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Local mental health agencies losing ground

Early edition: They don’t have enough funds to be effective.

By ALISA ULFERTS
Published December 14, 2006

The small, clear plastic bag contained a white powder and a nonsensical note: “From Sadam Heissian (sic) and his great assets Japanese Arts Medical Warfare at its finest.”

For leaving the package on the counter of the Morton Plant Hospital emergency room, Candace Montijo spent a year in Pinellas County jail.

She wasn’t convicted or sentenced; Montijo, 21, was ultimately declared too mentally ill to assist in her own defense and was ordered into a state mental hospital. But with a waiting list that approached 300, she stayed in jail until Dec. 5 without proper treatment.

Her case and others like it have garnered headlines nationwide.

What hasn’t gotten much attention is the deterioration of community mental health services intended to keep people like Montijo stable and out of the criminal justice system in the first place, according to advocates for the mentally ill. The number of inmates declared mentally incompetent has increased 72 percent since 1999.

“It is a fractured, underfunded system,” said Sue Homant, director of the Florida chapter of the National Alliance on Mental Illness, or NAMI.

Florida has between two and three times the number of severely mentally ill residents than the national average, yet the state ranks 48th in the country for per capita public spending on mental health care, according to NAMI.
Per-capita mental health spending by Department of Children and Families, when adjusted for inflation, is less now than it was 10 years ago.

And the privatization of Medicaid mental health services — in which the state controls costs by contracting with HMOs, which then subcontract with community providers — has forced some community mental health organizations to cut staff and even consider closing shop altogether.

The HMOs say they are more efficient at managing mental health care; the community providers say they can’t make as much money as they did when they billed the state directly for services without giving a cut to the HMOs .

(The Agency for Health Care Administration, along with Gov. Jeb Bush, has said privatizing parts of Medicaid is the only way to ensure its longterm viability).

Overall, NAMI gave Florida an “F” for its mental health system in a report released earlier this year.

“Our system is broke. We have neglected the mental health care system for too many years,’’ said Bob Sharpe, director of the Florida Council of Community Mental Health.

Sharpe, the former state Medicaid director, estimates the state needs to invest $600 million into the system to allow everyone who needs mental health services to get them.

“We have let whatever funding we have in the system erode,” Sharpe said.

The backlog of mentally ill inmates continues. For keeping Montijo and about 30 other severely mentally ill inmates in jail longer than the 15 days allowed by law, outgoing Department and Families Secretary Lucy Hadi was scheduled to be arraigned on contempt of court charges Thursday.

But with a new judge on the case — Pinellas Circuit Judge Crockett Farnell recused himself last week — Hadi’s lawyers were granted a delay until Jan. 11.

They also were given a chance to argue that Farnell’s previous orders that fined Hadi and threatened her with jail should be reconsidered. The date for that hearing is Jan. 31.

The backlog and lack of funding adds up to what advocates say is a crisis situation for poor and middle income residents, who rely on the same community organizations to provide services that private insurance plans don’t cover. Among the implications:

-Directions for Mental Health in Clearwater is the only facility in northern Pinellas County that will accept sliding scale payments for a psychiatrist visit, but the wait for new patients is two months.

-The primary mental health center in Daytona Beach nearly closed down this year due to a reduction in Medicaid funding; it was saved only after the county and several cities together pledged to keep it afloat.

-The state district that had the greatest recent increase in mentally ill inmates being found incompetent to stand trial, according to a state report,  includes Citrus County, which has no inpatient crisis beds, public or private.

In some communities services are so rare that clients must travel long distances to get them, or else wait for months at a time.

And without adequate caseworkers to ensure those people are taking their medications, clients can destabilize and end up back in the criminal justice system, said Pinellas-Pasco Assistant Public Defender Violet Assaid.

“You can’t expect a mentally ill person to take three bus transfers to get to their appointment,” Assaid said.

Layoffs aren’t yet on the table for Directions for Mental Health in Clearwater, but with half a million dollars less in Medicaid revenue this year compared to last, the center must be extremely careful, said center president Tom Riggs.

Layoffs are always a possibility, and a reality at clinics in other parts of the state, Riggs said. His center has applied for other grants to reduce its dependency on Medicaid revenue, but those grants frequently are restricted to very specific populations or services and don’t help the general public, Riggs said.

On top of that, Medicaid and other federal benefits such as Social Security disability payments are terminated when a person is in jail or prison.

They are not automatically restored, either, so mentally ill people who are released from jail or prison won’t be able to access publicly funded mental health care unless a caseworker helps them restore their benefits.

Without those services, the chance of recidivism is extraordinarily high, advocates say.

Said Florida NAMI’s Homant: “It shouldn’t be a crime to be sick.”

[Last modified December 14, 2006, 21:06:35]