The Newtown, Conn., elementary school massacre unleashed a debate nationwide about whether enough is done to identify and treat the dangerously mentally ill.
But in Florida, advocates for the mentally ill say Newtown is unlikely to lead to even tweaks in the system, and some fear changes already under way may lead to less state funding.
Despite a growth in the state’s anticipated revenue for the first time in six years, Gov. Rick Scott’s proposed 2013-2014 budget does not include any increase for mental health services. Neither Scott nor GOP legislative leaders mentioned the issue as a priority on the opening day of the legislative session Tuesday. And lawmakers appear split on the only two proposals in play — mandatory mental health screening of elementary school students and extending the observation period for patients who are involuntarily committed by law enforcement or health officials.
“There seems to be this disconnect between the reality that’s going on in the state and in the country and what the legislature needs to be doing,” said Rep. Mark Pafford, D-West Palm Beach.
The state also is in the early stages of privatizing the management of public services (the services themselves are already provided by private vendors) — an experiment that advocates say is moving forward without any proof it will improve the system or save money.
“The system is broken, has been broken and is going to stay broken until the funding goes in that’s needed,” said Judi Evans, Florida’s executive director of the National Alliance for the Mentally Ill.
Department of Children and Families Secretary David Wilkins has told lawmakers the “managing entities” the state will hire will save up to $185 million over four years. But he admitted the estimated savings could be off by as much as 20 percent.
The goal is to have more community-based care and reduce more expensive hospitalizations, “because once they’re in crisis, costs are five to 10 times more,” Wilkins said.
More than half of Florida’s mental health spending goes to hospitalization. Other states, on average, spend less than 30 percent on hospitalization, said Florida Council for Community Mental Health President Bob Sharpe.
Meanwhile, mentally ill people are forced onto waiting lists for services in scant supply — short-term inpatient and long-term outpatient treatment and follow-up services such as counseling. And the calls have doubled since the Sandy Hook shooting in December, said Liz Downey, executive director of NAMI of Palm Beach County.
“Every single day, I get a call where I just can’t do anything for them,” Downey said. “It’s very sad.”
Sharpe, Florida’s former Medicaid director, said lawmakers have a simple solution: Expand Medicaid under the federal Affordable Care Act.
He estimates that expansion would shift 200,000 people being served by DCF into Medicaid, which could free up to $200 million for residential treatment and supported housing programs.
“We should reassess our priorities and take a look at the effect of not funding these programs, both in human terms and from a cost standpoint,” he said.
A House committee recently rejected a proposed expansion of the state’s Medicaid program, but Scott has backed a three-year expansion and some Senate leaders have signaled support, too. Under the Affordable Care Act, the federal government would pay 100 percent of the expansion for the first three years. In 2017, the state would start contributing 5 percent, working its way up to 10 percent in 2020 and beyond.
The state provides DCF a mental health budget of $709 million a year for crisis intervention, community mental health services, case workers, the violent sexual predator program and mental hospitals for the treatment of the most seriously mentally ill and for those judged incompetent to stand trial or found not guilty by reason of insanity.
The state Agency for Health Care Administration gets $426 million a year in federal and state Medicaid money to spend on services including hospitalization, medication and counseling. State prisons and county jails also provide mental health care to inmates, but it’s difficult to isolate that spending from their overall health care spending.
Sen. Denise Grimsley, R-Sebastian, chairwoman of the Senate Health and Human Services Budget Committee, said lawmakers need a better grip on how money is being spent with the help of the new private management before boosting funding.
A former emergency room nurse, Grimsley said, “Obviously we want to fund it, but we want to do it right. What we’re trying to do is look at a big comprehensive package… . With more coordinated care, it will be easier for us to determine how much money to put into it.”
One new program the House is considering is mandatory screening of elementary school children. Studies show early intervention can reduce the chances of more serious problems and can even prevent violent episodes. Florida Partners in Crisis, an advocacy group of law enforcement, judges and health care professionals, recommends focusing mental health services on adolescents and teenagers.
But Senate budget chief Joe Negron, R-Stuart, objects to placing a potentially harmful label on children at a young age.
“Any time I hear about people from the government screening the population for anything, my radar is engaged on the possibility for abuses, especially for a lifelong designation from which you can never get away from,” he said.
Downey, however, said if her son, who is bipolar, had been diagnosed earlier, treatment may have prevented his illness from progressing.
“If a child had cancer, we wouldn’t wait because we didn’t want to label them,” Downey said. “This is a medical condition.”
The House also is considering extending the Baker Act – a 72-hour maximum observation period ordered for people considered an immediate danger to themselves or others. The three-day stays aren’t long enough to ensure that people are properly diagnosed and medicated, some experts say.
But mental health advocates such as Sharpe say more help for earlier treatment programs and follow-up care could reduce the need for so many Baker Act detentions.
DCF estimates that 35,000 out of 110,770 people held under the Baker Act last year had been Baker Acted before. Sharpe points to at least one man who was Baker Acted 100 times in a single year, meaning he was hospitalized nearly the entire year.