Even before proposed cuts, Florida ranks 49th in the nation for mental health funding.
By Ralph De La Cruz
Florida Center for Investigative Reporting
After taking repeated budget hits over the past five years, Florida’s mental health system has an unlikely champion: budget-scrimping Gov. Rick Scott.
“When the governor’s budget came out, we were basically delighted,” said John Bryant, vice president for legislative and external affairs for the Florida Council for Community and Mental Health. “There were no cuts for community-based organizations. There was even $15 million in special projects that had been recurring budget items.”
If Scott has his way, Florida could see a halt in cuts that have left Florida ranked 49th in the country for per-capita spending on mental health care and 35th in substance abuse care.
But that’s a big if. The governor’s budget is simply a recommendation.
With the state facing a $3.6 billion deficit as the legislative session opens this week, Senate lawmakers have talked openly about the need to take a more austere approach.
Sen. Joe Negron, chairman of the Appropriations Committee, has discussed the possibility of cutting health care by as much as $1.5 billion, with $500 million squeezed from mental health. That’s two-thirds of the current mental health budget in Florida.
In the United States, 1 in 17 adults and 1 in 10 children live with a serious mental illness, such as schizophrenia, major depression or bipolar disorder, according to a report released this week by the National Alliance on Mental Illness. NAMI is a grassroots mental health organization based in Arlington, Va.
Cuts to mental health funding tend to shift financial responsibility to emergency rooms, community hospitals, law enforcement agencies, correctional facilities and homeless shelters.
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FCIR partnered with the Washington, D.C.-based Center for Public Integrity to produce this report.
They also present potential safety risks.
Two months ago, Jared Lee Loughner opened fire outside a Tuscon, Ariz., shopping center, killing six people and wounding 14. News media discovered that Loughner had been barred from his community college until a mental health professional certified him as fit to attend. While the public mental health system may not have been able to stop Loughner, cuts to that system only increase the chances of extreme cases like his.
If Florida’s mental health funding is slashed, for example, facilities such as such as Henderson Mental Health Center in Fort Lauderdale would be unable to accommodate community demand.
“Last year, we served about 20,000 people,” said Henderson CEO Steve Ronik. “If they de-funded, we’d have to turn away thousands.”
That would be not only tragic, Rosnik said, but a poor use of state funds.
“It costs something like $125,000 to keep somebody in a hospital for a year,” he said. “For far less, we could treat that person. And treatment works. Eighty percent of people treated for depression get better. Compare that with treatment for heart disease, which has a 40 percent rate of success. But you’ve got to have the funding to do it.”
The state House of Representatives has proposed more modest cuts of five to seven percent.
“Thank God we’ve got two houses,” said Bryant of Florida Council for Community and Mental Health. “Funding is a three-legged stool that involves negotiations between the governor, the Senate and the House.”
But even minor cuts to mental health funding could be a back-breaker, said Bob Sharpe, chief executive of the Florida Council for Community and Mental Health.
“While the House of Representatives is exploring less harsh cuts to DCF mental health programs, no further cuts can be sustained,” he wrote in a commentary that was published in newspapers statewide. “Continuing to cripple these programs with further cuts will result in higher state spending and endanger the lives of Floridians in every community statewide.”
Lately, both Sharpe and Judith Evans, executive director of the National Alliance on Mental Illness’ Florida chapter, have taken to writing editorials in newspapers throughout the state to convince the public of the need for greater funding.
“Reducing these services will only exacerbate the problems we are already facing,” Evans wrote. “When states reduce budgets and lay off employees, cut contracts to third parties and reduce benefits, the need for mental-health care is increased exponentially.”
Floridians without insurance receive mental health care in one of two ways: through institutional programs such as juvenile justice and sexual predator programs or private community-based mental health centers. Currently, 43 percent of the mental health budget goes to institutional care and 57 percent to community-based programs.
A 2009 report by the Florida Center for Fiscal and Economic Policy found that, of the 325,000 adults with severe and persistent mental illness in Florida, only 42 percent receive state mental services at the current funding level. The situation for Florida children is also poor. Fifty-two percent of children with mental illness receive care in Florida, compared to 60 percent nationally.
“Only four other states had a lower rate of meeting the need for mental health and developmental services among children,” the report noted.
That’s one area in which Scott’s budget proposal may not offer relief. The governor is calling for $278 million in cuts to the Department of Children and Families. While those cuts could result the privatization of three state mental health hospitals — in Gainesville, Chattahoochee and Macclenny — it’s unclear how the cuts will affect other mental health and substance abuse programs.
Facilities such as Lee Mental Health in Lee County and David Lawrence in Collier County — which operate the only Baker Act centers in their respective counties — receive nearly half of their funding from DCF. If that state agency’s budget is cut, those facilities will have to find alternative funding sources.
Sharpe, of the Florida Council for Community and Mental Health, also pointed out that the state is simultaneously looking to reduce the prison population through diversion programs and by moving inmates to halfway houses.
While such cuts may seem fiscally prudent — Florida is third in nation for per-capita spending on corrections — cutting corrections and mental health funding at the same time could be a prescription for social disaster, according to Sharpe.
“You can’t do both,” Sharpe said.