Florida s Approach to Mental Illnesses and Substance Abuse: Penny-Wise and Pound-Foolish? A White Paper Proposal. Prepared by

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1 Florida s Approach to Mental Illnesses and Substance Abuse: Penny-Wise and Pound-Foolish? A White Paper Proposal Prepared by The Key Clubhouse of South Florida 260 NE 17 th Terrace, Suite 202 Miami, FL On behalf of consumers and family members in Miami-Dade County October 2012 DRAFT

2 Florida s Approach to Mental Illnesses and Substance Abuse: Penny-Wise and Pound Foolish? Mental illnesses and the diseases of addiction have a devastating impact, both emotional and financial, on individuals and their families. These medical conditions result in high rates of school dropout, unemployment, homelessness, incarceration and disruption of the family structure. Although these disorders affect a relatively large number of people, stigma and a lack of education cause many individuals and families to delay or avoid treatment, often with tragic consequences. When individuals do not receive treatment, Florida taxpayers bear the cost in terms of the increased need for publicly funded hospital emergency services, family services, foster care services, homeless services, unemployment benefits, law enforcement and criminal justice services. Mental illnesses and substance abuse are complex disorders that often occur together and require multi-faceted treatment. Individuals may require customized medication regimens in addition to intensive ongoing therapy, public assistance and social supports just to reach stability and be able to function in the community. Serious mental illnesses can result in cognitive and functional disability. Without any income or health insurance, individuals are forced to rely on free public health care or Medicaid for treatment, as well as public assistance for food, transportation and housing. In an effort to control the costs of publicly funded services, Governor Rick Scott and the state legislature have proposed reductions in spending in several areas that directly affect Florida residents who struggle with mental illnesses and substance abuse disorders. The state is looking at reducing services to save costs and treat individuals in least restrictive care settings. Advocates are increasingly concerned that these changes will have dire consequences for children and adults living with these disorders. Prevalence of Mental Illnesses and Substance Abuse Disorders Mental illnesses and substance abuse are widespread throughout the general population. According to national prevalence rates, nearly 500,000 adults living in Miami-Dade County have experienced some type of mental illness. Within that group, nearly 94,000 are living with a serious and chronic mental illness. Another 127,000 adults have struggled in the past year with substance abuse. More than 68,000 children in Miami-Dade have some type of emotional or behavioral health disorder. 1 Many of these children will go on to develop serious mental illnesses and substance abuse problems. Florida Miami-Dade Adults who experience some type of mental illness (19.9%) 2.9 million 496,790 Adults who have a serious and chronic mental illness (4.8%) 710,363 93,634 Adults with past year substance dependence or abuse (6.5%) 961, ,796 Children with some type of emotional or behavioral health disorder in the past year (12.5%) 500,585 68,340 2

3 The number of adults and children who actually receive services through state-funded mental health and substance abuse services represents only a fraction of those in need. Florida Department of Children and Families estimates that approximately 13% of adults and 10% of children with emotional and behavioral problems receive services from the state. Children and Youth: The Most Vulnerable Both mental illnesses and addiction often begin in adolescence or early adulthood, the prime of a person s life. One-half of all mental illnesses begin by age Although mental illnesses and problems with addiction often have genetic origins, childhood trauma can also be an underlying cause. Exposure to violence, abuse and neglect may leave deep wounds in a child s psyche. Children and youth with early onset of a mental illness are at high risk for abusing alcohol and other drugs. 3 Approximately 50% of students age 14 and older who are living with a mental illness drop out of high school. This is the highest dropout rate of any disability group. 4 Many end up in juvenile detention; it is estimated that close to 70% of youth in the juvenile justice system have at least one mental health disorder. 5 Typically there are long delays, sometimes decades, before a person is diagnosed and receives treatment. Stigma and lack of information are the primary reasons. Although families and youth may hear about the dangers of drug and alcohol abuse through school-based prevention programs, they learn very little about what to do if their child develops symptoms of a mental illness, or how to identify a mental health issue that may underlie substance abuse. Early intervention and treatment can have a profound impact on the life of a young people with a diagnosable behavioral health condition. Treatment can make it possible for children to stay in school and complete their education, or for a young adult to complete college. Treatment can help keep a young person from a lifetime of abusing drugs or alcohol. Children are also the victims of their parents untreated mental illnesses and substance abuse. Children who live with dysfunctional parents and other family members experience neglect, poverty and abuse. They frequently end up in the foster care system or passed from family member to family member when their parents can no longer care for them. Jails: Our New Psychiatric Institutions An alarming number of adults and children with undiagnosed and untreated mental health and substance abuse disorders end up in juvenile detention, jail and prison, one of the most expensive and dangerous places for them to be. 6 This is a national phenomenon: 2.2 million individuals with serious mental illnesses are sent to jails every year in the U.S. Inmates with mental illness represent the fastest growing sub-population within Florida s prison system. $425 million is spent annually to house and provide minimal treatment to inmates with mental illnesses. The number of inmates with mental illnesses in Florida prisons has risen by 72 percent since 2000, from 10,600 to roughly 18,500 and continues to grow every day. If we 3

4 continue to incarcerate individuals with mental illnesses at this rate, Florida will need to invest nearly $3.1 billion in the next decade for new jail beds just for inmates with mental illnesses. To add to the burden on state taxpayers, Florida currently spends nearly $200 million annually one third of all adult mental health dollars and two thirds of all state mental health hospital dollars on 1,600 beds serving roughly 3,000 individuals involved in the criminal justice system under forensic commitment. Here at home, the Miami-Dade County Jail is the largest psychiatric institution in the State of Florida, with nearly 20,000 bookings a year involving individuals with serious mental illnesses. 7 Most of these arrests are for minor offenses directly related to the person s untreated mental illness. Every day, 1,200 inmates received psychotherapeutic medication in the jail at an average daily cost of $ The annual cost to taxpayers for incarcerating people with mental illnesses in the Miami- Dade County jail is estimated at $58.8 million! Conditions in the jail for people with mental illness are alarmingly primitive, almost medieval. Inmates are kept in cold, overcrowded cells without clothing and sleep on metal cots or on the floor. The conditions are so bad that the U.S. Department of Justice-Civil Rights Division conducted an investigation in 2011 and concluded that the jail is deliberately indifferent to the suicide risks and serious mental health needs of its prisoners. 8 Florida s Cost-Cutting Efforts: Going Too Far? Approximately $1 billion of Florida s $70 billion state budget is earmarked specifically for mental health and substance abuse services provided through the Department of Children and Families. This funding provides public services to the approximately 470,000 adults and children, including many who are disabled and unable to care for themselves. 9 Florida ranks 49 th among states in its per capita spending on mental health services, spending even less than Mississippi and Alabama. 10 In recent years, the state legislature has struggled to find a path between providing necessary treatment services and achieving substantial budget reductions. Legislators are seeking ways to trim these costs even further, including reducing Medicaid benefits by turning over Medicaid funded treatment services to HMOs. Approximately 36% of Floridians with mental illness receive Medicaid benefits. This percentage has actually decreased from 43% in 2008, perhaps from state efforts to restrict Medicaid eligibility, as the need for Medicaid services continues has rise steadily every year. 11 In addition, Governor Scott and the state legislature have decided not to implement the Affordable Care Act in Florida and not to expand the Medicaid program to more Floridians without health insurance. This will further decrease the availability of behavioral health care resources to Floridians who struggle with mental illnesses and substance abuse disorders and do not have health insurance. 4 With proper investment in mental health services, Florida can expect greater rates of recovery and optimal functioning from people living with these chronic illnesses. Examining the Efficacy of Florida s Publicly Funded Mental Health Services, Gail P. Hutchings & Heather C. Cobb, Behavioral Health Policy Collaborative, 2012.

5 Can Florida afford to maintain a lean and mean approach to funding mental health and substance abuse treatment and services to residents? What happens to families and their communities when publicly funded programs are diminished or eliminated? There is clear evidence that if mental health and substance abuse treatment services are not adequately funded, there are significant social and economic reverberations across the state. Untreated and under-treated mental illnesses and substance abuse result in higher levels of school dropout, unemployment, arrests and incarcerations, poverty, hospital emergency room visits, and children in foster care, with increased costs in all of these areas at both the state and local level. The solutions seem clear: instead of investing millions in prison and jail cells for people with mental illnesses, state funds should be focused on early intervention, treatment, rehabilitation, employment and forensic diversion. No Cures, But Recovery Is Possible Science has not yet produced cures for serious mental illnesses and addictions but there are proven treatment methods that lead to recovery and stability. With good medical treatment and the right community supports, individuals who were once completely disabled by their illnesses including schizophrenia, bipolar disorder and serious drug and alcohol addictions are now able to achieve stability, independence and even part-time and full-time employment. People who have experienced recovery from a mental illness know from experience that longterm stabilization and return to a meaningful life requires much more than a bottle of pills and a monthly visit to a psychiatrist. Other essential elements that make recovery possible include rehabilitation and employment programs, social connections, healthy recreational activities peer support and affordable housing. These elements need to be integral parts of a community s mental health and substance abuse system of care to keep individuals from cycling in and out of crisis situations. Recovery from a mental illness or substance addiction has been defined as A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. 12 This should be the state s goal for all Floridians who live with these disorders, as people in recovery use the most costly public services less and are able to contribute the most to their communities. 1 Substance Abuse and Mental Health Services Administration. (2012). Mental Health, United States, HHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration. 2 Kessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, & Walters, E., Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Co-morbidity Survey Replication (NCSR). General Psychiatry, 62, June 2005, National Institute of Mental Health Release of landmark and collaborative study conducted by Harvard University, the University of Michigan and the NIMH Intramural Research Program (release dated June 6, 2005 and accessed at 5

6 4 11 U.S. Department of Education. (2001). Twenty-third annual report to Congress on the implementation of the Individualswith Disabilities Education Act, Washington, D.C. 5 Shufelt, J. & Cocozza, J. (2006). Youth with Mental Health Disorders in the Juvenile Justice System: Results from a Multi-State Prevalence Study. National Center for Mental Health and Juvenile Justice. Delmar, NY. 6 Hutchings, G. and Cobb, H., Behavioral Health Policy Collaborative. (2012). Alexandria, VA: Examining the Efficacy of Florida s Publicly Funded Mental Health Services: The Science, The Research, The Return on Investment. 7 Supreme Court of Florida.(2010). Constructing a Comprehensive And Competent Criminal Justice/Mental Health/Substance Abuse Treatment System: Strategies for Planning, Leadership, Financing, and Service Development. 8 U.S. Department of Justice, Civil Rights Division. Investigation of the Miami-Dade County Jail. (2011). Washington, D.C.: Author. 9 Department of Children and Families Substance Abuse and Mental Health Program Annual Data Snapshot as of February 11, 2011, Table 1 Persons Served Statewide per Program Area, Population, and Region During State Fiscal Year , Florida Department of Children and Families. These figures do not reflect an undetermined number of individuals who receive treatment through private insurance coverage. As many families with private insurance will attest, their health insurance policies do not cover the real costs of long-term treatment for these disorders. They often exhaust their financial resources, sometimes even selling their homes, to support their loved ones. 10 Kaiser Family Foundation. (2012). State Mental Health Agency (SMHA), Per Capita Mental Health Services Expenditures, FY Accessed on September 17, 2012 at 11 Florida 2011 Mental Health National Outcome Measures (NOMS): CMHS Uniform Reporting System Output Tables (2011). Substance Abuse and Mental Health Administration. Accessed on September 30, 2012 at 12 Substance Abuse and Mental Health Services Administration. (2012). Accessed on October 2, 2012 at 6

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