In the past several weeks
judges throughout Florida have brought public attention to the
problem of people in Florida with severe mental illnesses who sit in
our state jails. In fact, one Pinellas County Judge threatened to
hold the Secretary of Florida's Department of Children and Families
(DCF) in contempt if the agency did not provide a more appropriate
setting for this population. The Florida Psychiatric Society
appreciates that judges throughout the state are alerting our
citizens to the plight of these inmates. Jail is not a place to
treat persons with severe mental illnesses.
In the 19th century it
was not unusual to treat people with severe mental illnesses by
incarceration. Mental illness was not understood and jails were
often the only option to keep these patients off the streets. In
the 21st century we have much improved medical treatments and a
better societal recognition and acceptance of severe mental
illness. With this increased knowledge and recognition of severe
mental illness as a medical condition, continuing the trend of
incarceration within the confines of a jail is inexcusable. The cost
of caring for people with mental illness does not go away, it is
just being shifted from one part of the state budget to another.
Jails are a less effective and more expensive place of treating
people who have severe mental illnesses. Unfortunately services do
not exist for many patients in community settings. Under Florida's
current, broken system it often takes months of jumping through
bureaucratic hoops for patients to get appointments in community
mental health clinics. Many times before the patient can be seen
they are often back in a hospital or back in jail. Moreover, the
fact is that some patients require prolonged treatment in a safe,
humane, therapeutic residential setting.
Obviously the most
immediate cause of this problem is lack of state funding being spent
to treat persons who have severe mental illnesses. Last year the
State of Florida had increased revenues of over $7 billion. While
much of this surplus was used to fund the growth of state programs,
well over $1 billion was available for discretionary spending.
Ironically, during this fiscal bounty, the DCF budget was slashed by
$53 million. Another cause of this problem goes back more than 5
years when the state decided to close G. Pierce Wood Hospital and
further disrupt the continuum of care. It is no wonder that persons
who may have needed to be in a long-term care environment have found
their way to another type of institution – jail. Finally, perhaps
it is time to ensure that Florida manages the system of care for
people with severe mental illnesses under the aegis of a medical
public health model, under the direction of the Florida Department
of Health, rather than in the bureaucracy of the state’s child
welfare agency. At a minimum, the treatment and support needed to
improve the opportunity for recovery from severe mental illness will
be viewed as medical conditions deserving of physician care and
guidance.