The crisis affecting Florida's mental health system is not new. The State of Florida has languished at the bottom of national ranked spending in the U.S. for decades, with most recent data suggesting a 49th position in per capita mental health services expenditure. In my view, a dubious distinction that is largely gratuitous. Florida is the fourth most populous state in the nation. It was named on Easter, 1513, by explorer Ponce De Leon. The name means, "Flowery Easter." Florida is rich in history, natural resources and a vibrant hub of an inter-mix of diversity, cultural and ethnic populations. We have much to be proud of in this state. So, why have policy makers chronically refused to adequately prioritize and fund its mental health system, and sufficiently address the overall health needs of its citizens?
As a former member of The President's New Freedom Commission on Mental Health, it is important to be fair. The nation's record on mental health care in the United States is not good. In its interim report, issued to the White House, Commission Chair, Michael F. Hogan, stated:
Our review for this interim report leads us to the united belief that America's mental health delivery system is in shambles. We have found that the system needs dramatic reform because it is incapable of efficiently delivering and financing effective treatments-such as medications, psychotherapies, and other services that have taken decades to develop." Further, "The efforts by of countless skilled and caring professionals are frustrated by the system's fragmentation. As a result, too many Americans suffer needless disability, and millions of dollars are spent unproductively, in a dysfunctional service system that cannot deliver the treatments that work so well.
It is critical to appreciate that mental healthcare needs are cross cutting and highly prevalent. According to the National Association of Mental Illness:
Numbers of Americans Affected by Mental Illness
Getting Mental Health Treatment in America
- One in four adults -- est. 61.5 million Americans-experience s mental illness in a given year.
- Approximately 20 percent of youth, ages 13 to 18 experiences mental disorders in a given year.
- About 9.2 million adults have co-occurring mental health and addiction disorders.
- Approximately 14.8 million people live with major depression.
- Approximately 42 million people live with anxiety disorders, including obsessive compulsive disorders and post-traumatic stress disorders.
- Approximately 20 percent of homeless adults in shelters live with serious mental illness and estimated 46 percent live with co-occurring mental health and addiction disorders.
- Approximately 20 percent of those incarcerated (jail and prison) have a "recent history" of a mental health condition.
- 70 percent of youths in juvenile justice systems have at least one mental health condition.
The Impact of Mental Illness in America
- Approximately 60 percent of adults and almost one-half of youth's ages 8 to 15 with a mental illness received no mental health services in the previous year.
- African Americans and Hispanic Americans used mental health services at half the rate of whites in the past year and Asian Americans at one-third the rate.
- One-half of all chronic mental illness begins by age 14; three quarters by age 24. Despite effective treatment, there are long delays (sometimes decades) between appearance of symptoms and when people seek help.
- Suicide is the 10th leading cause of death in the U.S. (More common than homicide) and 3rd leading cause of death for ages 15 to 24 years. More than 90 percent of those who commit suicide have one or more mental disorders.
- Veterans represent 20 percent of suicides nationally (22 suicides per day).
- Over 50 percent of students with mental health condition age 14 and older and served by special education drop out -- the highest rate of any disability group.
- Untreated mental illness costs over 100 billion dollars per year in the U.S.
So, where or what will be the tipping point for Florida? For Texas, I think it was pride. Texas began its sustained march to transform its state-wide mental health system long before the President's New Freedom Commission delivered its final report to the White House. One only needs to read the 2012 Guide to Understanding Mental Systems and Services in Texas, published by The Hogg Foundation for Mental Health, to appreciate its long and dedicated legacy to former Texas Governor James S. Hogg. Whose family established this foundation in 1940 the University of Texas, Austin, to promote mental health. An in depth 188 page guide that clearly applied the roadmap of recommendations by The President's Commission, evidences the foundation's dedication to create a robust, integrative, inclusive and comprehensive behavioral health system that is strategic and visionary.
It is true, that for many years, the State of Texas stood along with Florida at the bottom of the national rung in mental health spending. Yet, Texas lawmakers were united in their mission to prevent a mass shooting, like Sandy Hook. In addition, to create the capacity to respond to law enforcement demands for new community based behavioral health resources in relation to jail diversion goals. Based on above, the policy decision to prioritize behavioral health and invest in its statewide behavioral healthcare system was, according to media reports, energetically embraced. So, where is our pride Florida? It is time to lift the sunshine state out of crisis and create an authentic legacy of health and public safety for all Floridians?