Delivering On the Promise Of A Modern Mental Health Care System In Florida
This article first appeared as a column in the October issue of South Florida Hospital News
By Mary Mayhew, FHA President and CEO
Decades ago, Florida and states around the country closed and/or greatly reduced the size of state psychiatric institutions. This was often done in response to class action lawsuits that rightfully argued against institutionalization of those with mental illness. But the patients and the needs of those patients did not go away just because the 1,000-bed institutions were closed. It is truly hard to believe that with the state-of-the-art advancements that have been developed and advanced in the United States, we are still struggling to effectively support a system of care for those with mental illness and especially for those with serious and persistent mental illness.
Far too many individuals with mental illness are trapped in the revolving door of hospital emergency departments, inpatient psychiatric units, and often worse, the county jails. The 28 year old with schizophrenia who believes when he is on his medication that he is well, will soon stop treatment and the acute cycle begins again which sometimes involves law enforcement and an involuntary commitment. And yet, much of this is preventable. We know how quickly the crisis and costly acute episode can be averted, especially with medication management. We know the value of wrap-around services that include behavioral health services and supports, physical health, and social services. The effectiveness of a comprehensive community-based continuum for mental health services that includes peer services, housing supports, vocational services, multidisciplinary teams and 24/7 community support is indisputable. In the end, our payment system has failed to appropriately reimburse for and incentivize these services and the staff needed to support this system of care.
Failure to make these financial investments does not mean that we are saving money. The reality is far more money is being spent on preventable emergency department visits, psychiatric admissions, criminal justice involvement, child welfare, educational impacts, and on and on. More importantly, it perpetuates the crisis-oriented, fragmented response that fails at the patient-centered approach. When individuals are ready for and in need of community mental health treatment, the door needs to be open and services available as soon as possible.
More than 63 percent of adults with mental illness receive no treatment. Florida has more than 200 federally designated mental health professional shortage areas, which leaves just 21 percent of the need for mental health professionals being met. The state ranks 43rd in the country in mental health workforce availability.
Nearly 650,000 Floridians have a serious mental illness, including 1 in 6 homeless individuals. Nearly 62 percent of Florida’s children experiencing a major depressive episode do not receive treatment. And, the number of potentially preventable emergency department visits due to a mental health condition has gone up more than 11 percent since 2020.
Medicaid is the dominant payer for behavioral health services. For our children in Florida, over 66% of all children in Florida are covered by Medicaid and the Children’s Health Insurance Program. When we focus on the mental health and well-being of our children, the state Medicaid program must play a pivotal role in responding to and supporting a robust community network of providers to meet these needs. Without access to these services for children, the consequences are often heartbreaking. With these services, the promise of happiness, stability and resiliency and educational success are more likely.
The effects of unmet behavioral health needs are felt in every aspect of community life, from schools and workplaces to jails and the courts.
The good news is that there are solutions, and investments in proven programs and services are increasing. For example, widespread availability of wraparound services that include housing, medication, and social services help prevent relapses and repeat hospitalizations for those with severe mental illness. Models such as Clubhouse that integrate employment, housing, social activities, counseling, and education are proven to support recovery for people living with serious mental illness. And, with strong leadership from the governor and legislature, there is an incredible opportunity to have a more robust system of care. The state budget for 2023-24 includes 24 percent more funding for the Department of Children and Families and 47 percent more funding for community substance abuse and mental health services from last year.
More can and should be done to build on these programs and continue increasing investments. For example, as the largest payer for children’s health care in Florida, Medicaid has an obligation to modernize its payment policies to align with care needs and support effective delivery models. Yet, Florida Medicaid does not currently pay for collaborative care, despite its effectiveness in managing behavioral health conditions. Expanding the state’s commitment to community health models, such as Certified Community Behavioral Health Centers, is also needed as is meaningfully connecting behavioral health care providers in a robust health information exchange.
The many challenges to our behavioral health care system cannot be solved overnight, and there is much more to be done to ensure that every Floridian can access timely behavioral health care. There are signs of improvement, however, and with data-driven solutions and policies and sustained public investment, we can truly make a difference for so many Floridians.