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For mentally ill, help is lacking

By CHANDRA BROADWATER and JONATHAN ABEL
Published December 11, 2006

BROOKSVILLE - For the mentally ill in Hernando County, services are meager and being burdened more every day.

Unless mental health becomes a priority in the county, the system is on its way to becoming just as clogged as others around the state.

There are two locations for residents to seek treatment in Hernando: the Harbor Behavioral Health Care Institution, which is a county- and state-funded treatment center in Spring Hill, and Springbrook Hospital, a private facility in Brooksville.

Both facilities accept residents who have been taken into custody under Florida's Baker Act, declared by a psychiatrist or law enforcement officer as a danger to themselves and others.

The Harbor has 12 available beds for Hernando adults in this situation, and slightly fewer for children.

Though private, Springbrook and its 60 beds are usually full. It accepts patients 65 and older who have been committed under the Baker Act.

The hospital is designated for those with Medicaid as well as those with Medicare.

While Hernando hasn't had to deal with an increase of residents needing mental health treatment on the scale of more populated counties like Pinellas or Hillsborough, significant increases in the past few years - even in the past few months - have people like County Health and Human Services director Jean Rags worried.

The number of people committed under the Baker Act is up. The same is true of people court-ordered under the Marchman Act to seek treatment for substance abuse.

In the past three years, the number of county residents forced to seek drug and alcohol treatment has nearly tripled.

"The bottom line is that there are not enough resources for people who need service," Rags said. "And a growing number of people indicate that they are experiencing problems."

The results of the health needs study released in September revealed that Hernando County residents, especially the working poor, reported experiencing more mental health problems.

The same study also showed that mental health hospitalization rates were substantially higher in Hernando than the average across the state.

In 2001, there were 9.9 such hospitalizations per 100,000 in the county, while the state recorded 6.5.

As a result, the mentally ill often end up waiting for hours in hospital emergency rooms - where they have been taken by family or friends at a loss over what to do - and after they've been declared incompetent.

Or, if a person with schizophrenia or another illness commits a crime, he or she waits in jail.

Jails are holding pens for those needing help

A growing statewide problem, the issue of what to do with incarcerated mentally ill residents recently made headlines when a Pinellas-Pasco circuit judge threatened Department of Children and Families Secretary Lucy Hadi with jail and fines to end the crisis.

State law requires DCF to move mentally incompetent inmates out of local jails and into mental health facilities within 15 days. But hundreds wait in jails for treatment spots that aren't there.

For the past four years, the number of inmates found incompetent to stand trial increased by 34 percent. The number of available state mental health treatment beds increased by only 4 percent.

Meanwhile, critics blame DCF for cutting millions from its own budget.

This year, 87 beds were added statewide, but it did little to help remedy the problem. The average wait is still six times the 15-day waiting period.

Since Hadi was held in contempt, DCF has committed $5.1-million to creating 85 beds throughout the state. Hadi has also announced her retirement but has pledged to continue working on the problem.

As of Friday, one person in the Hernando County jail had been waiting more than 15 days for treatment at a state center, DCF District 13 spokesman Tim Bottcher said.

As a mentally ill person who has committed a crime, that inmate can be sent to one of just three hospitals in the entire state. They are in Chattahoochee, Gainesville and Miami.

The lack of resources worries county jail warden Don Stewart, who has dealt with the aftermath of three suicides at the jail and has since watched the numbers of mentally ill people filtering through the system consistently rise.

Stewart said about 200 of the 680 county inmates are taking psychotropic medication. The jail averages three to six inmates who have been deemed incompetent to stand trial.

The situation has cost the jail in terms of money and staffing, and in other ways, too.

"With jails handling more cases that are related to mental illness, it is causing our facility's mission to be impacted," Stewart said. "Our mission is not health care; it is primarily custodial care."

Rags said that the mentally ill need to be put into the appropriate facilities while getting the right care so they are not affecting the wrong places - like the jail.

"It's a vicious cycle," she said. "People end up in jail, get straightened out because they start taking their meds and get supervision, but then they are released, the stability falls away and they're back in jail."

Search for solutions to provide real help

Among other solutions, Rags and Stewart are pushing for the creation of diversion programs. As a warden in Oklahoma, Stewart helped start similar programs in the jail system there.

The goal is to provide a person with the proper care - for example, a combination of medication, counseling and frequent meetings with a case manager - and keep him or her out of jail.

Rags said that as part of the state Association of Counties, she and other county leaders will ask lawmakers to consider providing money to create a public safety reform match grant.

The annually funded program would provide a county that chooses to participate with matching funds to put together a public safety council. This group would then help establish the diversion programs.

But that, for Stewart, is years away. In the meantime, jails will likely have to continue to make up for mental health cuts.

"We're really nowhere at this point," he said, "other than a dream and a vision."

Chandra Broadwater can be reached at cbroadwater@sptimes.com or 352 848-1432. Jonathan Abel can be reached at jabel@sptimes.com or (352) 754-6114.

Baker Act commitments

July through September 2006, 207 residents were committed under the Baker Act, Jean Rags said. Of the 207, 94 were between the ages of 23 and 64. They were also predominately white and male. And of the 207, 121 made less than $15,000 a year.

Marchman Act treatment orders

In 2003, 39 people were ordered to undergo substance abuse treatment under the Marchman Act. In 2005, 93 people were ordered to seek treatment. In May 2006, the county was on its way to surpassing that number this year.

Baker Acts in Hernando

July through September 2006, 207 residents were Baker Acted, Rags said. Of the 207, 94 were between the ages of 23 to 64.

They were also predominately white and male. And of the 207, 121 made less than $15,000 a year.

Marchman Acts

In 2003, 39 people were ordered to undergo substance abuse treatment under the Marchmann Act. In 2005, 93 people were ordered to seek treatment. In May 2006, the county was on its way to passing that number this year.

[Last modified December 10, 2006, 23:07:48]