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Psychiatric overhaul urged

Treating the mentally ill before they become inmates would save a lot, a report says.

By Times staff and wires
Published November 15, 2007


Gov. Charlie Crist and the chief justice of the Florida Supreme Court called for a major overhaul of the state's mental health system on Wednesday to better address the needs of the severely mentally ill.

Crist and Chief Justice Fred Lewis released a 170-page report that lays out an ambitious plan to help the mentally ill who end up in jails and prisons because they haven't received the treatment they need.

Florida leaders say it's time to change the system to ensure that the mentally ill get the help they need before they get in trouble with the law and wind up incarcerated. Not only will it help the troubled, it will save money and better protect the public.

The report, sponsored by the Supreme Court, envisions using money now spent on mental health treatment for prisoners deemed incompetent to stand trial. Instead, those individuals would be targeted for intensive community-based mental health treatment before they get arrested.

Money for the project would also come from Medicaid, which doesn't cover people in institutions but can pay for treatment before they're institutionalized.

"What we're doing is focusing on this very small group of people who are costing the state a ton of money and are recycling through the criminal justice system," said Miami-Dade County Judge Steven Leifman, chairman of the Supreme Court's mental health subcommittee. "About 80 percent of those people can live comfortably and safely in the community."

Leifman said the project will need about $20-million in general revenue to get started, but after that, it will be able to sustain itself with Medicaid money and the $48-million now being used for the extra forensic mental health beds that he says will no longer be needed.

"You need to have the money up front to develop a system of care for them to move them into the community," he said. "We have people in there on third-degree felonies that don't have to be there."

Leifman said the plan eventually will save money. The state currently spends $250-million per year on 1,700 beds for mentally ill inmates. At this rate, the state will be spending $500-million per year by 2015.

That money is designed to restore competency to inmates so they can be tried for their crimes and then sent to jail or prison, where they continue to cost the state money.

Leifman said treating mentally sick people earlier will prevent them from becoming high-cost inmates.

Leifman led a subcommittee that studied the state's mental health system after the state Department of Children and Families found itself overburdened with the mentally ill. It got to the point the agency couldn't get inmates into treatment beds within the 15 days required by state law. In some cases, inmates languished in jails for months, straining jail guards' resources and, in some, cases harming themselves.

Hillsborough County sued the DCF in an effort to get the agency to follow the law.

Pinellas Circuit Judge Crockett Farnell threatened to fine and even jail then-DCF Secretary Lucy Hadi if she didn't follow the law.

Eventually the Legislative Budget Commission called a special meeting and allocated nearly $17-million to create more beds and $48-million annually to cover the costs.

But the Supreme Court recognized that wasn't the ultimate solution and directed a mental health subcommittee, led by Leifman, to study the issue and seek solutions.

"It's extremely positive, and it's recognizing the impact mental health issues are having on the criminal justice system," said Pinellas-Pasco Public Defender Bob Dillinger, who pushed for the DCF to address the inmate issue last year. "It can be done in a way that eventually saves a ton of money."

But the push to revamp how Florida deals with the mentally ill is coming during one of the worst economic downturns for the state in more than a decade.

Even Chief Justice Lewis acknowledged the challenge of Florida's budget situation on Wednesday. "Today I hope we are going to discuss plans and programs and ideas that may be implemented without creating unrealistic expectations," he said.

Crist had not reviewed all the recommendations included in the report, but said that the budget situation won't keep him from pushing for changes in the mental health system.

"We have some difficult times, but my heart is there," Crist said.

Rep. Bill Galvano, a Bradenton Republican and chairman of the House committee that deals with mental-health legislation, said lawmakers would likely consider the recommendations during the 2008 session. He said that despite bad financial times it was apparent to him that the current "system is broken."

"Even in a bad economic year, it may well be worth the fight," Galvano said.

Times staff writer Chris Tisch contributed to this report.