Community Care Not Crisis Care 2006 Annual Report

Transcription

1 Community Care Not Crisis Care 2006 Annual Report

2 Board of Directors Chair David L. Miller, Land O Lakes, President of the Senate Appointee Retired utilities company senior vice-president; former member, Boley Center s Board of Directors Vice Chair Joseph P. George, Jr., Miami, Speaker of the House Appointee Attorney, legal guardian Treasurer/ Secretary Rocky Rodríguez, Fort Lauderdale, Gubernatorial Appointee President, Broward County Alcohol and Drug Abuse Advisory Board Members Patricia M. Barton, Naples, Speaker of the House Appointee Founder, Florida Informed Parents; Founder, National Federation of Parents for Drug-Free Youth Christine Cauffield, Sarasota, Gubernatorial Appointee Licensed Clinical Psychologist; Former President & CEO of Coastal Behavioral Healthcare. Inc. Lisa Kane DeVitto, Tampa, President of the Senate Appointee Attorney, Board Member, Hillsborough Coalition for the Homeless; Past Chair, State Council on Homeless Larry D. Hart, Fort Myers, Speaker of the House Appointee Assistant Tax Collector, Lee County Marcia Mathes, Orlando Gubernatorial Appointee; Co-owner, Mathes Management Enterprises, Inc.; Chair, National Alliance on Mental Illness Florida Children s Committee Melanie G. May, Fort Lauderdale, Gubernatorial Appointee Judge, Fourth District Court of Appeal William Mellan, Lakeland, President of the Senate Appointee Professor of Psychology, Hillsborough Community College, Training Director, Law Enforcement Community Relations program; Formally chairman, Mental Health Care Inc. Ted Serbousek, Daytona Beach, President of the Senate Appointee Certified Public Accountant; Past Chairman and Current Member, Stewart Marchman Center; Board Member, Volusia/Flagler Coalition for the Homeless; Board Member, United Way of Volusia- Flagler, Inc.; Partner, Southeast Automotive Management, Inc.

3 Ex-Officio Members Ex Officio Members Christa Calamas, Secretary, Agency for Health Care Administration Robert Freidman, Acting Dean, Florida Mental Health Institute, University of South Florida Lucy Hadi, Secretary, Department of Children and Families Bob Janes, Commissioner, District 1, Lee County Clint Rayner, Consumer Advisor, Director of Consumer Affairs, Department of Children and Families Corporation Staff Ellen Piekalkiewicz, Executive Director Florida Statutes, The Substance Abuse and Mental Health Corporation shall direct efforts designed to improve interagency coordination of substance abuse and mental health services in order to ensure that these services promote recovery and resiliency-based systems of care. The Corporation shall provide oversight of the publicly funded substance abuse and mental health systems and make policy and resource recommendations that will promote system transformation by providing mechanisms for input from stakeholders, including primary consumers, family members, providers and advocates, concerning the management of the overall system, and that will improve the coordination, quality, and efficiency of the system. Lee F. Williams, Policy Assistant Acknowledgements The Corporation thanks the Cabinet Secretaries of the Department of Corrections, Children and Families and Department of Juvenile Justice, and their staff for working closely with the Corporation to improve the system of care for individuals with substance abuse disorders and mental illnesses.

4 Executive Summary A Human Life is a Terrible and Costly Thing to Waste! No one wants to be second best, yet Florida ranks 48th in the nation in per capita mental health funding. Over the last eight years, Florida has made great progress in funding substance abuse treatment, but a large treatment gap still remains. The cost of allowing the mentally ill and addicted members of our society to be incarcerated is far more expensive to State and local government than properly funding the front-end of the system by providing needed mental health and substance abuse treatment. We cannot build (jail and prison beds) our way out of the problem. The issue must be addressed head-on. The mentally ill and addicted members of our society have remained the stepchildren -- characteristically misunderstood and lacking the vital resources to restore themselves to Florida must make mental health, and continue to make substance abuse, a priority or suffer the consequences of massive incarceration of the mentally ill and addicted members of our society. productive members of our society. Sadly, many of them are among our most vulnerable our elders and our youth. The case for prioritizing mental health and substance abuse is clear -- it makes economic sense. We pay now for timely, quality care or pay later for more expensive treatment and probable incarceration. The so-called de-institutionalization of the mentally ill has resulted in massive homelessness and the re-institutionalization of the mentally ill in a prison system poorly equipped to handle this population. This is not just an issue for the State, it is a local issue both in costs and quality of life. In response to the growing crisis of jails and prisons overcrowded with the mentally ill and addicted members of our society, the Corporation convened a roundtable with legislators, the Secretaries of Corrections, Juvenile Justice, and Children and Families, county officials, judges, consumers, advocates, treatment professionals, and law enforcement. Recommendations ranged from diversion of non-violent offenders into treatment services to better transitioning for those either sentenced or committed due to their criminal activity. A Select Committee was established to develop more specific recommendations with an eye on short-term and long-range goals and the expansion of successful projects already implemented by innovative counties. (See Recommendation No. 5 on Criminal Justice). Substance abuse and mental health issues cannot be viewed in a vacuum. A large percentage of mental health consumers also have substance abuse issues co-occurring disorders. The structure of various executive agencies and funding streams prevent co-occurring disorders from being addressed in an effective way. (See Recommendation No. 2 on Co-occurring Disorders). Florida Substance Abuse and Mental Health Corporation

5 Housing, or the lack thereof, contributes to the plight of the members of our society with mental illness or substance abuse disorders. The housing gap is as significant as the treatment gap for these individuals. Existing funding mechanisms could be used to address this problem. (See Recommendation No. 4 on Housing). Florida is currently undertaking the transformation of its mental health system. Many counties, such as Miami-Dade, Alachua, Broward, Collier, Nassau, Lee, and Polk have already begun the process of addressing mental health in terms of recovery and resiliency. These local initiatives include consumer and family input and reliance on them to assist in the transformation. (See Recommendation No. 1 on Transformation). Medicaid, a major budgetary cost in Florida is in a transition period and experiencing the pains of change. The Corporation has highlighted significant areas to be addressed. (See Recommendation No. 3 on Medicaid). The State must follow these steps for effective change: The mission of the Florida Substance Abuse and Mental Health Corporation is to make recommendations to the Executive and Legislative branches on how best to address the public delivery of mental health and substance abuse services in Florida. Our goal is to make mental health and substance abuse treatment one of the top five priorities for state government. 1. Recognize mental health and substance abuse as a priority. 2. Re-direct the focus of spending to the front-end of the system (diversion, prevention and early intervention), it is less costly and avoids the more expensive incarceration option. 3. Take a holistic approach to mental health and substance abuse. This can be done by encouraging the involvement of all stakeholders in identifying problems and solutions and providing incentives that foster cooperation and innovation with the goal to alleviate the human suffering and societal costs associated with these illnesses. Solutions to these issues require leadership, strength, compassion and fiscal innovation. We have arrived at a time in our history that demands bold initiative and an immediate call to action. Meeting these demands will be our biggest challenge and our greatest victory Annual Report

6 Recommendation 1: Men Continue the ongoing transformation of Florida s publicly-funded mental health system to an individual and family-driven system focusing on prevention, recovery, and resiliency and embracing consumer and family involvement in policy-making, treatment planning, and delivery of care. Actions: 1. To insure the success of the transformation process, the State must develop and fund the certification of peer and family specialists so that the Department of Children and Families (DCF) and Medicaid can contractually fund these new community positions. 2. Support fair market pricing for the community mental health and substance abuse workforce to reduce the unacceptably high staff turnover and waiting lists for services. 3. Educate and train consumers, youth, family members, and mental health provider staff on personcentered and family-centered planning, a cornerstone for a transformed mental health system. 4. Implement recovery standards for the delivery of mental health services based on the Recovery Oriented Systems Indicator Measures (ROSI). 5. In order to shift the focus of system transformation to action in communities, continue and enhance senior-level staff support within DCF, and sustain the Office of Consumer and Family Affairs, the Transformation Working Group, and the Recovery and Resiliency Task Force. 6. Continue to make travel reimbursement available to consumers, youth, and families so that they can participate in the Transformation Working Group and Recovery and Resiliency Task Force. Mental Health Transformation depends on the energy of grassroots community efforts combined with consumer and family initiatives. 7. The Agency for Health Care Administration (AHCA), DCF, and managed care plans must continue ongoing communication and collaborative agreements to increase access of recovery and resiliency-based services. True transformation requires a fundamental change in core values and the creation of a new way of thinking. 8. Recovery and resiliency principles and services must be included in the state s Medicaid Plan for Community Mental Health and the Medicaid Handbook for Community Mental Health Services. 9. Medicaid Handbook revisions should include best practices for the provision of mental health treatment services, such as co-occurring treatment, tele-medicine, peer and family support specialists, alternative crisis interventions, self-directed care, and continuing Medicaid coverage for individuals residing in community-based residential treatment facilities. Florida Substance Abuse and Mental Health Corporation

7 tal Health Transformation Background The Corporation continues to chair the Transformation Working Group, which includes a cross-section of state agencies, consumer and family groups, providers and advocacy organizations. The group meets quarterly and serves as a sounding board for ideas and facilitates greater collaboration among stakeholders. The Corporation Board, its committees, and the Working Group have: Reviewed the Florida Mental Health Institute s study (Recovery-Oriented Medicaid Services for Adults with Severe Mental Illness) on the effect of Medicaid administrative service code changes on the delivery of services and consumer satisfaction. Facilitated collaboration among the Departments of Children and Families, Corrections, Juvenile Justice, Elder Affairs, Education and the Agency for Health Care Administration Helped align Medicaid and the mental health transformation effort. Advocated for behavioral health care to be given equal consideration in contracts under the Medicaid managed care plans. The success of Florida s transformed public mental health system will be evidenced by an increase in employed adults with mental illnesses living independently and children with severe emotional disturbances remaining at home and succeeding in school. Advocated for inclusion of consumer and family involvement in the revisions to the state Medicaid plan and for participation on the Mental Health Advisory Councils, Medicaid Advisory Councils, and other significant committees shaping mental health and healthcare policies and priorities. Advocated for consumer and family partnerships in all aspects of treatment and recovery. Mental Health Transformation depends on the energy of grassroots community efforts combined with consumer and family initiatives Annual Report

8 Recommendation 2: Provide integrated prevention and treatment services for individuals with co-occurring substance abuse and mental health disorders. Actions: 1. The Co-Occurring Disorders Work Group, staffed the Department of Children and Families (DCF) must evaluate the current system of delivery of services for co-occurring disorders and provide: a. Examples of best practice currently being implemented in Florida. b. Recommendations on how to expand these best practices throughout the state. c. Recommendations on the feasibility of an integrated system of care for Floridian s with co-occurring disorders. 2. The Governor s Office of Drug Control should convene a state agency task force on co-occurring to develop a strategic plan to integrate the provision of substance abuse and mental health prevention and treatment services across state agencies over the next three years. 3. By July 1, 2008, all state contracts should include requirements for co-occurring services. Contract language should be reviewed by the Office of Drug Control s task force by April 30, 2007 and made available to service providers by July The Legislature should include progress toward integration of treatment services for persons with co-occurring disorders as part of DCF s outcome measures for The Florida Substance Abuse Advisory Council should include strategies to address co-occurring disorders in the State Prevention Strategy and in recommendations to the Office of Drug Control. 6. The update of the Florida Drug Control Strategy, scheduled to be published in 2007, should include strategies to address co-occurring disorders. Background The State must make the integration of substance abuse and mental health prevention and treatment services a high priority. Even though the DCF administers the delivery of both substance abuse and mental health services, the integration of those services to those with co-occurring disorders has been slow. Categorical funding is a significant barrier to providing integrated care. DCF s efforts to address this issue have stalled and need to be revitalized. Treatment for co-occurring disorders must be a high priority for all involved in the substance abuse and mental health systems in Florida. Nationally, the recommended best practice is an integrated system that unifies appropriate components of the substance abuse 6 Florida Substance Abuse and Mental Health Corporation

9 Co-occurring disorders and mental health systems, particularly funding and programs. Today, Florida is not positioned to implement an integrated system; however, interim solutions will provide adults and youth with the best hope of recovery. In the short term, we must move from isolated examples of effective cooccurring services to statewide implementation. In the long term, integrated systems of care must be evaluated and more permanent solutions developed that will better meet the mental health and substance abuse treatment needs of Floridians. Integrated treatment leads to dual recovery and reduces costs. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), co-occurring disorders are common. Those consumers are at a higher risk for negative outcomes, including hospitalization, overdose, violence, legal problems, homelessness, victimization, HIV infection, and hepatitis. Providers, family members, administrators, and consumers have identified the issue of cooccurring disorders as a source of frustration, resulting in increased societal costs, and a profoundly negative impact on the consumer s quality of life. The national consensus four-quadrant model for categorizing co-occurring disorders can be used as a guide for services planning. Co-occurring Service Spectrum High Severity III Less severe mental disorder/more severe substance abuse disorder IV More severe mental disorder/more severe substance abuse disorder Low Severity I Less severe mental disorder/less severe substance abuse disorder Mental Illness II More severe mental disorder/less severe substance abuse disorder High Severity Adapted from Substance Abuse Treatment for Persons With Co-Occurring Disorders, TIP #42 (2005) 2006 Annual Report

10 Recommendation 3: Florida must pro-actively insure that managed behavioral health care integrates fragmented funding streams to improve clinical and financial outcomes. Actions: 1. The Department of Children and Families (DCF) must have significant input in the development of policies and procedures governing Medicaid funded behavioral healthcare. 2. Under Medicaid Reform, Specialty Health Plans must provide comprehensive and specialized recoverybased treatment and support services for people with Severe Mental Illness and Developmental Disabilities, including those designed for persons with addictive disorders and co-occurring disorders. 3. AHCA and DCF should continue to partner with the Corporation, consumers, families and providers to amend the Medicaid State Plan and revise the Medicaid Handbook and managed care contracts to reflect recovery and resiliency evidenced-based community services. 4. ACHA and DCF must increase their monitoring and oversight of behavioral managed health care including Medicaid Reform to ensure that individuals have appropriate access to needed treatment. 5. DCF and AHCA must continue to collaborate on the development and collection of mutually agreed performance measures for managed care, building on current agreements such as standard reporting formats and procedures for the functional assessment data, and the utilization of consumers to collect data for the evaluation of mental Health services in the Reform Areas, including enrollee satisfaction and days in the community. 6. AHCA must evaluate how the coordination among mental health treatment, primary care, and substance abuse treatment providers is being accomplished. Background The federal government requires states with Medicaid managed care programs implement certain standards and business practices regarding member rights and responsibilities, quality assessment and performance improvement, grievances and appeals, access and availability of services, practice guidelines, and utilization review. States are required to contract with an external quality review organization (EQRO) for an annual independent review of each managed care organization and prepaid inpatient health plan (MCO and PIHP) to evaluate the quality and timeliness of, and access to, health care services provided to Medicaid enrollees. Florida Substance Abuse and Mental Health Corporation

11 Medicaid With Medicaid Reform in Florida, interest peaked in data collection and new requirements were established across the state for both Pre-Paid Mental Health Plans and Health Maintenance Organizations (HMOs). As part of the new focus on data and quality review, the State entered into a contract with the health Services Administration Group (HSAG) in May Prior to that time, no External Quality Review Organization (EQRO) annually reviewed each MCO and PIHP to evaluate the quality and timeliness of, and access to, health care services provided to Medicaid enrollees. Managed behavioral health care with Pre-Paid Mental Health Plans has been in place for eight years and managed behavioral health care with HMOs for eighteen months. The Health Maintenance Organization (HMO) contracts for mental health care require the HMOs to submit encounter data and functional assessment data to AHCA. The HMOs will be required to administer functional assessments, and they are required to submit the data to the Agency for analysis and monitoring. AHCA reported that initially the data being submitted did require standardization due to providers using different templates. Through a series of meetings between AHCA and DCF, the two agencies were able to develop a standard reporting format and mutually agreed upon procedure for reporting functional assessment data. They also negotiated a methodology for including consumers in the Reform Evaluation process that is being conducted by the Florida Mental Health Institute, under subcontract with the University of Florida. Stakeholders have expressed concern that data is not being gathered or analyzed on a consistent basis. There are multiple systems collecting similar information, and major differences in the way data must be reported. Data systems cannot be fully utilized by policy-makers and providers because the reports are not produced in real-time and the data systems provide little or no connectivity to each other and users. The encounter data that the HMO s have been required to submit is reviewed by AHCA and AHCA has informed the Corporation that the data will be available to the stakeholders. AHCA also reports that it is continuing to work with the HMOs on the implementation of the data collection system as specified in the contract. Medicaid funds 60 percent of all publicly funded adult mental health services and 80 percent of all publicly funded mental health services for children Annual Report

12 Recommendation 4: The State should retain the full amount of dedicated documentary stamp tax revenues for use towards state and local housing programs, and assure that sufficient funding and policies are directed towards housing for persons with special needs and extremely low incomes. Actions: 1. The legislature should take steps to insure that the documentary stamp tax revenues are reserved for use in state and local housing programs. 2. The State should assure that individuals receiving treatment for mental illnesses and substance abuse have appropriate housing. Background Housing is not an isolated issue because it impacts healthcare and justice system costs. Frequently, individuals with special needs are trapped in institutions, in either the justice or healthcare systems, costing the state and our society an exorbitant amount of money. The lack of affordable housing prevents individuals with special needs from exiting facilities and living independently in the community. This decreases each individual s quality of life while increasing the State s healthcare expenses. Others with special needs lack any support system and face homelessness. On any given day in Florida, there are approximately 85,907 persons with no place to live, and 16,379 of these people, or 19 percent, have mental illnesses or substance abuse problems. Physical and mental illness, alcohol and substance abuse, are major contributors to the rise in homelessness in Florida, exacerbated by a lack of affordable housing for people with extremely low incomes. According to the National Center on Family Homelessness 1999, Institute for Children and Poverty the effect on children is devastating. For example, 47 percent have problems with anxiety and depression and/or withdrawal; only 77 percent attend school regularly and homeless children are two times more likely to repeat a grade compared to children with a home. Homelessness is costly; it demoralizes the individual and degrades the community. The financial cost of homelessness extends beyond outreach services and emergency shelters; it includes costs incurred by the criminal justice and health care systems: 10 Florida Substance Abuse and Mental Health Corporation

13 Housing According to a 2004 study of Duval County: The criminal justice system spent $5 million in one year arresting individuals that are homeless, primarily for trespassing, only to return them to homelessness upon release. The health care system spent $1.8 million in one year for crisis stabilization and detoxification services. Oftentimes patients return to homelessness after hours of care. These expenses do not include other aspects of the healthcare system, such as mental health services, emergency room care, hospitalization, and psychiatric hospitalization expenses. There is a documented lack of available housing in Florida for persons with low incomes or disabilities. The Department of Children and Families documents a shortage of housing for persons who are homeless as follows: 9,889 emergency shelter beds, 9,883 transitional housing beds, and 13,671 units of permanent supportive housing units. The total housing shortage is 33,443 beds or units; only 10 percent of the need or 3,183 units are under construction. The financial cost of homelessness extends beyond outreach services and emergency shelters; it includes costs incurred by the criminal justice and health care systems. 20.1% were homeless in year before arrest Percentage of Homelessness of Offenders State Prison Federal Prison Local Jail Mentally ill Other Mentally ill Other Mentally ill Other inmates Inmates inmates inmates inmates inmates Homeless In year before arrest 20.1% 8.8% 18.6% 3.2% 30.3% 17.3% At time of arrest Source: Bureau of Justice Statistics 2006 Annual Report 11

14 Recommendation 5: Crim The State must adequately fund community mental health and substance abuse treatment services to avoid more costly state-funded residential juvenile commitment and adult prison beds. Actions: 1. Establish a Criminal Justice Behavioral Health Matching Grant Program funded with recurring general revenue dollars to be awarded to counties to develop criminal justice community plans for creation and improvement of such program as crisis intervention teams, pre-arrest and post-arrest diversion programs or facilities, teen, drug, mental health and probation courts. Participating counties would match the state grants with local county funds. 2. Appropriate funding for the Department of Children and Families (DCF) forensic bed and diversion budget request, including expansion of secure forensic treatment bed capacity, forensic step-down bed capacity at state treatment facilities, funding for community residential treatment, and community outpatient mental health and substance abuse treatment for people living independently in the community while under conditional release. 3. Appropriate funding for comprehensive community service teams to provide outpatient mental health and substance abuse services, including medication, housing supports, and employment services, for county jail inmates and persons with serious mental illnesses and co-occurring disorders who are at risk of incarceration. 4. Restore $7.9 million in Department of Juvenile Justice (DJJ) prevention funding to the, which was cut during the 2000 Legislature and the December 2001 Special Session. 5. Appropriate $17 million in the DJJ budget for mental health overlay services for residential facilities, of which $11 million would provide overlay services for 940 secure beds and 470 non-secure beds. The request would provide $35 per day for mental health services in addition to the per diem now received by the facilities. It is recommended that DJJ explore maximization of federal Medicaid dollars for these overlay services. 6. Increase funding for substance abuse services by funding a yearly increase of $25 million in general revenue as recommended by the Florida Office of Drug Control Advisory Council. This investment would begin addressing the substantial treatment gap in substance abuse treatment services. Based on an average treatment episode of $3,000 per person, an estimate which DCF uses, this amount would provide services to an additional 8,300 adults and children. 7. Appropriate $5.4 million for Children s Community Action Teams. Children s Community Action Teams (CAT Teams) are designed to target children who have a serious emotional disturbance and who have current or previous involvement with a DJJ prevention program, multiple crisis unit admission, or are at high risk of placement in a residential treatment or juvenile justice facility. (The total amount is based on approximately serving 600 children at $9,000 per child.) 12 Florida Substance Abuse and Mental Health Corporation

15 inal Justice/Juvenile Justice 8. Appropriate $8.5 million for substance abuse services to replace federal dollars and expand capacity in the Department of Corrections (DOC). Of the total, $4 million would increase in-prison treatment capacity by 631 treatment slots/beds; $1.4 million would replace federal grants dollars for 89 contracted residential substance abuse beds; and $3.1 million is for price level increases maintain 1,896 for residential substance abuse beds. 9. Support legislation to enact a pilot substance abuse re-entry program in DOC, which would require supervision of eligible inmates re-entering the community by drug courts. There would be a fiscal note attached to this bill, as there is no capacity in aftercare to serve these individuals. 10. Establish a dedicated funding stream for drug courts by establishing a local option to increase court fees. Prisons, jails and juvenile justice detention centers are being used as inadequate substitutes for treatment due to the lack of resources for both mental health and substance abuse treatment services. This practice is not only inhumane it is costly. 11. Encourage the Florida Supreme Court s subcommittee on mental health to consider requesting legislation for a mental health re-entry program and a dedicated funding stream for mental health courts. 12. Encourage DOC to work with communities to establish mental health probation officers who would specialize in mental health cases and have reduced caseloads. 13. The DCF and DOC should establish policies that prevent the discharge of adults with mental illnesses from state hospitals and prisons to homeless shelters. 14. Expand Memphis model Crisis Intervention Team (CIT) training in all communities and advance the use of Memphis model crisis intervention team core competencies for all law enforcement officers. 15. The DOC should review and revise the process by which inmates access Social Security benefits upon release to allow for better transitioning into the community from in-custody status. 16. The Legislature should require the DJJ to provide more useful outcome measures related to mental health and substance abuse; such as the efficacy of services provided, percentages of youth receiving services, school success and rates of recidivism for those receiving services compared to other populations within the system. 17. The DJJ and DCF need to revise their Memorandum of Agreement to identify strategies to determine Medicaid eligibility for youths prior to release from DJJ facilities. Continued Annual Report 13

16 Recommendation The Agency for Health Care Administration (AHCA), DCF, and DJJ should work together to identify and target children in the juvenile justice system who are not Medicaid eligible upon entry to make sure they are connected with Kid Care, Children s Mental Health General Revenue or private insurance upon re-entering the community. 19. AHCA, DJJ and DCF should determine if it is possible to expand the Family of One definition to children returning to the community under the current Medicaid State plan. 20. Amend s (6), to include, within the Social Services Estimating Conference, the official forecasts of admissions to civil and forensic mental health treatment beds and juvenile justice treatment capacity and determine the capacity needs for state planning and budgeting. Background Florida, like other states, has a growing number of adults and youth with mental illnesses housed in local jails, state prisons, and juvenile justice facilities. The numbers and the severity of the mental health and substance abuse problems have raised growing concern among policy-makers, advocates, and front-line criminal justice professionals. Prisons, jails and juvenile justice detention centers are The DJJ has acknowledged that juveniles requiring placement in specialized treatment facilities must wait longer than a month. being used as inadequate substitutes for treatment due to the lack of resources for both mental health and substance abuse treatment services. This practice is not only inhumane it is costly. The jail and prison populations are growing at a pace in Florida that exceeds available funding in county and state budgets for jail and prison beds. Despite a dramatic increase in spending on corrections both for juveniles and adults, rates of failure among youth and adults released from prison and jail, especially those with mental illnesses, remain unacceptably high. As a result, we continue to jeopardize public safety, and suffer from an un acceptably cycle of recidivism. The Juvenile Advocacy Project of Palm Beach completed a report in September, recommending ways to improve the mental health and substance abuse services in DJJ facilities. In November 2006 a juvenile court judge gave DJJ 10 days to detail the steps it is taking to provide mental health and substance abuse assistance to children in DJJ custody. The Department was also given until December 2006 to write a response to the Juvenile Advocacy Project report. The Corporation is encouraging dialogue among individuals, advocates, and agencies to find a better way of handling the criminal justice population with substance abuse and mental health treatment needs - one that would address the crisis through collaborative approaches involving both the criminal justice and the publicly-funded mental health and substance abuse treatment delivery systems. 14 Florida Substance Abuse and Mental Health Corporation

17 (Continued) Defining the Problem: Approximately 170,000 adults with serious and persistent mental illnesses and over 40,000 children with serious emotional disturbances have no access to public mental health treatment who need it (DCF) Approximately 780,000 adults with serious substance abuse treatment needs and over 250,000 children have no access to public substance abuse treatment who need it (DCF) An average of 1600 adults and children are on waiting lists for various substance abuse treatment services funded by DCF each month (DCF). 49% of all youth in Florida s juvenile justice commitment programs have been diagnosed with mental illnesses (Department of Juvenile Justice, DJJ) 35% of all youth in Florida s juvenile justice commitment programs have been diagnosed with substance-related disorders (DJJ) Up to 17% or 14,345 of Florida s state prison inmates have a serious mental illness (Department of Corrections, DOC) 13% or 11,130 inmates with serious and persistent mental illness were identified in 2005 as needing aftercare services (DOC). Florida s local jails have become the largest public psychiatric hospitals, housing over 10,000 offenders with mental illnesses, many of whom are low level offenders (National Alliance on Mental Illness, NAMI) Growing Release of Offenders Florida Department of Corrections Last year, the Department released more than 31,500 inmates back into their communities / / / / / / / / / / /05 Source: Dept. of Corrections Prison Releases 2006 Annual Report 15

18 Recommendation 5 (Continued) In-Prison Substance Abuse Treatment Statistics - Inmates Released FY Number of inmates needing and did not receive treatment, that were released to community supervision Statistics compiled by the Bureau of Research & Data Analysis Florida Department of Corrections Of the 5,401 who needed but did not receive treatment in prison, but were released to community supervision requiring psychiatric services and psychotropic medication. (14%) 765 Community Corrections Gaps: Services vs. Need Need 76% (109,773) -On 6/30/05, there were 144,229 offenders on active supervision. -Approximately 76% (109,773) of all offenders on active supervision are in need of substance abuse treatment. Statistics compiled by the Bureau of Research & Data Analysis, Florida Department of Corrections 16 Florida Substance Abuse and Mental Health Corporation

19 Department of Children and Families Mental Health Funding $26,098,541, 3% DCF Mental Health Appropriations FY By Category $25,280,746, 3% $291,414,200, 39% Program Management and Compliance Adult Community Mental Health Children's Mental Health $310,116,707, 42% Source: DCF $99,032,290, 13% Mental Health Treatment Facilities Sexually Violent Predator Program Mental Health Funding History from FY to FY $350,000,000 $300,000,000 $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $0 Source: DCF Adult Mental Health Services Children's Mental Health Services 2006 Annual Report 17

20 Department of Children an Adult Mental Health Treatment Gap Adults Not Served Adults Served 52% 167,982 48% 151,986 Source: DCF Child Mental Health Treatment Gap (0-17 years) Treatment Gap Children Served 32% 41,163 Source: DCF 68% 85,613 These numbers do not include adults and children served or not 18 Florida Substance Abuse and Mental Health Corporation

21 d Families Treatment Gaps Adult Substance Abuse Treatment Gap 13% Treatment Gap 112,449 Adult Served by DCF Source: DCF 87% 758,603 Child Substance Abuse Treatment Gap Treatment Gap 22% 76,064 Children Served by DCF Source: DCF 78% 277,095 served by other systems such as the criminal justice system Annual Report 19

22 Mental Health Transformation calls for a different set of values an entirely new way of thinking and a better way of providing services to consumers and families. Transformation calls for fundamental change at the very core of a system not on the margins. It leads to new behaviors and new competencies. Thus, in transformation, we are able to do things we were unable to do before. A. Kathryn Power, Director, Center for Mental Health Services, Substance Abuse and Mental Health Services and Administration, U.S. Department of Health and Human Services

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24 Florida Substance Abuse and Mental Health Corporation 1317 Winewood Blvd. Building 1, Suite 206 Tallahassee, FL (850)