Mental health care treatment is in a state of crisis in our community.

This realization came upon me as a policy maker last year when the Sheriff came to the County Commission to ask for additional funds for the Jail's pharmaceuticals budget. We were all surprised to learn that the pharmaceuticals budget for the Jail had been exhausted in the middle of the year because it had been used up on anti-psychotic medications!

As I began to look into this issue, it became clear to me that years of cuts at the state level for mental health treatment services had created a revolving door for persons with mental illness between the hospital, the homeless shelter and county jails... making County Sheriffs all across the state as the largest residential mental health treatment providers in their respective communities.

To address this crisis locally, government leaders from law enforcement, the City and County, the Courts and the health care system have joined together with community organizations to create the Leon County Partners in Crisis Coalition, based on the statewide Partners In Crisis model, for the purpose of advocating for humane alternatives to incarceration for persons with mental illness.

In order to meet this challenge, we realized that we must maximize the remaining resources in our community; educate the public about the scope and causes of the crisis, and advocate with the Legislature for the restoration of mental health funding programs.

Let's look at the scope of the problem just here in Leon County. Last year the Leon County jail incarcerated about 520 inmates with acute or historied mental health problems in the Leon County Detention Facility (The Jail). At just about any time last year, the Jail housed 75 inmates that meet the Florida State Hospital commitment criteria. They had either been returned from the State Hospital to stand trial, or were awaiting psychological evaluation for competence, or they are awaiting bed space at the State Hospital (67 of these people currently are on psychoactive medications). The cost of serving mentally ill patients in the Leon County Jail ranges from $120,000 to $172,000 annually. In addition, last year 308 mentally ill patients were admitted to the Emergency Room for lack of other treatment options. Of these, 37 patients waited OVER 12 HOURS prior to being transported to the hospital residential program at the Apalachee Center. There were also 157 patients seen in the Emergency Room and sent to Detoxification who were facilitated by the Psychiatric Emergency Response Program (PERP). That number does not include direct referrals from emergency physicians.

What is the cause of this crisis? Its clear that due to state funding cuts, the number of residential treatment beds in Leon County has been reduced from 120 in 1990 to just 24 today, and more cuts are likely. Also, Leon County now has NO outpatient services for mental health patients and NO community forensic program. Funding for the Alcohol, Drug Abuse and Mental Health Program in Leon County has gone from 7.3 million in Fiscal Year 1989/90 to 4.5 million in Fiscal Year 1998/99 -- a 39 percent reduction. Funding for Medicaid has also been cut -- from 9.1 million in Fiscal Year 1995/96 to 5.2 million in Fiscal Year 1998/99 -- a 42 percent reduction. The total number of mental health clients served in Leon County has dropped from over 9,000 in Fiscal Year 1993-94 to just over 7,000 in fiscal year 1998/99 - a reduction of 22 percent. Leon County mental health programs have experienced a 32 percent cut in clinical staffing from Fiscal Year 1994/95 to 1999/00, a reduction of 32 percent, and overall staffing for mental health services has been cut in the same period by one-third.

So what is the solution? The Leon County Partners in Crisis Coalition recommends the following:

RESIDENTIAL TREATMENT. The district needs additional Crisis Stabilization Unit and residential treatment capacity to properly address this problem. The closure of the G. Pierce Wood Hospital and the transition of civil beds to forensic beds has greatly limited District II's access to beds at Florida State Hospital. Public and private receiving facilities (Apalachee Center and Tallahassee Memorial) are operating at or above capacity and many clients are forced to be served in jails emergency rooms, or other inappropriate settings.

1. A 20 Bed Crisis Stabilization Unit (CSU).

2. 30 Bed Short Term Residential Treatment Program:

COMMUNITY FORENSIC PROGRAM: During state FY 1999-2000, a Forensic Work Group was established to address problems associated with the processing of individuals charged under Chapter 916 F.S. Treatment needs were identified and the district was given the responsibility of requesting support for a Community Forensic Program. The program will consist of case management, psychiatric consultation, and psychiatric medications.

20 BED SUBSTANCE ABUSE RESIDENTIAL TREATMENT PROGRAM: There exists a serious shortage of residential treatment capacity in District 2. We have waiting lists for both adolescent and adult beds. At a minimum, we need an additional 20 bed residential program to begin to address this need.

JUDICIAL CASE MANAGER to assist the Courts, the State Attorney and Public Defender manage cases involving mentally ill and substance addicted defendants out of the criminal justice system and into alternative treatment programs.

The desired effects of these recommendations would be to reduce jail overcrowding by reducing the number of mentally ill defendants being warehoused in the Leon County Detention Facility, reduce caseload burden on the State Attorney's Office, the Public Defender's Office and the courts, reduce crime rate by reducing recidivism among mentally ill probationers, and reduce the incidence of mentally ill patients burdening the emergency care resources of area hospitals by providing alternatives to hospital emergency rooms as the only place to receive treatment for psychological disorders and patients in crisis.

This is what we're doing locally with the Leon County Partners in Crisis Coalition. I hope you'll support this effort. If you'd like to be on our mailing list, please call my office at 922-7183 and talk to my aide Martin Green.