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.