Mental Health Crisis Care at Risk in Current Senate Proposal
By Kevin B. Lewis, Marshall T. Bower, Esq., and Sheriff Mike Scott
During the current Florida legislative session a bill emerged in a Senate Committee that would re-shape how Florida funds mental health crisis services for citizens in need. These services are currently delivered in Crisis Stabilization Units (CSU). Florida now purchases these services on an “availability” basis – kind of like how we fund fire departments – when you need them you want them to be there. Services such as fire protection, law enforcement or crisis stabilization services are seen as essential public safety services.
The proposed changes (Senate Bill 1726) would take 25 percent of funding currently used to assure availability and allocate it to providers such as SalusCare, the David Lawrence Center in Collier County and Charlotte Behavioral Health. The remaining 75 percent of the funding would be available to be billed against by willing and qualified providers throughout Florida. Sounds good in principle – only paying for what is actually used makes sense.
Using the fire department analogy, Senate Bill 1726 would fund the fire department when there is a fire – after all, why pay for them to be ready “in case” there is a fire? Few would recommend that we fund fire or law enforcement services on an “as needed” basis, yet that’s what Senate Bill 1726 would do for crisis stabilization units. The problem is this method of funding key services would result in them not being available when needed, which would be a serious step back for Florida.
Florida’s historical state support for mental health services is worth noting. Florida ranks 48th out of 52 states and territories (includes Puerto Rico and Washington D.C.) at slightly less than $40 per person in annual state funding. The national average is three times that amount at $120 per capita funding. In fact, a 2013 report to the Florida legislature on this essential level of care (Crisis Stabilization Reimbursement Transition Plan, January, 2013) ended by stating that “…current funding levels for mental health services in Florida are insufficient to meet the needs of individuals in need ofthese services.” This same report recommended the state consider changes in how crisis services are funded, but what’s proposed in SB 1726 is much different than what this report proposed.
The proposed Senate Bill wouldn’t add any money to the system, but simply redistribute the existing resources and add layers of oversight and utilization management. Inadequate funding strategies like this will reduce actual services delivered.
We are concerned that, if this proposal is enacted, law enforcement will face situations with people who need crisis care for mental illnesses with no place to go – leaving them stuck in patrol cars or jails. Neither place is suitable to best meet their needs and provide for their safety. We are concerned that when Florida families face a crisis with a family member, they may find that there is no provider able to offer CSU care to stabilize their family member and develop a plan for recovery. The result may be the fragmentation of the fragile behavioral healthcare system that responds to more than 17,000 individuals and families in Lee County today.
Please contact our Senators and Representatives and advise them SB 1726 is a bad policy for Floridians. We want to see the services provided in our community improve and grow – and this proposal misses that target. When the alarm sounds, we want a responsive mental health crisis system for our community – not a system where we “hope” to be able to offer help.
Kevin B. Lewis is the president and chief executive officer of SalusCare, Inc., the region’s leading treatment resource for individuals with mental health and substance use disorders. Marshall T. Bower is chairman of the SalusCare Board of Directors. Mike Scott is Lee County sheriff.