Treat the Mentally Ill--Don't Incarcerate Them

The current system for dealing with mentally ill people who commit crimes is, by all accounts, broken. And expensive: It costs Florida taxpayers tens of millions of dollars every year.

People with schizophrenia or other mental illnesses who get arrested are sent to expensive mental health facilities, where they're stabilized for the sole purpose of appearing in court. Most get released on time served, only to get sick again for lack of medication and treatment. They commit more crimes, and the process starts all over.

Florida spends $140,000 for each of 1,700 of these mental health beds, for a total of $250 million every year. That represents a third of all mental health funding in Florida.

"It's the worst money we spend," said Department of Children and Families Secretary George Sheldon.

Miami-Dade Judge Steven Leifman, tapped by the Florida Supreme Court to help reduce the number of mentally ill in Florida's corrections system, calls it "the insanity of all insanities."

Now, nearly three years after Pinellas-Pasco Public Defender Bob Dillinger sued the DCF over its lack of mental health beds for criminals, the Legislature is close to overhauling Florida's treatment of the mentally ill. If the proposed legislation becomes law, Florida would become the first state to take such an innovative approach, Leifman said.

And in a recession year when saving money is at the top of lawmakers' priority list, the changes could save the state tens of millions in taxpayer dollars.

"This will save us money, and it will help these people," said the bill's sponsor, Sen. Mike Fasano, R-New Port Richey. "Because they're not going to get the services they need sitting in the county jail."

The Department of Corrections, the DCF and the Agency for Heath Care Administration all support the proposal (HB7103, SB2018), which would treat and rehabilitate some of Florida's mentally ill in more comprehensive but affordable community facilities.

The latter two agencies would develop a plan for long-term services for the mentally ill who are at risk of ending up in the corrections system. A mentally ill inmate would first go to a locked facility for stabilization, then to a step-down facility that provides job skill training, drug and psychological treatment, and a case manager.

Leifman said the treatment would cost $25,000 per patient. But it would cost Florida less than that because the bill allows the state to apply for Medicaid money to pay for about two-thirds of the costs, which now have to be covered by general revenue.

The changes also would help some of the 4,000 or so people with serious mental illness who are sentenced to Florida's prisons each year. About half of those prisoners reoffend after they're released, so the new system would provide them the treatment they need to be healthy, functioning citizens.

The Pinellas-Pasco Circuit has already changed the way it deals with the mentally ill, and Sheldon considers its success a model for what the proposed statewide overhaul can achieve.

Dillinger a couple of years ago used $80,000 from the DCF to expand its jail diversion program for the mentally ill. Now in its fifth year, the program has diverted over 2,000 people from county jails into community facilities that provide housing, transportation, job transportation and therapy. The sites cost $800 a month per person, compared to $3,000 a month to house them in jail, Dillinger said.

The proposed legislation would create three pilot sites, including one in South Florida and one in Central Florida, to serve up to 1,000 people in ways similar to what Dillinger's program does.

"If you divert 1,000 people this year, you're talking about saving tens of millions of dollars," Leifman said. "This is serious bucks. And you're going to improve public safety because these people are much less likely to reoffend."

The legislation, sponsored by Fasano and Rep. William Snyder, R-Stuart, is based on recommendations issued by the Florida Supreme Court in a 2007 report that was commissioned after Dillinger sued then-DCF Secretary Lucy Hadi for not moving mentally ill jail inmates to hospitals.

"This is the most important mental health bill since the Baker Act in the 1970s," said assistant DCF Secretary Bill James. "We are talking about changing the system."

The proposal is making its way through the House and Senate, but even supportive lawmakers have expressed some concern over the costs of the pilot sites. Sheldon said the savings are worth any investment. And he said he can gradually get the pilots going by using money that would have been budgeted for new mental health beds.

"Some say, don't do something innovative in a tight budget year," Sheldon said. "I think this is the perfect time. Otherwise, this population is going to bust the bank."

an article by Shannon Colavecchio published in the St. Petersburg Times on Saturday, April 19, 2009