Health Care

Lawmakers overhaul system to create ‘no wrong door’ to mental health treatment

In February 2009, Judge Steven Leifman, right, shows Walter A. McNeil, center, Secretary of Florida Department of Corrections, and dozens of other officials, the current conditions at the Miami-Dade County Jail, 9C-wing, or psych wing.
In February 2009, Judge Steven Leifman, right, shows Walter A. McNeil, center, Secretary of Florida Department of Corrections, and dozens of other officials, the current conditions at the Miami-Dade County Jail, 9C-wing, or psych wing. Miami Herald file photo

Something Judge Steve Leifman said in his Miami courtroom made the psychologist standing before him snap.

Those aren’t my parents, the doctor — who had been calm moments earlier — screamed, pointing out the man and woman in the back of the room who had raised him, sent him off to Harvard and worked to find him the help he needed. My parents died in the Holocaust. Those people were sent by the CIA. They want to kill me.

It was clear that the man needed help, thought Leifman. But under state law, he wasn’t empowered to commit him to a facility where he could be treated for a mental illness.

“It was horrifying. This was a full-blown psychotic man,” Leifman said. “I had no choice but to release him.”

That was 16 years ago. Now, after a series of fits and starts, Florida is finally on the brink of a historic overhaul of mental health and substance abuse treatment that supporters say will better equip the criminal justice system to handle mental illness.

What’s more, advocates say, the changes could help people receive treatment earlier, addressing problems before they become more severe and reducing strain on the state’s mental hospitals. Those facilities are in the spotlight after reports by the Tampa Bay Times and Sarasota Herald-Tribune exposed that they are understaffed and don’t have enough resources to keep up with demand.

“Hopefully, what it will do is allow people to get services earlier on,” said Linda McKinnon, president and CEO of the Central Florida Behavioral Health network and a 30-year veteran of mental health treatment. “The goal is for the front door to be much earlier than the equivalent of having a massive heart attack.”

Hopefully, what it will do is allow people to get services earlier on.

Linda McKinnon, president and CEO of Central Florida Behavioral Health network

The goal is straightforward: A coordinated system of services for mental illness and substance abuse in which no matter how someone enters the system, they get the immediate help they need, as well as follow-up services in the future.

“There will be no wrong door,” said Rep. Kathleen Peters, R-South Pasadena, one of the Legislature’s foremost advocates for mental health reform.

To accomplish that, the Legislature passed bills requiring communities to work together, bringing to the table every group that has a role in mental health and substance abuse — health professionals, law enforcement, prisons and jails, juvenile justice agencies, courts and local charities.

They also expanded options for courts to divert the mentally ill toward treatment and voted to let psychiatric nurses prescribe certain medications, addressing a nationwide shortage of psychiatrists.

But overhauling the system could take a lot of work — and a lot more money.

At the heart of the changes are Florida’s managing entities, which are nonprofits that oversee state contracts in each of seven regions of the state. Lawmakers tasked them to work with the counties in their areas to create a new system for evaluating people in need.

That means creating locations in every part of the state to determine what kind of services people need — a sort of mental health emergency room to serve those in crisis, whether they recognize it themselves, are involuntarily committed under the Baker or Marchman acts, or a police officer decides it’s best to bring them there instead of jail.

Providers in some parts of the state, including Tampa Bay and South Florida, already collaborate, but the changes passed by lawmakers this year require them to bring law enforcement and other government agencies on board.

As an example, supporters often point to Orange County and its “central receiving center” in downtown Orlando where police take people they believe are in need of treatment.

The center describes itself as a “single point of entry into the mental health and substance abuse system.” That’s the model lawmakers want to create across the state, tailored to the needs of each area. In a rural region, for example, a handful of smaller sites with transportation agreements may be more practical than the Orlando model.

“If you have a designated receiving facility, that is the one that law enforcement know to go to,” said Rep. Gayle Harrell, R-Stuart, who worked for two years to pass the overhaul.

It’s an idea that law enforcement officers embrace as well.

Jails are too often home to people who should be in treatment, Pinellas County Sheriff Bob Gualtieri said.

“Law enforcement officers are the least equipped to really handle these problems, and they’re the ones that handle them the most,” Gualtieri said. “They need to be able to take these people someplace where you have professionals.”

But for the program to work, police need to be trained to respond when people are experiencing a mental health or substance abuse crisis.

Peters tells the story of a Pinellas County woman, who lashed out at police while she was having a psychotic episode. But the officers, one of whom was trained for such a situation, did not fire their weapons. Instead, they committed the woman under the Baker Act and she received help.

That’s what Peters and Gualtieri want to see happen across the state.

“We’ll have an absolute infrastructure that will work for every door,” Peters said. “And we won’t be using our jails and our prisons as mental hospitals.”

However, advocates say the policy changes alone won’t be enough.

“There needs to be some funding,” Gualtieri said.

The Legislature responded this year with $3.8 million to pay for five additional teams to provide mobile services in some counties, including Pasco and Palm Beach, a stopgap measure while the broader reforms are put in place.

It’s going to make treatment more available, which means we’re going to treat these illnesses over time, just like the illnesses they are.

Miami Judge Steve Leifman

Sen. René Garcia, R-Hialeah, the health budget chairman for the last two years and co-sponsor of some of the changes, said that lawmakers intend to bolster mental health spending in future budgets.

“The impact is just really making it easier for families to navigate the system,” Garcia said. “Then, eventually we’ll come back and put more money into the system.”

The state’s mental health services and substance abuse budget has increased from $943 million to $1.1 billion since Scott took office. This year’s budget, Leifman said, includes about $65 million in new spending on mental health and substance abuse.

“That’s a lot of money for us,” he said. “But is it enough? No.”

Roughly half of the money spent by the state on mental health goes to the state mental hospitals, which are expensive and treat the relatively few cases that are most severe. Leifman hopes that changing the system will change that statistic, too.

“It’s going to make treatment more available, which means we’re going to treat these illnesses over time,” he said, “just like the illnesses they are.”

Contact Michael Auslen at Follow @MichaelAuslen.

Florida’s mental health system at a glance

▪  One in four adults each year will experience mental illness.

▪  As many as 40,000 mentally ill people are in the state’s prisons, Department of Corrections Secretary Julie Jones estimated last year.

▪  Under the Baker Act, people can be involuntarily committed to be treated for mental illness.

▪  The Marchman Act is similar to the Baker Act but allows for involuntary substance abuse treatment.

▪  Florida spent $37 per person on mental health — less than every state but Idaho — in 2012, the last year for which complete data is available.

Source: Herald/Times research