In My Opinion

Fred Grimm: A sneaky vote against mental-health care

No one called Judge Leifman.

That's all you need to know about Florida Senate Bill 7122, one of those phantom pieces of legislation that seem to glide inexorably toward passage without the usual committee stops, without much scrutiny from lawmakers or input from experts.

It was as if the bill has been guided by the hand of God. Either that or the Senate president's office, whichever force might be more beholden to the for-profit hospital lobby.

SB 7122 would radically alter — make that devastate — emergency mental health treatment in Florida by cutting the guaranteed flat fee now paid to the non-profit Crisis Stabilization Units that handle mental health emergencies, based on each unit's bed capacity.

Instead, the guaranteed reimbursement would be based on 25 percent of a CSU's bed capacity. The balance of the money would be calculated by the number of patients CSU might admit against whatever money the Department Children and Families has left in its mental health budget. Of course, much of that money would then be diverted to hospitals, including for-profit hospitals who dearly want to snag a chunk of the $61 million the state now pays out each year for CSU interventions.

The senators who passed this out of committee last week — with a very sneaky vote — didn't bother consulting with Miami-Dade County Administrative Judge Steve Leifman, an odd oversight considering he's chairman of the state Supreme Court’s Task Force on Substance Abuse and Mental Health Issues, special adviser to the Supreme Court for criminal justice and mental health issues and chairman of Miami-Dade courts committee on mental health (just to mention a few of the items on his daunting list of credentials.)

No one in Florida matches Leifman's experience when it comes to getting the mentally ill off the streets and out of jail cells and into the mental health system.

So why didn't some senator on the Children, Families, and Elder Affairs Committee, confronted with a bill so laden with consequences for the public mental heath, make a call to Florida's go-to authority on crisis intervention? Leifman can guess why. “If you don't want to know the answer, don't ask,” he said.

The answer the senators didn't want hear was that the bill would have a devastating effect. With guaranteed reimbursements reduced by 75 percent, Leifman would have warned them, the state's network of non-profit CSUs will be forced to reduce the number of beds and staff. Excess patients will be funneled instead to hospitals. Except, Leifman said, it will cost the state about $1,200 for each crisis intervention treated in a hospital, compared to $291 in a CSU.

All this extra money would be coming out of a finite budget. Which means fewer patients who could be diverted into treatment. “It's going to be a disaster. The police are freaking out,” Leifman told me Monday. He said a police officer, with a mentally unstable person in custody, simply won't wait around a hospital admitting office for hours, waiting for a bed to come open. “They'll just take them to jail.”

For years the courts have been pushing for alternatives to incarceration for the mentally ill. Leifman talked about how Miami-Dade and the city of Miami police departments have now trained some 4,000 police officers in crisis intervention. In 2012, county police answered 5,225 calls for mental crises. Some 1,803 individuals, most of whom would have been arrested in the old days, were diverted to crisis intervention units. Only six went to jail. In Miami last year, 4,823 calls brought only five arrests and 202 CSU diversions.

Leifman fears that the Legislature, at the behest of the hospital industry, is about to undo all this progress with some legislative trickery, attaching the measure, perhaps, as a rider to budget bills in the House and Senate, skipping the usual scrutiny afforded such an important piece of legislation. “Some lobbyist was paid a lot of money for this,” he said.

And it's not just Leifman who’s worried. The Florida Partners in Crisis, a mental health advocacy group, sent out an urgent message Monday afternoon beseeching members to warn their legislators to kill SB 7122. “The way the bill is worded now, and this is not an overstatement, it would completely destabilize our system of care in this state.”

According to the Tampa Bay Times’ John Romano, the controversial bill came up for a committee hearing on April 1. “So, after a healthy amount of consternation and concern, they postponed further discussion of SB 7122 to a later date. Twenty-eight minutes later, once the experts and some senators have left the room, the legislation is reintroduced for an immediate vote. It passes the committee 6-4.”

Very sneaky. Which says all you need to know about SB 7122.

Read more Fred Grimm stories from the Miami Herald

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