Florida proposed budget includes at least $101 million for mental health care

WINTER HAVEN – Florida’s proposed budget, which is scheduled for a vote on Monday, includes an unprecedented $101 million in recurring annual funds for community mental health and substance-abuse services.

Lawmakers included the allotment in the Health and Human Services budget.

Polk County Sheriff Grady Judd has been a longtime proponent of helping the mentally ill so his deputies don’t have to encounter the untreated and so the Sheriff's Office doesn’t have to treat them at the county jail – currently the largest mental health facility in Polk County. He applauded the Legislature’s decision to include increased funding.

“I certainly welcome the state and Legislature to being sensitive to the communities needing additional resources toward mental health services,” Judd said. “One of the first things we must do is break down the silos between mental health community providers, schools and local police agencies to make sure we get appropriate services to those who are significantly mentally ill. I certainly hope the proposed legislation survives the budget process.”

Judd added that he has asked Sen. Kelli Stargel, R-Lakeland, to ensure the money goes directly to fund psychiatric or counseling services, along with medication, for those who need it.

“I left word with Kelli, I hope they put language in there that that $100 million has to go directly to services of those who need it and doesn’t get caught up in the bureaucracy,” Judd said.

An advocacy group that lobbies on behalf of seven of the state’s largest mental health entities applauded the Legislature’s move, saying it will change Floridians’ lives for the better.

“The Florida Legislature has truly shown up for Floridians and prioritized the behavioral health services that many rely on to lead productive and healthy lives,” said Florida Association of Managing Entities CEO Natalie K. Kelly. “The more than $100 million in recurring funding for behavioral health services will help expand services, increase care coordination and enhance the overall system in Florida for residents of all ages.”

Florida’s seven local managing entities work with a network of more than 300 behavioral health care providers who deliver services to more than 300,000 of Florida’s most vulnerable residents, including children, expectant mothers, veterans and the chronically homeless.

In addition to the $101 million, another $25 million in recurring funding was placed in the supplemental area of the budget.

Funding for various programs is funneled through different departments and agencies, making it difficult to track all mental health spending.

Gov. Ron DeSantis did not respond to repeated requests for a comment, but the governor's press secretary, Christina Pushaw, said more than $306 million is provided throughout the budget "to expand community based behavioral health services, increase forensic bed capacity, and support the operations of the state mental health treatment facilities."

Polk County programs

A major change was also announced in Polk County in recent days.

Polk County officials announced on Thursday that mental health services are now easier to obtain for residents using the Polk HealthCare Plan after county officials made mental health care a covered benefit. The addition was approved by the Citizens HealthCare Oversight Committee and began this month.

“We want people to be able to take advantage of this,” said Joy Johnson, the program’s administrator. “It’s here for them to use, and we want them to use it. By changing behavioral health to being a covered benefit, we are eliminating extra hurdles our clients have to jump through to receive the treatment they need.”

The Polk HealthCare Plan is for those who are caught in the gap between not qualifying for Medicaid or Medicare and unable to afford marketplace insurance. Although the plan is not health insurance, it is a way for qualified individuals to get health care. Polk’s Indigent Health Care program manages a provider network for the health care plan that includes primary care and specialty care physicians, urgent care centers and five area hospitals.

While behavioral health was not previously a covered benefit in the Polk HealthCare Plan, members could access those services through a referral to a community partner. But when she looked at the data, Johnson found that patients were not accessing those services.

Between August 2020 and July 2021, nearly one-third of the plan’s membership had identified a behavioral health need; however, only 5% of clients were accessing those services.

“There’s a bottleneck that we must fix,” Johnson said. “By streamlining access, we are taking the opportunity to remove those barriers and encourage the clients to get the care they need.”

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Commissioner tried to make meetings more accessible to the public. His peers said no.

Another change includes a program through Winter Haven Hospital Foundation to treat the area's indigent mental health patients.

Morgan Davies, 32, spent six months last year working as a fourth-year, psychology practicum student at Winter Haven Family Health Center's First Avenue South office as part of the county’s new Mental Health Access Program. She helped patients with everything from adult addiction issues and trauma to children with attention deficit and hyperactivity disorder.

Davies saw more than 200 patients from July through December, including primary care patients with medical issues, when the grant for the program began.

“I got to work both with the medical doctors in the clinic, seeing patients for brief interventions, or a lot of different issues that they would come with,” said Davies, who is set to graduate this year from Florida Institute of Technology. “But then I also got to do some longer-term therapy.”

The program Davies was working under, which also includes Florida State University psychology students, recently saw a $1 million, three-year grant added to it from Polk County commissioners to help care for indigent patients who might not otherwise be able to afford care.

Officials say the Mental Health Services Access Program is a doctoral-level, clinical-psychology program designed to improve initial access and sustained availability to mental health services in Polk. The program includes Winter Haven Hospital Psychology Services, Florida State University and Florida Institute of Technology School of Psychology. Through the program, qualified residents can receive services at the Winter Haven Hospital Mental Health Emergency Department, the Winter Haven Hospital Street 5 Psychiatric & Substance Abuse Unit, the Winter Haven Hospital Center for Psychiatry, and telehealth once a mobile medical clinic becomes active.

The program is designed to serve about 1,000 residents a year for biopsychological testing and assessments, crisis management, Baker Act initiation and release, psychological evaluations, treatment plan development, case management and other therapies.

The grant came after The Ledger’s eight-week, 25-story series in November and December detailing issues with a mental health system a grand jury says is in a “sad state” in Florida.

► Read The Ledger's complete mental health series here.


A critical shortage of mental health counselors in Polk

In Polk County, mental health treatment stakeholders finished a year-long study last summer that showed one in seven of your friends, neighbors and co-workers indicate that they live with depression or are otherwise at risk for behavioral health challenges.

But the Polk Vision report also shows that there is a critical shortage of mental health counselors in Polk County.

The ratio of the population to mental health providers in Polk is 1,190 to 1. Florida is 670 to 1. The national benchmark is 310 to 1.

"The lack of sufficient providers to meet the growing need in Polk County has great impact on our community’s mental health, quality of life, economy, growth and development," the Polk Vision report states.

County Commission Chairwoman Martha Santiago said she began seeing an alarming increase in the need for mental health specialists when she was provost at Polk State College half a dozen years ago.

“We realized that we needed more mental health specialists instead of counselors because the issues that we were dealing with were beyond the range of a counselor,” Santiago said. “Why? So many various reasons. I can't, I'm not an expert and I can’t pinpoint exactly what it is. Bottom line is that we need the programs, we need the money to run the programs, and we need specialized people to help us with this.”

Santiago and her colleagues on the commission voted unanimously to accept and implement the $1 million grant.

“Mental health, behavioral health has been a concern for the whole commission, so anytime we could, we can get some money to help our community or whoever they are that need the help, we'll try to do it,” Santiago said.

She said public and private entities are all competing for the same pool of people and she would like to see an increase in graduates going into behavioral health care.

The $1 million grant is paying for:

  • The Mental Health Access Improvement Program: $790,380 over a 3-year period ($263,460 annually) effective July 1, 2021.

  • A Mobile Medical Clinic: $215,000 over a 3-year period. The mobile clinic is not operational yet.

Nathan Falk, director of Florida State University College of Medicine’s Family Medicine Residency Program at Baycare in Winter Haven, and Shannon Smith, director of psychology training for the program.  Smith said there are only three psychologists in the Winter Haven area to treat patients. A grant is helping to pay for practicum students from FSU and also Florida Institute of Technology.
Nathan Falk, director of Florida State University College of Medicine’s Family Medicine Residency Program at Baycare in Winter Haven, and Shannon Smith, director of psychology training for the program. Smith said there are only three psychologists in the Winter Haven area to treat patients. A grant is helping to pay for practicum students from FSU and also Florida Institute of Technology.

Shannon Smith, director of psychology training at Florida State University College of Medicine’s Family Medicine Residency Program at Baycare in Winter Haven, said there are only three psychologists in the Winter Haven area to treat patients. The grant is helping to pay for practicum students from FSU and also Florida Institute of Technology in Melbourne. In addition, there are two spots for accredited psychology internships.

“There's just a huge need for mental health services here,” Smith said. “There's a lot of underserved communities in this area.”

Smith said she directly oversees patient care and diagnosis by the practicum students and interns.

“With assessment cases, I'll always be involved in meeting with them and during the intake process and also in the appointment where we talk about the results of the evaluation,” Smith said. “One benefit is the fact that you get, you know, two brains for the price of one. Essentially, you get your therapist brain plus the supervisor brain. And we really work together on that case. They often have a little bit more time to spend with each patient, so you get more attention a lot of times, which can be really beneficial for a lot of our patients.”

In addition, she said students can be more up to date in recent developments in psychology and newer treatments, as well as some of the newer psychological assessments.

Since the Polk County Commission accepted the grant, Polk also has been awarded two new grants in support of the Helping HANDS Jail Transition program, which cares for inmates in jail and once they transition back into society:

  • Criminal Justice Mental Health Substance Abuse Grant: $1.2 million over a 3-year period to support and expand the Helping HANDS Jail Transition program by providing a measure of prevention and early intervention to target residents following a behavioral health crisis through a mobile crisis counselor. The goal is to keep them from being institutionalized for a mental health/substance use disorder.

  • Second Chance Act Grant: $900k over a 3-year period to support the Helping HANDS Jail Transition program by providing medication assisted treatment and services to eligible inmates with substance-use disorders, and continues to link them with supports upon re-entry into the community.

In all, Polk County spends more than $7.5 million on mental health programs.

State level changes

In the past week, two important changes were made by the Florida Legislature by helping families more easily access care for a loved one and by allowing a parent to bring a child in for emergency mental health care without fear of court involvement.

Florida Behavioral Health Association President and CEO Melanie Brown-Woofter thanked the Legislature “for their unwavering commitment to improving access to lifesaving mental health and substance use care,” and in particular Senate President Pro-Tempore Aaron Bean, R-Jacksonville, Sen. Danny Burgess, R-Zephyrhills, and Rep. Ralph Massullo, R-Beverly Hills, and Linda Chaney, R-St. Petersburg.

Senate Bill 1262 allows a hospital, mental health facility or licensed detoxification or addiction center to contact a patient’s emergency contact that is on file with the Florida Department of Highway Safety and Motor Vehicles to inform them of the patient’s whereabouts. Currently, if a loved one calls one of those facilities, administrators can’t confirm a patient is being treated there without a special code.

It also allows patients to release their medical record to their health care surrogate or proxy, attorney, representative or other known emergency contact within 24 hours of admission on a voluntary basis.

“By updating the Baker Act and Marchman Act to reflect best practices, SB 1262 makes it less intimidating for families to access emergency behavioral health services. These changes will eliminate barriers to care by ensuring that families and loved ones have every opportunity to engage in patient care,” Brown-Woofter said.

In addition Senate bill 1844 calls for minors who are being committed to a mental health facility to undergo a clinical review by medical personnel, rather than a legal hearing in court. It also calls for law enforcement officers transporting anyone to a mental health facility to restrain them in the least restrictive manner available.

“Thanks to Senator Bean and Representative Chaney for their leadership by sponsoring Senate bill 1844, which guarantees that a child being treated for a mental health condition is no longer subjected to the court process,” Brown-Woofter said. “Removing court involvement shifts mental health crises out of the legal system, emphasizing that mental health should instead be addressed by our health care system and is just as important as physical health.”

Polk County mental health funding:

Mental health programs already being funded in Polk County.

  • Peace River Center for Personal Development: Mandated per Florida Statute 394.76 to provide alcohol, drug abuse and mental health services. $912,972

  • Tri-County Human Services: Mandated per Florida Statute 394.76 to provide alcohol, drug abuse and mental health services. $640,397

  • Unassigned funds available for FL Statutes mandated services. $46,601

  • Department of Children and Families/Polk County cash match contribution required by the ROOTS grant. $40,000

  • Tri County Human Services: Criminal justice mental health and substance abuse grant (ROOTS). Supported housing and benefits assistance for clients in Helping HANDS jail transition program. $251,436

  • Corizon: Provides upon discharge from the Polk County Jail a 30-day supply of the medications prescribed to the inmate while in jail. This is for clients that are enrolled in Helping HANDS jail transition program. $126,529

  • Lakeland Regional Health outpatient and telehealth behavioral health services $600,000

  • Peace River for Personal Development Inc.: Outpatient and telehealth behavioral health services. $430,000

  • Polk County Fire Rescue Division Fire Rescue: Provides community paramedics to serve as the primary conduit between inmate release and long-term post-release mental health care for participants in the Helping HANDS jail transition program. $187,950

  • 10th Judicial Circuit: Behavioral Health Court Jail diversion program for qualified Polk residents. $268,805

  • Tri-County Human Services: Peer specialists work with the individual clients to develop an individualized recovery support plan. $220,434

  • Tri-County Human Services: Helping HANDS Clinical Oversight Coordinator - $5,000

  • Tri-County Human Services: Case management services and care coordination for those served by the Helping HANDS jail transition program. $128,150

  • Winter Haven Center for Behavioral Health: Outpatient behavioral health services to 50 participants of the Helping HANDS jail transition program. $136,350

  • Trust Fund Pass Through Tri-County Human Services: In-jail evaluations to determine if pretrial individuals would benefit from recommendation to a substance abuse/mental health treatment program in lieu of jail. $28,000

  • Tri-County Human Services: Jail Alternative to Substance Abuse program provides services for incarcerated adult males screened by the Sheriff's Office. Services include psycho-social assessments, individualized treatment plans, therapeutic group and individual counseling sessions, alcohol and drug education, urine screening, OED classes if available, case management and aftercare services. $ 174,100

  • Tri-County Human Services: Residential and intensive outpatient treatment in New Beginning Program for up to 30 men and 12 women at two residential locations. $1,341,660

  • Tri-County Human Services: Outpatient and telehealth behavioral health services. $700,000

  • Winter Haven Center for Behavioral Health: Outpatient behavioral health services to 375 adults. $886,275

  • Unassigned funds available for discretionary use. $155,303

  • Winter Haven Hospital Foundation: Mental Health Services Access Program. Designed to serve about 1,000 residents a year. $263,460

Grand Total: $ 7,543,422

Ledger reporter Kimberly C. Moore can be reached at kmoore@theledger.com or 863-802-7514. Follow her on Twitter at @KMooreTheLedger.

This article originally appeared on The Ledger: Mental health care would get a huge boost in proposed state budget