Schizophrenia Daily News Blog

Mental Health Challenges in Florida

Excerpt from a report by the newspaper "The Ledger" (Lakeland, FL)

Facing Invisible Demons; Resources are few for many area poor with mental illnesses.

By: ROBIN WILLIAMS ADAMS The Ledger

Greg Popwell, an unemployed truck driver, was saved from a suicide attempt when someone at the motel where he was staying in East Polk County smelled gas and called for help.

''The depression got so bad, I isolated myself from the world,'' he said. ''I got to the point where depression froze me, made me physically unable to function.''

Winter Haven Hospital sent Popwell to the Peace River Center Crisis Stabilization Unit in Bartow, where he was monitored and treated by a psychiatrist. It gave him insight into the breakdown that led him to try suicide.

But after he was released, he encountered the hard reality of being poor and mentally ill.

The impact of mental illness ripples through Polk County, in strained family relationships, poor job performance, unemployment, school discipline issues, homelessness and people in crisis taken involuntarily to hospital emergency departments.

Local treatment programs provide help for thousands of residents. But advocates for the mentally ill are in agreement: Polk's public mental-health system, dependent on state money, is chronically underfunded.

What's missing goes beyond waiting for treatment. Far too many mentally ill residents can't get the housing, medication, job training, emotional support or transportation to programs that they need.

In ''Matters of the Mind,'' The Ledger will spend the next year examining the issues of mental illness and their impact on Polk County and Florida.

Some people who have mental illnesses agreed to let their full names be used.

However, others didn't, fearing they may be ostracized because of the stigma surrounding conditions such as bipolar disorder, depression and schizophrenia.

After Popwell was released, he had to wait a month before he saw a psychiatrist with Winter Haven Hospital Behavioral Health. Without income, he couldn't afford prescriptions to treat his depression, anxiety and insomnia.

But he was fortunate: He got his medications at a homeless shelter clinic in Lakeland.

On medication, he has found a job driving for a citrus plant, and can afford co-payments on prescriptions through the mental-health system.

''It's real hard for someone without insurance,'' he said. ''It's like a maze of agencies.''

Like Popwell, David has a mental illness and needs more help than he gets.

On a February night, at a private home in Lakeland, he asked a ministry healing group to pray for him. And he shared his frustrations.

''I've lost four jobs in the past six months because I was slow,'' said David, who bears a strong resemblance to George on television's ''Seinfeld.''

Trained as an accountant, but held back by severe depression, David had few options. He lived on the streets until he found a place at a group home.

But David can't stay at the group home indefinitely.

He doesn't know where he will go.

UNMET NEEDS

Peace River Center and Winter Haven Hospital Behavioral Health -- Polk's two community mental-health centers -- can't reach all who need assistance.

Popwell and David get help from them. Others in need don't.

The Florida Council for Community Mental Health estimates that, in Polk County alone, about 23,500 adults have severe mental illnesses. The Department of Children and Families puts the number higher -- 29,262 adults with serious mental illnesses.

And at least 5,000 of those would get treatment for their mental illness if they could, but haven't been able to.

Jails, homeless shelters, schools and families in Polk County often end up bearing the brunt of unmet needs.

Jails become dumping grounds for the mentally ill.

People live on the streets or in substandard housing.

Polk County children are hospitalized in Tampa, Orlando and other cities because local hospitals don't have children's psychiatric units.

Lack of money limits programs and threatens access to prescriptions.

''There are people living under bridges and people not getting services,'' said Neal Dwyer, mental health supervisor for the local District 14 DCF. ''We don't know who they all are.

''But, for the ones who are able to access the system,'' he said, ''we're able to provide some services.''

IN JAIL OR ON THE STREETS

Mental illness and substance abuse, which frequently go hand-in-hand, are primary reasons people become homeless. At least one-fourth of the homeless have some mental illness, according to DCF.

Other estimates put that number even higher -- between 35 percent and 50 percent, said Catherine Bussey, nurse practitioner at Good Samaritan Clinic at Talbot House Ministries, a Lakeland shelter for the homeless.

The Polk County Sheriff's Office, which operates the Polk County Jail, is a major provider of mental health services locally.

Nearly 1 in 5 inmates at the jail -- about 460, according to a recent count -- were being given psychotropic drugs to treat various forms of mental illness.

The Central County Jail has a Special Needs Unit, able to house 30 men and 16 women with mental illnesses.

''We take a lot of pride in what we do in the Special Needs Unit, but obviously, jails are not the best place for many of the mentally ill,'' said Derek Zimmerman, mental health liaison for the department.

A PLACE FOR CHILDREN?

One of the groups most in need is children.

Winter Haven Hospital closed its children's inpatient psychiatric unit more than five years ago. Lakeland Regional Medical Center, which treated teens, temporarily shut that unit this year.

The number of teens admitted to Lakeland Regional averaged only one every 21/2 days. That meant not having enough patients to make a separate unit feasible, hampering things such as group therapy.

If the four children's beds at the Crisis Stabilization Unit in Bartow are full, those who need that type of short-term stabilization are sent outside Polk.

Children aren't totally without assistance. There is outpatient counseling, in varying degrees of intensity, from both Winter Haven Behavioral Health and Peace River, along with other family support programs.

But countywide, about five children per day are likely to need inpatient treatment, said Dr. Sean Harvey, Lakeland Regional's medical director for mental health. These are the ones for whom outpatient treatment isn't enough.

The lack of inpatient children's psychiatric units hurts the insured and uninsured.

Mental-health providers say more local children's programs are essential.

MONEY TALKS

It's all about money.

Florida ranks 46th in per-person funding for mental health, according to a 2004 report by state mental health program directors.

That keeps mental-health care in Florida in a crisis mode, said Bob Sharpe, president of the Florida Council for Community Mental Health.

''If you don't invest in a variety of mental-health services, you end up spending in the wrong places at the wrong times,'' he said.

State money covers care for fewer than half of an estimated 37,000 to 40,000 adults and children with mental illness in DCF District 14, which is made up Polk, Highlands and Hardee counties.

DCF identified 22,853 people who are most in need in the district -- 11,227 adults with severe, persistent mental illnesses and 11,626 children with serious emotional disturbances.

Last year, 10,664 adults and 4,992 children in those counties got help through mental-health dollars allocated by DCF and Medicaid.

Not everyone with a mental illness needs state-funded care, since some have insurance. And national figures indicate, as many as two-thirds with serious mental illness won't seek help.

But DCF and mental-health providers agree more people need care in Polk County.

In fall 2003, the state identified Polk, Highlands and Hardee as areas with a shortage of mental-health services.

State officials encouraged Peace River Center and Winter Haven Hospital Behavioral Health to ''transform'' the system by adding more programs that enable people with mental illnesses to hold jobs and by helping direct their care.

But that's virtually impossible to do when state funding doesn't increase and demand does, local providers said.

''There has been an erosion of traditional outpatient services because of the emphasis on rehabilitation,'' said Behavioral Health Division Director Kathy Hayes.

Demand for psychiatric care keeps increasing, she said. Four weeks is a typical wait for a doctor's appointment.

Peace River and Winter Haven officials said they work to do the best job possible despite the constraints of state funding, growing need and high costs.

''The resources just aren't enough,'' said Cathy Hatch, executive director of the Polk County chapter of National Alliance for the Mentally Ill.

DIFFICULTY WITH DRUGS

Peace River and WHH Behavioral Health, fresh from fighting Medicaid changes that restricted access to some drugs, are now struggling to steer their clients through Medicare Part D, the drug plan.

Patients report being told the plan they're in won't cover their psychotropic medicines.

Medications are a crucial part of treatment for severe mental illness. And the results can be catastrophic for those who can't afford them or are unwilling to take them.

''Some of these folks who have been chronically mentally ill have taken years to find the right combination,'' DCF's Dwyer said.

If the drugs are working, people need to stay on them, said Risdon Slate, Florida Southern College criminology professor and department head.

''A psychiatrist may have an individual on 17 different medications,'' said Slate, who has bipolar disorder. ''Pull one out and the whole house of cards will just fall.''

Gov. Jeb Bush's proposed new budget includes $6.8 million for 84 new state hospital beds and $5.4 million more for increased hospital drug costs.

But overall it does little to improve funding for community mental health, said Ellen Piekalkiewicz, executive director of the Florida Substance Abuse and Mental Health Corp.

''In a time when we have additional state resources, it's very disappointing there was no investment in community-based services for mental health,'' she said. ''We have a mental-health crisis in the state.''

In addition to restricted dollars, Peace River and WHH Behavioral Health must conform to state dictates for spending them.

As an example, more than half of the people with lifetime mental disorders have a lifetime substance abuse problem, but funding for programs to treat those related problems is allocated separately.

Piekalkiewicz estimates $1,153 a year is spent per adult to treat severe mental illness in Polk. That's below the $1,225 per person DCF recommended seven years ago for counties like Polk, whose community mental-health services took a hit when G. Pierce Wood Hospital in Arcadia closed, she said.

The figures differ from those provided by the state. District 14 receives funding equivalent to $1,333.06 per person this year, which is $6.46 per person lower than a state benchmark of $1,139 per person, according to the Florida Council for Community Mental Health.

Dwyer said spending reaches $1,701 per adult with persistent, severe mental illness, the most severely ill who need more treatment. This includes the cost of state hospital beds, he said.

Despite the funding limits, new initiatives are under way.

Peace River recently added substance abuse outpatient treatment, with master's level clinicians, in a program that will address substance abuse and mental health diagnoses.

Winter Haven is getting a grant from Polk County indigent-tax dollars that will let it put mental-health workers at Central Florida Health Care in eastern Polk and at the Polk County Health Department's Auburndale unit.

Another new Peace River program, Club Success, reflects the current state and federal emphasis on rehabilitation. Club members have authority in running the clubhouse, from preparing meals to calculating bills.

The council, in which Polk's community mental health centers participate, wants legislators to use some of Florida's more than $3 billion unexpected tax revenue for crisis stabilization units and as seed money to help communities start jail diversion programs for the mentally ill.

Local advocates hope that lobbying effort and others succeed.

''There are positive things taking place,'' FSC's Slate said, ''but I don't think there are enough of them.''