example, is the largest psychiatric institution in Florida, the 11th Judicial Circuit reported last year. About a fifth of annual bookings involve people with mental illnesses who need intensive treatment.
On any given day, the jail houses about 2,400 individuals receiving psychotherapeutic medications, costing taxpayers roughly $232 million per year, the court system said.
That’s why the commission plans to urge Florida to create more pre- and post-arrest diversion programs to place those with mental illnesses into community-based treatment instead of keeping them in jail.
Initiatives could include additional crisis intervention training for police officers and sheriff’s deputies, where they get lessons on psychiatric diagnoses, de-escalation techniques and trauma so they know when to get people into treatment instead of arresting them. Or they could include programs where individuals with mental illnesses get their misdemeanor charges dismissed or modified if they agree to enter into monitored treatment outside of jail.
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Florida could also make sure 911 call-takers redirect those in a mental health crisis to 988 operators. The three-digit national suicide hotline launched in July. Nonprofits that answer 988 can usually de-escalate situations without police intervention.
Prioritizing community treatment
The commission will likely suggest that Florida curtail its use of competency restoration for those diagnosed with mental illnesses and charged with misdemeanors or low-level felonies. Competency restoration is a process used to make sure defendants understand the charges against them and can assist in their defense.
At state facilities, competency restoration does not focus on long-term wellness and recovery for defendants who have conditions such as schizophrenia, bipolar disorder or major depression. It aims to restore their ability to participate in legal proceedings. Once they are deemed mentally fit, they head back to jail to face their charges. Most of the time, Leifman said, their charges are dropped, they get credit for time served or they receive probation.
“They leave the courthouse without any access to treatment and often reoffend before they hit the street. It’s a big waste of money,” he said, adding that the process is “systematically broken.”
He pointed to the state-funded Miami-Dade Forensic Alternative Center as a model that can be expanded to other parts of Florida. Adult defendants who face nonviolent second- or third-degree felony charges and who are incompetent to stand trial get sent to a 16-bed locked inpatient unit at Jackson Memorial Hospital that prioritizes “community reintegration.”
After people are stabilized and deemed competent, they get diverted into less restrictive treatment in the community. The program continues to monitor them and provides support. This is more effective and cheaper than sending nonviolent offenders to state facilities over and over again, said Leifman, a member of the commission’s subcommittee on criminal justice.
“We would save the taxpayers hundreds of millions of dollars,” Leifman said, and “be able to shift those dollars to more front-end services so people can get better access to care and not continue to cycle through our criminal justice system.”
Competency restoration, he said, should be reserved for individuals who commit “horrible offenses.”
A Pulitzer Prize-winning investigation published in 2015 by the Tampa Bay Times and Sarasota Herald-Tribune found that Florida spent at least $50 million per year restoring the competency of defendants whose nonviolent crimes were so minor they never spent a day in prison.
Identifying mental health trends
Multiple Florida agencies receive money for behavioral health services, but data on their programs is siloed, making it difficult for state officials to get a complete view of the mental health care system and identify trends in how people are cycling through it. There isn’t a centralized database.
The commission wants Florida to create one.
Data would be collected from the Department of Children and Families, the Agency for Health Care Administration and the Department of Juvenile Justice, among other Florida agencies.
This could help state leaders identify problems in the system, like whether programs are unsuccessful or there are gaps in access. The database would not include information that reveals patients’ identities.
Earlier this year, Florida was ranked 46th in the U.S. for access to mental health care by national advocacy group Mental Health America. The nonprofit based its rankings on access to insurance, treatment and special education, along with the cost and quality of insurance and the number of mental health providers.
Tracking how Florida funds care
The commission plans to keep requesting data from state agencies to figure out how Florida is spending money on mental health care.
It’s “daunting” to track how much the state is investing in the system, according to the nonprofit Florida Policy Institute.
Behavioral health funding is appropriated to several agencies. Most of it is separately administered by the Agency for Health Care Administration through the state’s Medicaid program and by the Department of Children and Families.
Medicaid provides health care coverage to individuals with disabilities and very low-income families and children. During fiscal year 2020-21, Medicaid expenditures on mental health services totaled over $10 billion in Florida.
The Department of Children and Families is responsible for safety-net behavioral health services for uninsured adults and children. It contracts with seven organizations that distribute money to local providers. The department was appropriated $1.1 billion for community-based care in the state’s most recent budget, according to the Florida Policy Institute.
“The system of care is a patchwork, currently, of programs, care delivery and oversight that is complex, disjointed and inequitable,” Clara Reynolds, a commission member and chief executive officer of the nonprofit Crisis Center of Tampa Bay, said at an October meeting.