ORLANDO, Fla. – UPDATE: Since this article was published, Gov. DeSantis signed the budget which included the $126 million in recurring revenue for mental health funding.
Natalie Hussein’s phone had been ringing nonstop.
The day the president of the Brevard County chapter of the National Alliance for Mental Illness spoke to News 6, she had been fielding phone calls – mostly from parents of adult children.
In one phone call, a parent was seeking help for a son in jail in Port St. Lucie. The 18-year-old had psychosis and was in bad shape.
“I don’t know how I can help. I really never had to deal with this,” Hussein said.
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Hussein is new to all of this. The small chapter of NAMI is made up of volunteers trying to help people in a county where resources for the mentally ill are scarce, and people who are trying to get help for loved ones are trying for answers anywhere they can get them.
“They might call the police because they really don’t know what else to do, if they can’t get someone to go into the hospital on their own,” Hussein said. “And it’s very traumatic because anytime someone in 911 is called and then the police comes and they have to go to a psychiatric care facility, they have to be handcuffed in the cruiser.”
Once at one of the county’s two psychiatric facilities, the patient is evaluated and can only be held up to 72 hours, according to Florida’s Baker Act. Sometimes they are held less than that. It’s not nearly enough time to make sure their medications are taking effect – or that they’re taking them at all.
It’s a situation that plays out across many Florida counties, as unstable funding and a lack of affordable care exacerbate a growing mental health crisis.
There is a new effort in the state to change this in the proposed state budget this year. Mental health experts say it’s a good start, but more will be needed.
Mental health in Florida: By the Numbers
Florida ranks 49th in the nation for access to mental health care, according to Mental Health America.
The ranking is based on nine measures, ranging from adults and youth who did not get treatment, to those who are uninsured or unable to afford care, to the availability of mental health workers.
According to Mental Health America:
Nearly 2.9 million Florida adults, about 17% of the population, have some form of mental illness.
More than 1 million have reported a substance abuse disorder.
Some 682,000 Floridians report thoughts of suicide.
The last two years have led to an increase in people seeking help for mental illnesses, particularly anxiety and depression.
“Since the last two years, we’ve seen that that has been something that has emerged,” said Marni Stahlman, president of the Mental Health Association of Central Florida. “And for a lot of individuals that previously may not have had to grapple with how to manage their mental health and wellness, they’re particularly concerned and are seeking services.”
But 512,000 Floridians with a mental illness are uninsured, and 1.8 million Floridians with a mental illness did not get treatment.
Moreover, some 1,343 per month, on average, are on a waiting list for services.
Florida’s refusal to expand Medicaid with federal funds is part of the reason, said Anne Swerlick, an analyst with the Florida Policy Institute who has researched Florida’s mental health funding.
“There’s a substantial number of people, particularly adults, who don’t qualify for Medicaid and in large part that’s due to us not doing Medicaid expansion,” Swerlick said. “So without Medicaid expansion, if they’re low income, they need to turn to the safety net program which is what the Dept. of Children and Families runs.”
Floridians, according to NAMI, are also five times more likely to be forced out of network for mental health care than for primary health care. This can make mental health care less affordable.
NAMI says 49.7% of adults in Florida did not get mental health care because they couldn’t afford it.
“So imagine the difference between saying you can have as much as you need for your oncology, for your chemotherapy, but after four sessions of psychotherapy, we want to talk to your provider and we want to reverify that you’re still sick. It’s just not a good system. And it’s not fair and it’s not equal,” Stahlman said.
The other problem is that Florida simply does not allocate enough money to mental health programs for people who are uninsured and underinsured. And what money there is is not stable, recurring funds. That means programs that utilize state mental health dollars don’t know if they will get that money from one year to the next.
How state mental health dollars get to patients
Every year, Florida lawmakers allocate funds for substance abuse and mental health care in the annual budget.
Those funds are spread across many state agencies and line items in the budget, with no one place coordinating all of those funds and programs.
The agency that handles substance abuse and community mental health care is the Department of Children and Families.
DCF takes that chunk of money and disburses it among seven nonprofit “managing entities” throughout the state.
“They’re the ones responsible for sort of coordinating all the services regionally, figuring out how that money gets distributed and keeping track of what’s happening with those dollars,” Swerlick said. “It’s really been shifted away from the Department of Children and Families to these managing entities do all the on-the-ground stuff.”
Once those managing entities get the money, they distribute it to providers who manage crisis care facilities, clinics, community centers, peer groups and other programs to help people manage their mental health.
But not every service is available in every county, for one reason or another.
Swerlick says there is an overreliance in Florida’s mental health budget on funding that is non-recurring – money that is not stable.
“So that really has a chilling effect on being able to staff up programs for clients to be able to rely on whatever service or provider they’re able to get this year they’ll be able to get it next year.”
“And these are for core services,” Swerlick pointed out, “Like crisis services. These are not for needs that are going to disappear after a year.”
Local programs are also having trouble keeping staff.
“Really in our case with the safety net system, it’s really been impacted by the lack of behavioral healthcare professionals that are available to serve,” said Christine Cauffield, CEO of LSF Health Systems, the managing entity that handles 23 north central Florida counties, including Flagler, Lake, Marion, Sumter and Volusia counties.
“Many of our therapists that, they have a passion for working in the mental health system and nonprofit world but they have a family that they have to feed and so they leave for more money, for sign-on bonuses,” Cauffield said. “And historically, our community mental health centers and our system of care do not pay those kinds of salaries that are now being offered. So again, our clinicians are going to hospitals, they’re going to Medicaid managed care plans, the school system, other opportunities for them and it’s really, really causing a real problem for us in the state.”
In Brevard County, Natalie Hussein with NAMI says there is a desperate need for “step down” services – programs for people who get out of that initial crisis care to help them transition back to a more manageable condition back at home.
“We don’t have good supportive housing, like say if they do stay in the hospital and they do get their meds, it’s regulated,” Hussein said. “So they’re, you know, after a month or two, they’re feeling better, but they don’t really have any like a step down where it’s between hospital and home where they would be like, in supportive housing.”
Hussein says the county also doesn’t have a lot of programs for adults with mental illness who are medicated but have few meaningful activities or peer groups.
“They’re at home, they’re taking their meds, but they don’t have anything to do other than sit and watch TV,” Hussein said. “They don’t really have any meaningful opportunity to get trained for a job, even part-time. They don’t have an opportunity to get together with other people who are understanding of their emotions, their feelings of you know, ‘I feel like a loser, I feel like I’m not contributing to society.”
A cash infusion
New money in the Florida budget this year could make a difference for community mental health care.
The proposed budget passed by the Florida Legislature includes over $126 million in recurring revenue. That means there will be a stable pot of money in the future for mental health funds. Gov. Ron DeSantis has not signed the budget yet.
“There is no question the COVID-19 Pandemic impacted mental health in so many ways,” said State Sen. Kelli Stargel, R-Lakeland, who championed the funding. “Enhancements to our mental health infrastructure with increases to (Florida Assertive Community Teams) funding and modernizing the Florida Safe Families Network will help ensure we are better prepared to address mental health challenges moving forward.”
The money has Dr. Christine Cauffield, the president of LSF Health Systems, excited.
“We’re not waiting for the budget to be signed,” Cauffield said. “We’re reviewing all of the information that we have about the gaps in service delivery, where are our wait lists, where’s the critical need, what populations need, what services and we’re already working with our provider network, to be able to stand them up quickly when that money does come in.”
Marni Stahlman at the Mental Health Association of Central Florida sees the money as a good step toward helping the programs already in place to expand their services, but she says it’s not enough.
“That has to be split across the entire state,” Stahlman said. “And so when you think about the need and you think about the fact that we still have an incredible number of people that are on waitlists and going without services at our community centers, much like ours, while it seems like a big number, it really is not even close to what we need to bring us up in the state, national standard.”
If you or someone you know needs mental health help, we have a list of resources on the News 6 website.