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Mental-Health Reform Has Human, Fiscal Urgency

Sunday, September 27, 2009

As many as 125,000 people with mental illnesses requiring immediate treatment are arrested and booked into Florida jails every year. And on any given day, more than 70,000 people with serious mental illnesses reside in Florida's jails and prisons or are under correctional supervision in the community.

Frequently, these people enter the justice system as the result of committing relatively minor offenses that are directly related to symptoms of acute, untreated mental illnesses. Unfortunately, many find that they are either denied community-based care or that the care they do receive is fragmented and insufficient to adequately respond to their level of need.

Disabled and vulnerable, they recycle through the system, creating a revolving door of criminal and legal involvement.

Measures have been taken in the past to reform this unsystematic approach to Florida's mental-health system, but to no avail. The movement from institutional to community-based treatment was never fully executed or funded, resulting in decades of fragmented mental-health care.

The existing community mental-health system leaves enormous gaps in treatment and access and is not designed to serve the needs of those who experience the most chronic and severe forms of mental illnesses.

Some of us have served on trial courts across the state and have witnessed firsthand the problems that are created when courts are forced to deal with mental-health issues. Without proper treatment, these people appear and reappear in court. But all of us know that the problems with the current system weigh heavily on law enforcement and the criminal-justice system — courts see increasingly high numbers of cases, and jails are continually overcrowded.

Based on recent trends, Florida can expect the number of prison inmates with mental illnesses — now about 16,000 — to nearly double in the next nine years, to more 32,000, with an average annual increase of roughly 1,700. To keep up with such demand, the state would need to open at least one new prison every year.

Florida currently spends a quarter of a billion dollars annually to treat roughly 1,700 people under forensic commitment; most of them are receiving services to restore competency so they can stand trial on criminal charges and, in many cases, be sentenced to serve time in state prison. Without a change to the existing system, the state faces potential forensic expenditures of a half-billion dollars annually by the year 2015.

But there is hope. A comprehensive plan was recently unveiled under the joint leadership of all three government branches and with sponsorship from Chief Justice R. Fred Lewis and Gov. Charlie Crist. The initial six-year plan would effectively respond to the needs of people with mental illnesses by reorganizing services and service delivery to reduce demand for costly and inefficient levels of care, while reinvesting the savings in more efficient prevention and community-based treatment services.

For the first time in decades, a solution is at hand: an infrastructure for more comprehensive community-based treatment for individuals and families; an opportunity for recovery; increased public safety; and savings of critical tax dollars. Reform of our mental-health system is crucial to ensuring humane treatment of all the citizens of Florida. Our jails and prisons should no longer be asylums.

Under this redesigned system of care, there will be: programs incorporating best-practices to support adaptive functioning in the community and prevent people with mental illnesses from inappropriately entering the justice and forensic mental health systems; mechanisms to quickly identify and appropriately respond to people with mental illnesses who do become inappropriately involved in the justice system; programs to stabilize these people and link them to recovery-oriented, community-based services that are responsive to their unique needs; and financing strategies that redirect cost savings from the forensic mental-health system and establish new Medicaid funding programs.

We strongly urge the Legislature to adopt and implement the recommendations made for the transformation of the public mental-health system. In doing so, lawmakers will achieve the dual purposes of addressing needed change and improvements in efficiency of the mental-health system, as well as reducing a costly and unnecessary burden on all facets of the justice system.

Posted on 09/27