TALLAHASSEE — Republicans, Democrats and experts agree that Florida is in a bad headspace.
Across the state, early data shows troubling indicators like drug overdoses and incidents of violent domestic abuse are trending up. In a state that already ranks last in per capita mental health funding, experts and lawmakers fear an overwhelming post-pandemic demand for services.
“What I’m worried about is the surge,” said Sen. Gayle Harrell, R-Stuart, at a March 15 meeting of the Senate’s Select Committee on Pandemic Preparedness and Response. “Our systems are not in place to handle what I anticipate we’re going to see.”
But if the talk coming from Tallahassee about mental health is dramatic, the solutions that are getting serious consideration this legislative session are not.
Florida’s mental health and substance abuse treatment network is a patchwork of services spread across several state agencies. Nonprofit “managing entities” that contract with the Department of Children and Families to connect children with local services play perhaps the most prominent role. But school districts, sheriff’s offices, the state’s Medicaid program and the corrections system each have a piece of the mental health pie.
Advocates say the system’s greatest weakness is structural. With so many different agencies and groups responsible for providing care, the state has trouble tracking an individual’s progress.
“There’s too many silos and too many competing interests,” said Pinellas Sheriff Bob Gualtieri, who chairs the state’s Marjory Stoneman Douglas High School Public Safety Commission.
Gualtieri gave a hypothetical example of a child who gets mental health services from three places: at school, from a community program and from a private plan covered by insurance. The child could have three treatment plans, and the state would have little idea, Gualtieri said.
The Legislature is not looking to break down these structural barriers this session. Instead, lawmakers are advancing a series of more marginal reforms.
One proposal, House Bill 701/Senate Bill 1024, would make the Department of Financial Services write a yearly report to the governor’s office and the Legislature detailing the number of consumer complaints it gets about the lack of access to mental health care. That proposal would also require insurers to notify customers about this complaint system.
Another, HB 231/SB 260, would use federal grant money to make it easier for veterans to access services through a telephone referral system. Those two proposals are all but certain to become law: they’ve sailed through each of their committee stops essentially unopposed.
Linda McKinnon, CEO of the Central Florida Behavioral Health Network, one of the state’s managing entities, said those bills would improve the system. However, she said, they don’t address the state’s biggest issues.
“The problem is these silos of funding. How do we ... put those together under one managing agent?” McKinnon said. “None of these bills talk about any of that.”
Gualtieri argued that now is not the time to reform the whole system. Instead, it’s important to give providers time and space to respond to the pandemic. Throwing a load of sweeping changes onto the desks of providers would only further overwhelm the system.
“The dust needs to settle. Because the system is so taxed right now, the time is now to focus on individual needs,” Gualtieri said. “You can’t do both.”
State leaders are working on longer-term fixes to the state’s mental health structure. A bill passed in 2020 gives managing entities greater leeway to coordinate treatment plans for children across various programs. A proposal this year would create the Mental Health and Substance Abuse Disorder Services Commission that would recommend changes to the system. And lawmakers are also working to reform the process of removing children experiencing a crisis from school. The Tampa Bay Times documented thousands of such removals in a 2019 series on the state’s Baker Act.
Gov. Ron DeSantis also wants to spend $72 million from the latest round of federal relief to build a state-of-the-art data system that can track patient data across Florida’s mental health care providers.
But such technology wouldn’t be ready until late 2022 at the earliest. Advocates say the mental health system is in bad shape now. And history shows that building a high-stakes technology solution is anything but a slam dunk for Florida’s government. The CONNECT website built by Deloitte consultants to handle unemployment claims melted down spectacularly last spring, frustrating thousands of Floridians.
A DeSantis spokeswoman noted that the governor’s budget recommendations include more than $250 million in mental health initiatives, including $10 million more than last year for mental health programs in Florida schools. Mental health is a top priority for First Lady Casey DeSantis.
“Governor DeSantis and his staff will continue to work the Florida Legislature to appropriately address these critical issues and he looks forward to signing a budget that adequately addresses the many needs of Floridians and our state,” the spokeswoman, Meredith Beatrice, wrote in an emailed statement.
Kyaien Conner, an assistant professor of Mental Health Law and Policy at the University of South Florida, noted that mental health problems disproportionately affect minority communities. The problem is urgent: while Floridians wait on a more ambitious mental health care fix, there is more the state can do now to shore up existing programs, she said.
Offering so-called “peer-to-peer” services, in which a person seeks help from someone in a similar situation, goes a long way toward decreasing the stigma around mental health services, Conner said. HB 231/SB 260, the veteran mental health care law moving this session, is an example: It builds on a program in which veterans are able to call a hotline and hear from other veterans. So is SB 130, which would expand the use of peer specialists.
The state could also do more to make sure mental health services are reimbursed by insurance at the same rate as other medical services, and expand access to telehealth even further, Conner said.
Advocates also note that expanding Medicaid under the Affordable Care Act to hundreds of thousands of working-class Floridians would also make mental health services more widely available. But leaders in the Republican-led Legislature have said that won’t happen any time soon.
Hanging over all of these policy discussions is the question of funding. The House and Senate will soon begin wrangling over how state and federal money will be spent. Conner said that, at minimum, it’s critical that the state refrain from mental health spending cuts.
“There are people that are dying, and those things can be prevented,” Conner said. “This is something we have to get ahead of right now.”
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Tampa Bay Times Florida Legislature coverage
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