Turnaround for mentally ill

DCF secretary says jail inmates are getting timely care, not waiting.

Published May 10, 2007

Department of Children and Families Secretary Bob Butterworth walked to the courtroom podium Wednesday morning and announced that a deed once thought impossible had been achieved.

No inmates who have been declared mentally incompetent have to wait longer than the 15 days the law allows for a bed in a mental institution.

"We are here today to say that the number of people waiting for a forensic bed ... is zero," he said.

And the end of their waiting marked the final chapter in what had been a knock-down, drag-out fight between Butterworth's predecessor, former DCF Secretary Lucy Hadi, and Pasco-Pinellas Public Defender Bob Dillinger.

The feud began in the fall, when retired Pinellas-Pasco Circuit Judge Crockett Farnell, at Dillinger's urging, threatened to jail and fine Hadi $80,000 for ignoring orders to find space in one of the three state mental hospitals for inmates who had been declared incompetent to stand trial. This earned Farnell the scorn of former Gov. Jeb Bush, who accused the jurist of throwing a "judicial temper tantrum."

Hadi's lawyers said the department lacked the capacity to house all the inmates; the number of inmates declared too mentally ill for trial has increased 72 percent since 1999.

The matter seemed headed for further escalation until a chance meeting in February between Dillinger and Butterworth, who had been picked by Gov. Charlie Crist to replace Hadi and turn DCF around, and who had been given orders to resolve the issue as quickly as possible.

"He thought it was totally inappropriate for one agency of government to be suing another and using those resources," Butterworth said of Crist.

The February meeting led to a deal, quickly approved by Circuit Judge Robert J. Morris, Farnell's successor: Using the money set aside to pay Hadi's $80, 000 fine, DCF began treating mentally ill inmates while they were still in jail, rather than waiting for an available bed at a state facility. But the agency still attempted to transfer inmates declared incompetent to a state facility within the 15 days allowed by law.

The earlier treatment helped stabilize inmates faster, allowing them to go to less expensive community programs rather than a state hospital. The savings then went back into the pilot program, which has already been duplicated in Orange and Broward counties, Butterworth said.

The cooperation didn't end there. Lawmakers this year approved an emergency $16.6-million infusion, which paid for another 373 beds at an annual cost of about $125, 000 each. "Mothballed" facilities owned by the departments of Juvenile Justice and Corrections were quickly converted, Butterworth said.

In the end, all the pieces clicked and the waiting list for inmates deemed too ill to assist in their own defense fell from close to 300 in January to zero - a full two months ahead of when DCF officials thought it could possibly be done.

The combined efforts earned praise from Morris.

"I think this is overwhelming evidence that we all accomplish a lot more when we work together instead of working against each other," Morris said.

While relishing the victory, Butterworth and Dillenger agreed it would only be sustainable if lawmakers continue to strengthen the state's community mental health care system that helps keep the mentally ill stable and out of jail in the first place.

"Unfortunately, Florida ranks 48th in per capita spending for mental illness, " Dillinger said. " I think the Legislature is going to have to pony up the dollars."

In the $71.9-billion budget approved last week, lawmakers agreed to continue funding the extra hospital beds and even added $4.6-million to enhance the in-jail mental health services.

But, without any discussion or debate, lawmakers also eliminated a requirement that HMOs spend at least 80 percent of the money they get to manage Medicaid mental health care directly on care, rather than on overhead or profit.

Many of the community clinics that provide the care have laid off workers or closed some services entirely since the HMOs started managing the care a few years ago, according to a recent trade group survey.

Often. the first positions let go are the case managers. These are the workers who stay in touch with mentally ill clients and ensure they are taking their medicines and keeping their appointments. Without this safety net of supervision, agencies say, the clients are more likely to destabilize and commit crimes that can land them in jail.