The recent decision by leaders in the state Legislature to back away from a bill that would have jeopardized Florida’s system of community-based crisis stabilization units (CSUs) in favor of a more-thoughtful analysis of how beds in these facilities are being utilized is a welcome and potentially life-saving alternative to what would have been a disastrous shift in public policy.
CSUs provide short-term treatment to indigent people who are experiencing psychiatric emergencies. These units are critical to preventing the need for more costly care in hospitals and the criminal-justice system
However, CSU funding is not the real problem. It is a symptom of larger problems plaguing an underfunded, outdated and fragmented system of care, which often contributes to the inappropriate criminalization of people with mental illnesses. The costs to taxpayers are staggering, and the effects on individuals and families are heartbreaking.
Consider: The Florida Mental Health Institute at the University of South Florida examined costs associated with 97 individuals in Miami-Dade County diagnosed with serious mental illnesses (SMIs) and identified as frequent recidivists to the criminal-justice and acute-care treatment systems. Almost all of these people were diagnosed with schizophrenia and were homeless. Over a five-year period, they experienced 2,200 arrests, 27,000 days in jail and 13,000 days in hospitals and emergency rooms. The cost to taxpayers is conservatively estimated at $13 million with no demonstrable return on investment.
Shocking? Yes. Surprising? No. Florida ranks 49th nationally in funding for community mental-health treatment. Yet it spends exorbitantly to house people with mental illnesses in criminal-justice settings. There are roughly 17,000 state prison inmates, 9,000 local jail detainees and 1,500 people in forensic hospitals who experience SMIs. The cost to taxpayers to house them is nearly $1 billion annually.
In Miami-Dade County, home to the largest percentage of people with SMIs of any urban community in the United States, 9.1 percent of the population — 185,000 adults and 50,000 children — experiences SMIs, yet only 1 percent receives services in the public mental-health treatment system. Not surprisingly, the county jail has become the largest psychiatric institution in Florida, housing 1,200 individuals with mental illnesses and costing taxpayers $65 million annually.
By investing so heavily in correctional facilities — where mental-health treatment is constitutionally mandated — but not in the community, the current system negligently drives people into the justice system. There are 89 public receiving-facility beds in Miami-Dade County and 1,971 statewide. Compared with the number of mental-health beds in prisons, jails and forensic hospitals, this means there are 14 times as many mental-health beds in criminal justice settings as in the community.
In Miami-Dade County alone, for every 100,000 residents there are 46 mental-health beds in the jail compared to just three public receiving-facility beds in the community.
If we treated people with primary healthcare needs the way we treat people with mental illnesses, there would be rampant lawsuits and criminal indictments. For example, people who need a knee replacement undergo surgery, remain hospitalized until they are medically cleared and then are sent to a rehabilitation center until they are ready to resume their life activities — all paid for with insurance, Medicaid or Medicare.
But people in a psychiatric crisis without financial means who are admitted to a hospital or CSU receive treatment only as long as they are considered dangerous to themselves or others — frequently a few hours or a few days. Such people are then discharged, often to homelessness, and eventually find their way into the criminal-justice system again — and again and again.
If we are to craft a more-sensible, equitable and sustainable system of care, it is imperative that we work deliberately to examine and fix the system as a whole, and not just react as problems bubble to the surface. We must:
• Revisit our mental-health laws, which are more than 40 years old, to ensure an appropriate balance between civil liberties, public safety, due process and need for treatment.
• Ensure that services available in the community are appropriately funded and responsive to individuals’ treatment needs.
• Leverage advances in information technology to improve treatment planning and care coordination.
This is a community problem requiring a community solution. None of us created this crisis alone. Nor will we solve it alone. For this reason, the Miami Downtown Development Authority will host a meeting at 8 a.m. on May 28 at Miami Dade College’s Wolfson Campus to discuss ways in which businesses and residents can come together to support approaches for improving treatment and care. This should be the beginning of an ongoing call to action that will finally lead to meaningful community solutions.
Miami-Dade County Judge Steve Leifman is chair of the Florida Supreme Court Task Force on Substance Abuse and Mental Health Issues in the Court.