Mental Health: Help can be found in hospitals and inpatient care centers

·20 min read
Brian Jacobsen, Crisis Counselor works at his desk at the Peace River Crisis Center on S. Lake Avenue in Lakeland, Fla., Tuesday March 24  2020. Peace River Crisis Center is offering a 24/7 mental health hotline open to individuals who are experiencing anxiety or fear about the COVID-19 crisis. It also has a crisis clinic that continue to be open for walk-in appointments.
Brian Jacobsen, Crisis Counselor works at his desk at the Peace River Crisis Center on S. Lake Avenue in Lakeland, Fla., Tuesday March 24 2020. Peace River Crisis Center is offering a 24/7 mental health hotline open to individuals who are experiencing anxiety or fear about the COVID-19 crisis. It also has a crisis clinic that continue to be open for walk-in appointments.

BARTOW – When the phone rings at the Peace River Center crisis hotline in Bartow, one of several operators answers the phones, ready for anything.

Their voices are often the first that people in crisis hear when they finally decide to ask for help.

“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, director of Peace River Center’s crisis response services. “When that phone rings, we never know.”

Fasshauer, 56, added that their lobby on Golfview Avenue is open 24 hours and takes walk-ins. In addition, they have a mobile unit that can go to people in crisis.

“The crisis doesn’t need to come to us, we can go to it,” said Fasshauer, who has worked in mental health care for 33 years. “Homes, emergency rooms, schools call. We can go to the local Winn-Dixie parking lot.”

Kirk Fasshauer, director of crisis response services and professional development at The Peace River Center in Bartow. 

Tuesday June 15 2021.  

ERNST PETERS/THE LEDGER
Kirk Fasshauer, director of crisis response services and professional development at The Peace River Center in Bartow. Tuesday June 15 2021. ERNST PETERS/THE LEDGER

Peace River Center is one of the main organizations in Polk County that provides mental health services to people in need, including nine inpatient and outpatient centers from Avon Park to Lake Wales and Lakeland.

Other service providers are Lakeland Regional Health Medical Center, Winter Haven Hospital-BayCare, Tri-County Human Services, and Advent Health’s Lake Wales Hospital. In addition, there are about 100 private practice centers in the Central Florida area.

Related: Mental health in Polk County and Florida: Read every story in our series

Unmet needs

Several recent analyses of health in Polk County – including the Polk County Community Health Assessment in 2020 – identified behavioral health (including mental health and substance use) as the leading health-related priority. But many people struggle to find or access to it , a report from Polk Vision states.

One of the top needs listed in the 2021 Polk Vision Report on Mental Health Care is to increase the number of care providers – particularly in Polk’s rural areas.

Certapet.com, a telehealth company, recently identified 10 of the top worst cities in the country for mental health care, based on factors like therapy session rates, prescription costs, mandatory treatment laws, criminalization of mental illness, the ratio of providers to residents, poor metal health days per county, and overall community well-being. While Dallas, Texas ranked the worst city in the country, Florida had four cities in the top 10:

  • Jacksonville – 3

  • Tampa – 5

  • Orlando – 6

  • Miami – 8

“In Florida, therapy costs $142 per session on average, which is higher than most of the states we analyzed. Furthermore, access to care is throttled by relatively few providers for the population,” certapet.com wrote in a September press release. “For example, Miami has only one mental health provider per 590 residents while Tampa only has one per 550 residents. This means care is both expensive and hard to secure compared to other states we analyzed.”

Polk County is substantially worse off than its larger neighbors. According to the Polk Vision report, 2020 data shows that in Polk County, the ratio of the population to mental health providers is 1,190 to 1, Florida is 670 to 1, and the national benchmark is 310 to 1. Lakeland Regional statistics show it is 1,400 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.

There are 109 listed care providers in the database of behavioral health service sites in Polk, Osceola, Orange, Hillsborough, Hernando and Pasco Counties to service about 720,000 Polk County residents. Lakeland has the highest amount by far, with 54 – half the total amount, something Polk Vision officials say impedes care in more rural parts of the county.

“The perceived concentration of providers around the greater Lakeland area (and subsequently fewer providers elsewhere in the county) creates a barrier to care for those living outside of Lakeland,” the Polk Vision report stated. “The large area of Polk County contributes to the difficulty of receiving care. The lack of providers has a domino effect such that inadequate numbers of providers lead to long wait times for initial visits, long wait times for follow-up visits and medication management services, and a more highly acute patient population – often requiring more services.”

The number of mental heath providers in Polk County is mainly concentrated in the Lakeland area, leaving the more rural areas vulnerable.
The number of mental heath providers in Polk County is mainly concentrated in the Lakeland area, leaving the more rural areas vulnerable.

Rural, poor areas need counselors

Auburndale, Lake Alfred, Polk City, Davenport, Frostproof, and Babson Park show no service providers for mental health care. Those areas have high concentrations of impoverished residents and it is difficult for Polk County’s poorest residents to get help because of affordability of services or transportation issues to get to an appointment, the Polk Vision report states.

The percentage of people in Polk County living in poverty is 12.5%

Haines City has the highest poverty rate in the county at 22.3%, but Polk Vision shows only two mental health providers in Haines City.

Transportation can be a huge issue for poor people trying to get to a doctor, especially if they are dependent on public buses.

“Many respondents indicated they needed to travel unreasonably long distances to receive care or found it very difficult to schedule doctor’s appointments around bus schedules,” the Polk Vision report states. “This could mean that someone can spend almost an entire day traveling to, attending and traveling from an appointment, with much of the time being spent waiting for the bus or other transportation. ... Someone may have an 11 a.m. appointment, but they get picked up at 8 a.m., so it’s all day.”

Hospitalizations

The Polk Vision report states that the age-adjusted hospitalizations for mental disorders per 100,000 people in Polk County was 976 – the same as Florida – or 7,033 people annually.

Of those 2020 inpatient behavioral health admissions:

  • 49% include psychoses as the primary diagnosis

  • 81% include psychoses, alcohol abuse and neuroses diagnoses

  • 25% include alcohol abuse and dependence diagnoses

  • 6% include a diagnosis of major depression

But the demand far outweighs the resources. According to Peace River Center, about 70% of people who need help don’t get it, either because they don’t know where to look or don’t have the resources to do so. In addition, sometimes people have to wait for a bed to open up in one of the area’s treatment centers:

  • Lakeland Regional has 68 inpatient beds.

  • Winter Haven Hospital-BayCare has 30 inpatient beds.

  • Lake Wales Hospital AdventHealth has 42 inpatient beds.

  • Peace River has 50 inpatient beds.

  • Tri-County Human Services has 137 residential beds and mainly deals with people with dual diagnoses of mental illness and substance use.

  • The Polk County Jail has 140 beds for mentally ill inmates.

Lakeland Regional Health

Lakeland Regional Health Medical Center's Behavioral Health floor expanded do a downstairs area in recent years as the need for mental health intervention has grown. Kimberly C. Moore/The Ledger
Lakeland Regional Health Medical Center's Behavioral Health floor expanded do a downstairs area in recent years as the need for mental health intervention has grown. Kimberly C. Moore/The Ledger

For decades, Lakeland Regional Health Medical Center’s seventh floor has long been known as the place where Baker Acted patients are housed for their 72-hour involuntary psychiatric evaluation. But the need became so great in recent years that LRHMC opened up more beds on the ground floor, bringing the total to 68 inpatient beds for adult and adolescent care for depression, anxiety disorders, substance abuse and memory disorders. LRHMC also serves as a Baker-Act receiving hospital. In 2019 alone, Lakeland Regional Health cared for more than 5,500 Baker Act cases.

The demand has outstripped the availability.

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, natural light, and artwork, all designed to provide a calm atmosphere.

“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 Alice Nuttall, LRHMC vice president of behavioral health services. She added that the space would help them get better by making it “lovely and nurturing and somewhere that you would want to go.”

New Lakeland Regional Health Center for Behavioural Health & Wellness under construction in Lakeland Fl. Tuesday November 16  2021.  ERNST PETERS/ THE LEDGER
New Lakeland Regional Health Center for Behavioural Health & Wellness under construction in Lakeland Fl. Tuesday November 16 2021. ERNST PETERS/ THE LEDGER

LRHMC’s new Center for Behavioral Health & Wellness will focus on multiple services:

  • Emergency stabilization

  • Adult inpatient care

  • Substance abuse disorders

  • Memory disorders

  • Child and adolescent inpatient services

  • Adult outpatient care

  • Child and adolescent outpatient care

  • Family behavioral health and wellness

  • Non-residential intensive behavioral health programs

“Our hope is that we can care for people across the gamut, so that we will continue to care for individuals that are very ill, schizophrenics, and dealing with things that could almost be law enforcement kind of issues,” said Nuttall, 42. “But at the same time, it would be a place that you would feel comfortable bringing your elderly mother or your neighbor who’s going through a really difficult divorce, or your young child who’s been dealing with bullying and can’t sleep or is having nightmares. We have designed it in such a way that all of those individuals will be able, with their dignity and their rights protected, to have safe productive care.”

An artist's rendering of Lakeland Regional Health Medical Center's new $46 million, stand-alone  behavioral health center. It is slated to open next year. Provided Photo
An artist's rendering of Lakeland Regional Health Medical Center's new $46 million, stand-alone behavioral health center. It is slated to open next year. Provided Photo

The need for care providers for juveniles has reached an acute level, said Nuttall. She said it is so urgent that, when beds fill up, juveniles are being placed in facilities in Tampa and Orlando.

“A lot of kids we’re having to transfer, transport an hour to 90 minutes away,” Nuttall said. “Peace River has some beds right down here in Lakeland and then we have beds, but when those beds fill up – and we’ve had that happen over and over – and we have that happen on a routine basis, there continue to be more needs.”

Florida has three beds for every 100,000 people in the population for juveniles suffering a mental health crisis. Polk County has one.

Nuttall said COVID-19 has exacerbated the situation, with more children needing more beds that are unavailable.

Nuttall said the overwhelming majority of their mental health patients were brought to them involuntarily and she would like to see that change.

“One of the things that we see here in Polk County is that the majority of patients are being cared for inside of inpatient psychiatric beds in the county – they are all Baker Acted by law enforcement,” Nuttall said. “Here at Lakeland Regional, approximately 90% of all the patients that we admit and serve have been a call to 911 or some type of intervention by law enforcement, and to me, what that says is that we’ve really dropped the ball in that there were multiple opportunities in that individual’s life for intervening, in caring for them, before it reached such a crisis.”

Alice Nuttall , Associate Vice President for Behavioural Health Services stands in the parking garage near the new Center For Behavioural Health and Wellness under construction in the background at Lakeland Regional Health in Lakeland Fl. Wednesday August 18 2021.  ERNST PETERS/ THE LEDGER
Alice Nuttall , Associate Vice President for Behavioural Health Services stands in the parking garage near the new Center For Behavioural Health and Wellness under construction in the background at Lakeland Regional Health in Lakeland Fl. Wednesday August 18 2021. ERNST PETERS/ THE LEDGER

She said for almost all people who’ve been Baker Acted, there had been signs of a brewing crisis for people who interacted with them at school, work, in the community, through social services, their primary care physician, and prior interactions with health professionals and, perhaps, law enforcement.

“There were either therapies, treatments, support, housing – all kinds of things – that if that person had had the opportunity to have access and appropriate resources ahead of time, it wouldn’t have risen to such a crisis where a commitment took place,” Nuttall said.

Tri-County Human Services

Tri-County Human Services has an abundance of inpatient, residential and outpatient services that aid people, with their main focus on people who have a dual diagnosis of mental illness and substance use.

The 2020 Polk Vision report stated that, of the 2020 inpatient behavioral health admissions, nearly half – 44% – had both a mental health and substance abuse diagnosis.

Tri-County’s 2020 Management Report shows it treated:

  • 380 people in multiple residential substance abuse programs

  • 888 people in several detoxification programs

  • 3,283 people in substance abuse outpatient programs

  • 2,681 people through mental health programs

  • 157 in Jail Alternative to Substance Abuse

  • 442 juveniles in substance abuse programs

  • 616 juveniles in mental health programs.

Based on admission diagnosis data, the most used substances were alcohol, methamphetamines and cannabis. The most common mental health diagnoses given at admission included major depressive disorder, bipolar disorders, and post-traumatic stress disorder.

“All of our beds are designated to dual diagnoses,” said Robert Rihn, CEO of Tri-County Human Services.

An Avon Park facility has 40 licensed beds to treat both mental illness and substance use. The Agape Center for Women in Lakeland has 15 beds, while New Beginnings for men – currently in Bartow – has 30 beds and New Beginnings for Woman along Lake Parker has seven beds.

Agape Center, known as The Res, is a step-down unit for five women.

“The folks are going to work in the community or going to a learning environment so they can step up and go to work and get themselves stable for re-entry into the community,” Rihn said.

Tri-County also runs The RAZU Center for Women, which has 15 beds and deals with things like postpartum depression.

Finally, Tri-County runs a detox facility just outside of Bartow that houses up to 20 people.

A 90-day follow-up survey of people served by Tri-County in 2020 showed that 92% of former clients had not been re-arrested, are currently abstaining from alcohol and other drugs, and are employed.

Peace River Center

Peace River Crisis Center on S. Lake Avenue in Lakeland is offering a 24/7 mental health hotline open to individuals who are experiencing anxiety or fear. Peace River also has a crisis clinic that continue to be open for walk-in appointments. Lakeland, Fl., Tuesday, March 24, 2020.
Peace River Crisis Center on S. Lake Avenue in Lakeland is offering a 24/7 mental health hotline open to individuals who are experiencing anxiety or fear. Peace River also has a crisis clinic that continue to be open for walk-in appointments. Lakeland, Fl., Tuesday, March 24, 2020.

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

Peace River Center offers mental health counseling, victim services – including a rape recovery, and a domestic violence center – and substance use disorder services throughout Polk, Highlands, and Hardee counties via multiple programs.

Peace River has a staff of more than 400, operating 36 programs out of 27 locations and provides 24/7 emergency psychiatric response services to the community. In fiscal year 2020, Peace River Center had contact with and provided services to more than 21,500 children, adolescents, adults and seniors.

PRC’s mobile crisis response team is a free, mental health and crisis outreach service “designed to provide immediate on-site crisis assessment and intervention by phone, mobile response, or walk-in at the Bartow or Lakeland Crisis Stabilization units.”

Fasshauer, who oversees the mobile crisis response team, said he had started out his life wanting to study computer science.

“What drew me to this was I was fascinated by how the brain works and its impacts on people’s behavior,” Fasshauer said.

He stepped into the program at Peace River as G. Pierce Wood Memorial Hospital was getting set to close, displacing dozens of mentally ill people into the community. That hospital’s closure, along with many others throughout the country, came as complaints of abuse and neglect were brought to light.

“Some were horrible, horrible places, but some seem to have been doing it right,” Fasshauer said. “You close down the good with the bad.”

The Crisis Stabilization Units are for those in immediate danger of suicide, self-harm or harm to others. The CSUs offer short-term, intensive, psychiatric stabilization, evaluation, and discharge planning services to people in need of emergency treatment. The secure units provide people who have been committed under a Baker Act –Florida’s mental health commitment law – with services including group counseling, medication management, recovery education, discharge planning, referrals, and family education.

Under a Baker Act, people are assessed and may be admitted voluntarily or involuntarily if they are a threat to themselves or others. They remain hospitalized until the mental health emergency is stabilized and continuing care referrals are made. The average length of stay is typically less than four days, although a judge can extend that.

The CSUs take people of all ages, but Peace River Center is the only CSU in Polk, Highlands and Hardee counties that takes children aged 10 years old and younger. The CSUs are open 24 hours a day, 365 days a year.

Persons with schizophrenia

Fasshauer said someone hearing voices could be suffering from schizophrenia – “that’s the MacDaddy of mental illness. I cannot think of a worse illness for a person to get.”

Fasshauer explained that a person with schizophrenia will go through their elementary and secondary schooling and go to college or out into the workforce when they suddenly start seeing things or people who aren’t really there and/or hearing voices.

“All of a sudden, your brain starts to fight you,” he said. “It’s a war (in which patients) fight to stay based in reality. You’re hearing voices screaming at you and sometimes seeing hallucinations. It’s sensory overlap – dementia when you’re young. They start to unravel the brain’s functioning, disconnecting, misfiring, a synaptic pruning process.”

Fasshauer said the brain, which doesn’t stop developing until people are in their mid-20s, will go into a hyperactive pruning process of synapses – a tiny pocket of space between two cells where the cells pass messages and communicate, according to the Dana Foundation. That communication is called neurotransmission and neuroscientists now understand that the synapse plays a critical role in a variety of cognitive processes – especially those involved with learning and memory.

Fasshauer said the hyperactive pruning process of a schizophrenic damages that communication process and can cause auditory and/or visual hallucinations.

“Think of pruning a bush – you do it, stand back, and it’s nice,” he said. “But if you overdo it, it can ruin the bush.”

Other Peace River programs

Peace River also offers adult and juvenile outpatient therapy and psychiatric services, including intake assessment, individual, family, and group counseling, and medication management.

For people who need a long-term place to stay while they get better, Peace River offers Success House, a 15-bed, unlocked group home where clients receive direct skills supervision and training, paraprofessional counseling, medication supervision and training, crisis intervention, interaction therapy, and socialization skills training. A referral is required.

Peace River Center Apartments provide a permanent place to stay for people with a mental illness.

Substance use treatment is also a major service provided by Peace River, including help for alcohol and drug-abusing adolescents and adults, as well as their families.

“Our program features an abstinence-based treatment program model that focuses on the development of healthy behaviors and lifestyle choices,” the Peace River website states. “Every person has exceptional individual strengths – our goal is to help identify and build upon those unique strengths.”

Fasshauer also oversees a new, innovative program providing mental health counselors at Polk County Sheriff’s Office substations.

“In the last year, it really took off – being with the sheriff office,” Fasshaeuer said. “We doubled the size of the program from 14 to 25 (counselors).”

In addition, Fasshauer helps to train law enforcement officers in Crisis Intervention, which teaches law enforcement officers how to deal with someone in a mental health meltdown.

“With people with mental illness, if you don’t understand that the person in front of you might be hearing seven different voices, they’re not going to respond and people get hurt, including law enforcement,” Fasshauer said.

Funding

Data collected by The Ledger show funding for mental health increasing at local, state and federal levels, but major problems remain.

Lakeland Regional Health Vice President of Development and Chief Public Relations and Communications Officer Timothy Boynton said they could not provide funding levels for treating the mentally ill because he said it is done throughout the hospital and not just in their treatment center.

“Lakeland Regional Health has estimated annual net losses in the millions for its Behavioral Health Service Line when factoring in direct costs and estimated indirect costs associated with its operation.”

Peace River’s budget for fiscal year 2021-2022 includes revenue of $30.3 million and expenditures of $29 million.

Last year’s revenue for Tri-County Human Services was $18.4 million.

The Polk County Jail budget is $63.3 million, including $9.7 million for all inmates’ medical expenses, including mental health help.

Data with the U.S. government show federal funding under the Substance Abuse and Mental Health Services Administration has increased nearly 169% in the last 10 years, from $3.6 billion to a requested $9.7 billion in fiscal year 2022. Funding held steady at $3.4 billion in the waning years of former President Barack Obama’s administration and increased each year up to $5.7 billion under former President Donald Trump’s administration. President Joe Biden’s administration has requested a 70% increase over his predecessor to $9.7 billion.

Funding for the federal Substance Abuse and Mental Health Services Administration

Requested in Fiscal Year 2021-22 $9.7 billion

  • 2020-21- $5.7 billion

  • 2019-20 - $5.8 billion

  • 2018-19 - $5.7 billion

  • 2017-18 - $5.6 billion

  • 2016-17 - $4.3 billion

  • 2015-16 - $3.4 billion

  • 2014-15 - $3.4 billion

  • 2013-14 – $3.4 billion

  • 2012-13 - $3.4 billion

  • 2011-12 - $3.6 billion

  • 2010-11 – $3.6 billion

According to the Substance Abuse and Mental health Services Administration figures, Florida spent $783.5 million on mental health in 2019, but is last in per capita spending at only $36.59. Maine spends $211, New York $315.48, and Alaska spends $292.92.

A document provided to The Ledger by the office of the Florida Senate president shows that funding has increased by the state Legislature:

  • Fiscal Year 2019-2020 - $834 million

  • Fiscal Year 2020-2021 - $$838 million

  • Fiscal Year 2021-2022 – $1.05 billion

The Polk County Jail is the largest mental health facility in the county, housing up to 140 mentally ill inmates, who’ve been arrested for everything from petit theft to murder.

Polk County Sheriff’s Office spokesman Scott Wilder said medical expenses for inmates, which includes mental health help, is $9.7 million.

“I would prefer that, one, they didn’t abuse drugs that creates this paranoia and this whole hallucinating and this committing crime,” Polk County Sheriff Grady Judd said. “There are those that are legitimately clinically significantly mentally ill. They have not been taken care of and they end up violating the law and they end up, when they come to jail, we give them mental health support. We put them in the Peace River Center or either bring services to the jail, depending on the circumstances. It’s the only time they get help.”

Judd said that even the mentally ill have to be held accountable when they break the law. He cited a case from overnight Thursday in which a suspect with multiple arrests on his record for burglaries, DUIs, drug possession and possession of drug paraphernalia, broke into a North Lakeland home and was shot by the homeowner. Judd said the man has been involuntarily committed several times.

“This guy’s been Baker Acted in the past but he’s been Baker Acted, I submit to you ... as a result of his drug addiction,” Judd said. “So because you abused drugs does not give you a free pass to violate the law.”

And Polk’s top law enforcement officer cites his frustration at laws that he thinks need to be changed and the closure of mental health facilities that once helped people.

“They dumped them from mental health hospitals into homeless camps into the county jail, and onto friends and family,” Judd said. “And what people don’t recognize, unless they’re dealing with somebody in this circumstance, a lot of them are not only reluctant to, but absolutely, unequivocally refuse their psychotropic drugs. And when you’re 18 years of age or older you have the right to deny medical, whether it’s mental health treatment or our medical physical treatment.”

Hope

Both Fasshauer and Nuttall want people to know there is hope.

“There’s no cure for any of the mental illnesses,” Fasshauer said. “But there is recovering and maintaining.”

Nuttall said she would rather people frame the question about the mentally ill in terms of what happened to that person, rather than what’s wrong with them.

“You know there’s something in their past that ... something that could have been done or they had some type of abuse,” Nuttall said. “One of the other pieces that I would love just for you to have in your mind is that people get better. We know people heal and get better and are able to sustain recovery.”

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: Help can be found in hospitals, inpatient care centers

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