Mental health in Florida: System ‘a sad state’ with devastating consequences, report says

·24 min read

To get help

Polk County’s Peace River Center offers a 24-Hour Emotional Support and Crisis Line: 863-519-3744 or toll-free at 800-627-5906.

LAKELAND – When Marcelle Jerrill Waldon was a child, long before police say he broke into a Lake Morton home in November 2020 and killed the married couple living there, he heard voices telling him to hurt people.

The week before Bryan James Riley, 33, allegedly shot up a household on Labor Day weekend, killing a three-month-old, his parents, grandmother and the family dog, Riley had been hearing God, telling him to find a girl named “Amber,” investigators said.

“God told me to kill everyone and to rescue ‘Amber’ because she’s being sex-trafficked,” Riley told detectives when he confessed to the crime, according to Polk County Sheriff Grady Judd.

These incidents cast a dim light over the national mental health crisis and how internal battles, untreated, can have devastating consequences. The two homicide cases are indicative of a state mental health system that a Florida grand jury recently described as “a sad state” and one that has “urgent problems.”

A grand jury recently described Florida’s mental health system as “a sad state” and one that has “urgent problems.” In 2002, Florida closed down the G. Pierce Wood State Hospital in Arcadia, which gave inpatient care to mentally ill patients, adding to an overburdened system and leaving some patients without a place for treatment. (File Photo)
A grand jury recently described Florida’s mental health system as “a sad state” and one that has “urgent problems.” In 2002, Florida closed down the G. Pierce Wood State Hospital in Arcadia, which gave inpatient care to mentally ill patients, adding to an overburdened system and leaving some patients without a place for treatment. (File Photo)

“To put it bluntly, our mental health care ‘system’ – if one can even call it that – is a mess ...(a) patchwork of interlocking, often-conflicting sources of care,” states the December 2020 report of the Twentieth Statewide Grand Jury, empaneled following the mass shooting at Marjory Stoneman Douglas High School in Parkland in 2018.

Nearly one in five Florida adults pre-pandemic (17.5%) had a mental illness, and more than 7% of Florida’s adults had a substance use disorder, according to statistics from the Substance Abuse and Mental Health Services Administration.

Lakeland Assistant Chief Of Police Sam Taylor holds up a photo of Marcelle Waldon, who was arrested and charged with 10 felony counts in the murder of Edith Henderson and her husband David Henderson, during a press conference at Lakeland Police Department headquarters on Nov. 12, 2020. Former City Commissioner Edith Henderson, also known as Edie Yates, 67, and her husband David Henderson, 64, were found dead in their home on Lake Morton.
Lakeland Assistant Chief Of Police Sam Taylor holds up a photo of Marcelle Waldon, who was arrested and charged with 10 felony counts in the murder of Edith Henderson and her husband David Henderson, during a press conference at Lakeland Police Department headquarters on Nov. 12, 2020. Former City Commissioner Edith Henderson, also known as Edie Yates, 67, and her husband David Henderson, 64, were found dead in their home on Lake Morton.

Struggling to find care

According to Judd and Lakeland Police Assistant Chief Sammy Taylor, neither Waldon nor Riley were under any treatment for mental illness, nor taking any medications for it – remedies which could have allowed them to live normal lives.

No one – not even Waldon or Riley themselves – stopped the dark waters swirling in their minds before they left families devastated and a community wondering how this happened.

Alison Yager, director of policy advocacy for the Florida Health Justice Project, wrote a June 2020 report about the state of Florida’s mental health care. She pointed to statistics from the Substance Abuse and Mental Health Services Administration, known as SAMHSA, which show more than half a million adults in Florida experience serious mental illness.

“Too many Floridians with mental illnesses struggle to find the care they need,” Yager wrote. "Floridians with mental illness face significant obstacles in accessing necessary and appropriate health care. In fact, almost 60% of adults with mental illness in Florida do not receive treatment. In a national measure of access to mental health care that includes access to insurance, access to treatment, quality and cost of insurance, and workforce availability, Florida ranked 40 out of the 50 states."

Quadruple homicide suspect Bryan James Riley is led from the Polk County Sheriff’s office on Sept. 6.
Quadruple homicide suspect Bryan James Riley is led from the Polk County Sheriff’s office on Sept. 6.

Judd serves on the Marjory Stoneman Douglas Public Safety Commission, empaneled after 14 students and three staff members were killed at the Parkland school by a young man psychiatrists said is mentally ill.

Judd and the commission were instrumental in getting the Marjory Stoneman Douglas High School Public Safety Act passed by the Florida Legislature, which “promotes school safety and enhanced coordination between education and law enforcement entities at the state and local level.” It also established the Coach Aaron Feis Guardian Program, which places an armed guard on every public school campus in the state and provides training for them.

Judd and Polk County mental health care workers are striving to improve what is done in Central Florida for the most mentally vulnerable among us – something Judd said has been ignored for too long.

“God doesn’t like that. In fact, my Bible talks just to the contrary of that,” Judd said. “That’s why we are doing everything we can with the resources we have in this county to get everybody in the boat together rowing in the same direction.”

What causes mental illness?

According to the Florida Department of Health, there is no single cause for mental illness, but several factors can contribute to the risk for mental illness. Those include:

• Early adverse life experiences such as trauma or a history of physical or sexual abuse and witnessing violence.

• Biological factors such as genes or chemical imbalances in the brain.

• Use of alcohol or recreational drugs.

• Having few friends.

• Having feelings of loneliness or isolation.

Gov. Ron DeSantis is also taking steps to change the system.

On June 29, he signed into law a bill creating the Florida Commission on Mental Health and Substance Abuse, following recommendations by the Marjory Stoneman Douglas grand jury. The 19-member commission is examining the state’s methods of providing mental health and substance abuse treatment, and making recommedations to improve current practices, procedures and programs.

Several changes that most mental health, law enforcement and education experts agree need to be made is fostering better communication among health care providers, law enforcement and schools in order to help people and stop criminalizing mental illness.

They also want to see an overhaul in how the system is funded.

“Behavioral health is siloed and it is siloed not because I woke up one day and said I just want to stay in my sandbox and do my thing,” said Alice Nuttall, associate vice president of behavioral health at Lakeland Regional Health Medical Center. “It is based on a larger, systemic infrastructure that, you know, goes all the way back in history and through the government and how funding flows that has created a wicked, very complex multi-factoral situation and so, therefore, the solution is just as complicated and has as many moving parts.”

Currently, piles of money flow through local, state and federal channels, with restrictions on some of the dollars. In addition, Florida has opted out of expanding Medicaid, which strips the state of hundreds of millions of dollars that could be used for people who are categorized as the seriously mentally ill.

Florida’s system ranks 16th in the country for total mental health spending at $783.4 million, not including Medicaid funding, but ranks next to last among all 50 states in per-capita spending on mental health programs, according to a July report issued by the federal Substance Abuse and Mental Health Services Administration. Florida spends $36.59 per person to treat residents, with only Arizona, at $12.49, spending less. Vermont spends the most, at $424.66.

According to SAMHSA, its expenditures for community mental health services in Florida totaled $404.8 million in 2020, along with state expenditures of $643.6 million, for a total of $1.048 billion. The United States spent $46 billion.

In Mental Health America’s 2022 The State of Mental Health in America report, Florida is ranked 49th of the 50 states for access to care and tied for second with Georgia at 63.5 percent for adults with a mental illness who did not receive treatment.

Florida Behavioral Health Association President and Chief Executive Officer Melanie Brown-Woofter said funding, its sources, and its restrictions have long been a problem throughout the U.S. and in Florida. She said, ideally, there would be “one door into health care” and the patient could access anything they needed once they walked in.

“Revise the system so we reimburse those services instead of piecemealing it, so that we look at the individual and what the individual needs and we can provide,” Brown-Woofter said. “Have the person come in and have the treatment professional say. ‘This is what you need,’ rather than saying, ‘I know you need all these things but this is what we’re limited to.’ Right now it’s splintered and that’s an artifact of a lot of history. That’s nothing we’ve done deliberately in Florida. ... Changes would have to be made at the national level.”

Brown-Woofter and her colleagues said they do not know exactly how much the state spends on mental health care because different programs are run by different agencies, including the Department of Children and Families, the Department of Corrections, the Florida Education Finance Program, along with Medicaid and Medicare programs.

The Ledger spent the last six months interviewing various mental health stakeholders in the county and state, visiting a homeless camp and mental health facilities, reviewing more than 1,000 pages of legal documents, along with federal, state and county reports on the subject. They all paint a grim picture of an escalating crisis.
The Ledger spent the last six months interviewing various mental health stakeholders in the county and state, visiting a homeless camp and mental health facilities, reviewing more than 1,000 pages of legal documents, along with federal, state and county reports on the subject. They all paint a grim picture of an escalating crisis.

Mental health history in the U.S.

The United States instituted a system of state-run asylums starting in the 1800s, following the British model. The mentally ill were taken to these homes and locked away, almost never to return to their families.

Many of these “insane asylums” were overcrowded and understaffed, often providing inadequate care and mistreating patients. Many had come under fire for inhumane, bleak and unsanitary conditions.

But a confluence of multiple events happened in the 1950s and early 1960s that created a prescription for deinstitutionalizing hundreds of thousands of mentally ill patients from these vast state-run asylums – possibly as many as 650,000 people across the United States in the decades that followed, according to Torrey’s book “American Psychosis.”

Torrey explained that four things took place in short order:

  • Highly publicized stories were written about the shocking conditions inside institutions.

  • Psychotropic medications like chlorpromazine were developed and “helped to alleviate delusions, hallucinations and manic symptoms.”

  • Several men helped to establish the National Institute of Mental Health and strongly believed in shifting patients out of large asylums for treatment at a network of a proposed 2,000 small, community mental health centers.

  • John F. Kennedy, whose sister Rosemary had undergone a botched lobotomy for possible schizophrenia, became president of the United States.

As patients began taking medication and getting better and as community health centers were built, federal officials decided that the need for large state-run and state-funded institutions, many of which simply warehoused patients, were no longer necessary.

In 1975, the United States Supreme Court ruled on the case of a paranoid schizophrenic man who was held at Florida State Hospital in Chattahoochee. He had been held for 15 years without cognitive therapy, although he refused medication and electroshock therapy because of his religion. The court found that the state cannot constitutionally confine a non-dangerous mentally ill person capable of living outside of a mental health facility.

By the late 1970s, 789 community mental health centers had been constructed throughout the United States, substantially fewer than the 2,000 NIMH leaders had envisioned. But the federal government left it up to the states to provide funding to staff these facilities.

After his 1977 inauguration, President Jimmy Carter created a commission to look into the U.S. mental health problem. Just before the 1980 election, he signed into law the Mental Health Systems Act, which would have extended funding for more community mental health centers, among many things. At the time, it was called “landmark legislation” in mental health care policy.

A few months later, after President Ronald Reagan took office, most of the law was repealed – including funding for the remaining 1,211 community mental health centers.

While G. Pierce Wood in Arcadia, the main recipient of long-term mental health patients in the Central Florida area, remained open into the 2000s, it was finally closed in 2002 and turned into a juvenile detention facility before being sold off by the state in 2014.

Homelessness a result of closed asylums

As the large asylums closed units, then entire wings, and finally shut down altogether, many seriously mentally ill patients, who may have benefitted from the use of medication while institutionalized, were left to their own devices on the outside.

Many either chose not to continue taking their medication or couldn’t afford it. If their family or friends didn’t take them in, if they didn’t wind up in a nursing home or a privately run “board-and-care home,” they simply wandered the streets or found a place in the woods, under a bridge or in a public park to set up camp and survive. The Ledger encountered people who have been living this way for more than a decade or longer.

And while some argue, and the courts have ruled, that the mentally ill have a civil right not to be treated, Torrey states that this “freedom some say they have doesn’t make them ‘free.’” Torrey added that it makes them a prisoner to the auditory and visual hallucinations that haunt them throughout their everyday lives.

Experts also argue a person’s mental illness can actually cause something called anosognosia, making them unaware of their illness or the need to take medication to control it.

“The freedom to live in the community while psychotic may also interfere with the rights of other members of the community,” Torrey wrote.

Torrey notes that the homeless can sometimes wreak havoc on a neighborhood, as was the case when police say Waldon, who was homeless, allegedly killed the Hendersons and inflicted a deep psychological scar on Lakeland residents, particularly in the Historic Lake Morton neighborhood.

But mental experts caution – and multiple studies show – that it is the mentally ill who are far more likely than the general public to become victims of crime, including violent crime.

“Being a young male or a substance abuser is a much higher risk factor for predicting violent behavior than is being mentally ill,” Torrey wrote.

Local experts agree.

“One thing we know for sure is that poverty and socioeconomic conditions and then especially substance abuse and alcohol abuse are much more predictive of violence than mental health,” Lakeland Regional Health’s Nuttall said. “Just the fact that someone has a mental health diagnosis is not predictive of violence.”

Greater risks for committing violent acts

Torrey added that a review of studies from 11 countries involving more than 18,000 patients concluded that, “compared to the general population, men with schizophrenia had a two to five times greater risk for committing violent acts, and women with schizophrenia had a four times greater risk.”

But, Torrey said, “it should be emphasized that almost all the increased risk of violent behavior by individuals with serious mental illnesses applies only to those who are not being adequately treated with medications. For those who are being treated and take their medications, there is no evidence for any increased risk.”

Studies show that “people with untreated mental illnesses are responsible for approximately 10% of the homicides in the United States. Rampage killings are becoming more common.”

And according to Torrey, the worst result of the institutions’ closures are murders like the Hendersons’ and the Gleasons’.

“The most publicly visible consequences of the failed mental illness treatment system are violent behaviors, including homicides ... such acts became prominent in the early 1970s in California as deinstitutionalization accelerated, and they appear to have continued to increase over the subsequent 40 years,” Torrey wrote.

Psychiatrist Keith Ablow said the U.S. is not facing an epidemic of gun violence or first-degree murder.

“We are facing an epidemic of mental illness, improperly triaged and treated, leading to killings with no apparent motive,” Ablow said in Torrey’s book. “They will stop when we decide to stop them – by providing robust mental health care services, targeted to those individuals whose mental illnesses include a component of violent or psychotic thinking.”

The Federal Bureau of Investigation’s National Instant Criminal Background Check System for firearm purchases includes people ruled in a court to be mentally incompetent.

“Most information for this prohibition is not available in the (Interstate Identification Index) ... but entry into the NCIS is an alternative,” the report reads. “Information on persons adjudicated as a mental defective or involuntarily committed to a mental institution for treatment may be entered into the NCIS Indices. Criminal cases with ‘Not Guilty by Reason of Insanity’ qualify for entry into the (index).”

The number of people for each state is listed in a 2020 report. Florida has 189,743 active mental health records in the NICS Indices as of Dec. 31, 2020. California has the most, with 1.04 million, followed by Pennsylvania with 945,000, New York with 786,700 and New Jersey with 504,600. The total for the U.S. is 6.1 million.

One of the areas in which Polk County gets applause is the Polk County Sheriff’s Department’s use of Crisis Intervention Training to de-escalate tense situations with people who might be enduring a mental health crisis. All deputies and detention deputies receive 40 hours of training, with the 911 call center coming online this year, as well.

Their training is based on The Memphis Model, developed in 1988 and used nationwide. In Polk County, the Sheriff’s Office provides training for any local law enforcement agency that wants it, and most police departments have taken advantage of that training.

In addition, the Sheriff’s Office contracts with Peace River Center to provide counselors to help with mental health crisis calls.

Law enforcement agencies have become the front line of the mental health crisis, Torrey wrote.

The Polk Vision report states that many police officers and sheriff’s deputies are intimately connected to their communities and know when one of their residents is having a crisis.

They “are often aware of individuals needing – but not getting – behavioral healthcare ... One person reported that, when needed, they arrest these individuals specifically so they can receive help for their illness, as they may fall into one or more of the high-risk groups, who have a hard time accessing care,” the report states.

Jail inmates in need of behavioral health services

According to the Polk Vision report, “some law enforcement personnel said they can readily identify which inmates are in need of behavioral health services.”

According to Torrey’s “American Psychosis,” a 1990 National survey found that “approximately 10% of inmates in prisons and jails, or approximately 100,000 individuals, suffer from schizophrenia or manic-depressive psychosis.” A decade earlier, it had been 5%.

A Florida Health Justice Project shows that the number of inmates statewide with mental illness has skyrocketed in the past 25 years, far outpacing Florida’s population growth rate. The numbers show:

  • 1996: 6,777 mentally ill inmates in a total population of 14.4 million people

  • 2013: 17,168 mentally ill inmates in a total population of 19.5 million people

  • 2023 projected: 30,170 mentally ill inmates in a projected total population of 22.4 million people

  • 2028 projected: 40,000 mentally ill inmates in a projected total population of 23.8 million

Florida’s projected total population is from the University of Florida’s Bureau of Economic and Business Research.

According to Polk Vision, in the Polk County Jail, inmates identified as requiring behavioral health care are housed in one of two cell blocks: In one, inmates agree to medication management and are otherwise able to share a cell with two other people. The other cell block houses inmates not willing to comply with medication management or are acute enough to require a one-person cell.

“In either case, inmates requiring behavioral health care – not to mention general population inmates who would benefit from care – receive no (or minimal) counseling services,” the 2021 Polk Vision report said.

On Sept. 20, there were 2,964 inmates in the Central and South County Jail facilities. Of those, 92 were housed in the mental health wings, which have a capacity of 140 beds.

For those 2,964 inmates, the Polk County Jail employs one on-call psychiatrist, one full-time psychiatric advanced registered nurse practitioner, three mental health counselors and two as-needed nurse interns.

“Keep in mind, when you run a county jail, the average stay here is 28 to 34 days,” Sheriff Judd said. “Some people are in there for years, some people book in and book out. We don’t – with the exceptions – we don’t deal with long-term people. We put them on medications immediately, but most take more than that to kick in.”

The Sheriff’s Office gets high marks for a program it developed to help inmates upon release, according to Polk Vision. Helping Hands tries to ensure that inmates who need medication and counseling get their prescriptions and make it to their counseling sessions.

A look at Behavioral Health Court

Some inmates are identified as good candidates for a program that has been hailed as successful from all involved: Polk County’s Behavioral Health and Veterans Court.

Established in 2008, the special court handles defendants who attorneys think would “benefit the most from the program, providing participants access to the least restrictive treatment, training, and support services necessary.”

Behavioral Health Court is a voluntary program, and participants agree to the rules, including providing a urine sample at least once a week – sometimes more, if necessary – and appearing before Judge David Stamey each Wednesday.

Once a participant is selected, they are evaluated by a mental health counselor, who will diagnose them. They are then assigned one of several Behavioral Health Court case managers, who will develop an individualized plan to address their specific needs, problems and use of available resources in the community.

Veterans courts are “designed to assist justice-involved defendants with the complex treatment needs associated with substance abuse, mental health, and other issues unique to the traumatic experience of war,” according to the program’s webpage. In addition to a case manager, they are assigned a mentor – another veteran who understands their issues.

In Polk County’s Behavioral Health Court, 284 participants have graduated since 2008, with 82% of them going on to lead successful lives without re-arrest. However, 51 have been taken into custody again and faced more criminal charges between 2008 and 2020.

Helping vulnerable juveniles

Polk Vision said the county’s youngest residents “not only tend to be among the most vulnerable, but they also tend to be the group that respondents offered the most amount of hope and opportunity to affect change for future generations.”

Officials said that “investing in caring for children now should provide incalculable benefits for both individuals and the community in the years to come, and should at some point alleviate the burden on the healthcare system.”

Children today carry loads that previous generations didn’t have, including high-stakes tests, active shooter drills, vicious physical fights posted on social media, and bullying that doesn’t end when the bell rings at the end of the day. Horrible comments can follow children home on Snapchat, Twitter, Facebook and other social media sites. And now the worry from a pandemic is added to the mix, juvenile mental health experts say.

“Start early – in order to have ‘normal’ adults then we need to start with children,” the Polk Vision report states.

Some of the most alarming statistics in the Polk Vision report came from the percentage of juveniles who have put serious thought into killing themselves, made a plan for it or attempted it – including those in elementary school. Girls were about twice as likely as boys in each of those three categories.

On average, one out of every five school-aged children in Polk County have seriously thought about killing themselves, with high-schoolers more likely to have what’s called “suicidal ideation” at 23.8%. Nearly 11% of high schoolers say they have attempted suicide.

“The data suggests that of the roughly 25,000 middle school students in Polk County, nearly 2,000 may have attempted suicide at least one time,” the report states. “If we spent as much time and money on mental health, social/emotional aspects as we did putting up gates, active shooter drills, panic buttons in each classroom, then we wouldn’t have this reactionary response. Prevention is key, not paperwork. (We) need teachers, guidance counselors, social workers working as a team.”

Treatment centers

Often, the first line of defense for people in crisis, if they are proactive, is to call Peace River Center’s 24-hour hotline (863-519-3744 or toll-free at 800-627-5906).

“Anybody can call that number and get to speak with a counselor for everything from information referral up to somebody who is actively suicidal and reaching out for help,” said Kirk Fasshauer, Peace River Center’s director of crisis response services mobile response team. “When that phone rings, we never know. The lobby is open 24 hours. You get folks to come in. Crisis counselors are here. The crisis doesn’t need to come to us, we can go to it – homes, emergency rooms, schools. We can go to the local Winn-Dixie parking lot.”

One of the major obstacles to getting help is accessing it. While Lakeland has a plethora of behavioral health care providers, other areas of the county might have one or, in the cases of Auburndale, Babson Park, Davenport, Fort Meade, Indian Lake Estates, Lake Alfred and Polk City, none at all.

“There is no question that there needs to be a coordinated way by which a community can identify, assess, support, engage, treat, and care for its members who suffer from mental illness,” the Polk Vision report states. “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.”

Polk Vision data from 2020 shows that in Polk County, the ratio of the population to mental health providers is 1,190 people to one mental health professional, and across the state that number is 670 to one. The national benchmark, meanwhile, is 310 to one.

The Polk Vision report lists 109 inpatient and outpatient treatment facilities, programs and counselors in Polk, Osceola, Hillsborough, Pasco, Orange, Hardee, and Highlands counties utilized by the Central Florida Behavioral Health Network.

The major facilities in Polk County are Lakeland Regional Health Medical Center, Baycare Winter Haven Hospital, AdventHealth Lake Wales, Central Florida Healthcare/Tri-County Behavioral Health, and Peace River Center.

For decades, Lakeland Regional Health Medical Center’s seventh floor has been known as the place where Baker Acted patients are housed for their 72-hour stay – or longer if a judge thinks they need to extend their treatment. But the need is so great that LRHMC opened up more beds on the ground floor in recent years.

This year, Polk County’s largest hospital broke ground on a $46 million, self-contained Behavioral Health Center that will include a state-of-the art design, with courtyards, gardens and artwork.

“The whole design of that new building is actually one of the treatment methods that we're going to be using for our patients, using that space to encourage them to be in groups, encouraging them to feel safe, help them rest, have quiet time, have active time to participate in treatments that are evidence-based,” said Lakeland Regional’s Nuttall. “People get better. We know people heal and get better and are able to sustain recovery.”

According to statistics provided by the medical examiner for the 10th judicial circuit, the area’s suicide rates are dropping. In 2019, 171 people living in Polk, Hardee or Highlands counties died by suicide. In 2020, that number fell to 118. By the end of September, the total was 76.

As for Waldon and Riley, both men are now being housed in a maximum security area of the Polk County Jail, labeled as dangerous inmates, as they await trial for the killings of which they are accused.

Riley’s attorney has indicated he is considering using an insanity defense in the homicides of the four family members Labor Day weekend.

Judd said both men will be held accountable.

“It’s important to underscore, just because you have mental health problems does not mean you’re not criminally liable,” Judd said. “But the reality is, this nation doesn’t do enough for those that are mentally ill ... there are millions that have mental health episodes that don’t do this, that are not mass murderers.”

Read the full series.

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

2022 The State of Mental Health in America

Overall ranking of mental illness prevalence and access to care

Florida ranks 28th, improving from 35th last year

Nevada is worst and Massachusetts is best.

Prevalence of mental illness:

Florida is 50, behind New Jersey. Oregon has the highest prevalence.

Access to care:

Florida is 49th

Adults with any mental illness who did not receive treatment:

Florida is tied for 2nd with Georgia, at 63.5 percent. Hawaii is worst at 67.1%

Adults with a substance use disorder in the past year:

Florida is last, at 5.98% of the population. The District of Columbia is highest, at 12.3%

Source: Mental Health America report

This article originally appeared on The Ledger: Florida’s mental health care system has ‘urgent problems,’ report says

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