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State Leaders Look to Improve Mental-Health Funding, Policy

December 7, 2015 - 7:30pm

After an ambitious effort to revamp Florida's mental-health treatment system died at the end of the last legislative session, state officials are readying a new round of proposals for 2016.

Gov. Rick Scott has proposed an increase of $19 million for mental-health and substance-abuse treatment services in his recommended budget for the next fiscal year, with the lion's share going to treat people with mental illnesses in the community instead of in a state-run institution.

Rep. Charles McBurney, R-Jacksonville, is back with a bill (HB 439) that would create a statewide framework for counties to offer treatment-based mental health courts --- similar to a measure he sponsored last spring, only to see it die when the House adjourned three days early amid a budget dispute.

State Sen. Rene Garcia, a Hialeah Republican who chairs Senate Health and Human Services Appropriations Subcommittee, is working with treatment providers as he readies a new version of SB 7068, a sweeping reform bill he sponsored in 2015. That measure, along with a similar House bill spearheaded by Rep. Gayle Harrell, R-Stuart, were also casualties of the truncated session.

"We're working together" on a reform measure for 2016, Garcia said Monday. "I think this is one piece of legislation that both the House and the Senate --- along with the governor's office and the executive branch --- agree that we have to get done."

Last month Garcia and Rep. Jose Oliva, a Miami Lakes Republican who is in line to become House speaker in 2018, co-hosted the Mental Health and Substance Abuse Policy Summit in Miami with judges, doctors, providers, state officials and advocates taking part.

Garcia also said he'd discussed his plans with Scott and Senate President Andy Gardiner, R-Orlando.

"The president's on board," Garcia said. "One of the things I mentioned is that we are going to need some extra funding in order to make sure that Florida's not next to the bottom as it relates to mental health and substance-abuse funding."

For now, Garcia said, Scott and Gardiner "want to see the proposal, because one of the things we want to ensure is that there's not a duplication of effort going on in communities. And we see that a lot of times where, in Miami-Dade County or Orange County or Leon County, they have different providers doing the same thing. Obviously we want to maximize the existing dollars, and the way you do that is by limiting the scope of who can do what."

Last year's failed legislation would have required more coordinated care, especially for Floridians who use the system most. It also would have coordinated mental-health and substance-abuse services with primary health care and changed the bidding process for state mental-health contracts.

"Part of what we have to address is both the policy in how we do things, and the resources to do them," said Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association, which represents substance-abuse treatment providers. "I think we are now having those conversations."

Already, Scott and Department of Children and Families Secretary Mike Carroll have laid the groundwork for the Legislature's discussions. Scott signed executive orders in July and September establishing DCF pilot programs in three counties to conduct a countywide inventory of all state programs that address mental-health needs. The governor said at the time that the pilot programs would help the state track its mental-health services across the agencies and funding sources that address those needs.

Carroll said the executive orders are helping his agency understand whether it has "the most effective coordination of care. Are all those pieces talking to each other? Because the way that system is funded --- between federal dollars, state dollars, local dollars and then private dollars --- there is lots of money on the ground."

Both Carroll and Harrell, who chairs the House Children, Families and Seniors Subcommittee, contend that providing mental-health and substance-abuse treatment to parents helps to prevent child abuse. Scott's budget recommends $2.8 million to expand the use of Family Intensive Treatment teams, which provide services to families at risk for child abuse or neglect, to six counties with high numbers of abuse reports.

As to the DCF-run state forensic mental-health hospitals, which recent media reports have excoriated for a lack of safety, Carroll said the state must have a long-range strategy in order to make decisions about the sprawling facilities.

"Even if we were to upgrade the facilities, what do we do with all the other land and other buildings?" he asked. "There's going to be some difficult decisions for folks to make. ... We shouldn't do this willy-nilly."


What greater purpose is being served by denying extremely medically needy children healthcare? It’s safe to assume that the answer is: There is no greater purpose — and there’s no excuse. Not when the state of Florida was flush with a $635.4 million surplus. Not when parents and grandparents with meager resources are left to fend for themselves. Not when children with severe disabilities and medical conditions are unable to get treatment. And, especially, not when the state of Florida itself is tricking parents into unwittingly undermining their own child’s welfare. Since May, about 9,000 children with unique medical needs have been purged from the Children’s Medical Services roster. State leaders call it the result of a reorganization. They can call it whatever they want. In reality, it’s Florida’s longstanding attempt to save money by rationing care, and it’s taking it out on the most vulnerable. It’s nothing new, but it remains a disgrace. In her two-part series, Bitter pill, Miami Herald reporter Carol Marbin Miller reveals the extent to which state healthcare leaders have gone to prevent the “sickest of the sick” from getting care. The state introduced a “screening tool” that asks parents seeking help to answer five questions. Question No. 3, critics say, is a trap: “Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?” Answer No, and the child is not eligible, even if he or she previously had been getting care. Parents want their kids to be seen as “normal” — able to attend school, for instance — but it in no way means they are not sick or in desperate need of care. One child profiled in the story is nearly blind — detached retina. The state provided care to protect what little is left of his sight, but he was kicked out of the program, before finally being reinstated. Another young boy with a host of conditions and his grandmother are getting the runaround, and he can’t get necessary medication. As always, state administrators stick to the script, even in the face of damning evidence to the contrary: “We are dedicated to the care of children with serious and chronic medical conditions, and their families,” said the state Surgeon General John Armstrong, head of the Department of Health. “We want every child in Florida to achieve his or her full potential. And this program is so important for the medically fragile children in the state.” Sound familiar? It’s called denial, pretty much the default position of department heads, especially those serving in the Rick Scott administration. In 2013, after several children in the Department of Children & Families died in rapid succession, one DCF staffer explained: “When a child dies, it’s not because DCF dropped the ball. It’s because their families failed to protect them.” Last year, a DCF spokeswoman insisted that: “The safety and well-being of Florida’s vulnerable children is DCF’s top priority. Understanding and assessing child fatalities is one way the department analyzes the issues facing families and develops strategies to meet the needs of struggling families and protect vulnerable children.” That was the department’s response to clear evidence that the state was undercounting the number of deaths of children in its care. This is absolutely the wrong place in which to pinch pennies. Is the care expensive? Yes, it can be. But rest assured, the state can pay now or will pay — more — later for its shortsighted and inhumane stinginess. And again, what greater purpose is being served? Read more here:

Mental health care in Florida is joke. Rick could care less. He is more concerned about giving tax cut to his buddies then the well being of Floridians.

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