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Backers Hope 'This Is The Year' For Mental Health Reform

Adrian Clark

The Florida House and Senate will reform the state's troubled mental-health system during the 2016 legislative session, predicts one of the lawmakers spearheading the effort.

"I think everyone understands that this is the year to get it done," said Senate Health and Human Services Appropriations Chairman Rene Garcia, a Hialeah Republican who during the 2015 session tried to pass a sweeping bill to streamline delivery of mental-health and substance-abuse treatment --- only to see the measure die at the tumultuous end of the session.

The bill would have required more coordinated care, especially for Floridians who use the system most. It also would have synchronized those services with primary health care, changed the bidding process for providers and sought more federal Medicaid funding.

Since then, Garcia and Rep. Jose Oliva, a Miami Lakes Republican who is in line to become House speaker in 2018, have been working on a new version of the bill. This week, they co-hosted the Mental Health and Substance Abuse Policy Summit in Miami with judges, doctors, providers, state officials and advocates taking part.

"(Last year) there was a lot of momentum to get something major done quickly," said Judge Steve Leifman, who is known for reforming mental-health services in Miami-Dade County's 11th Judicial Circuit and who spoke at the gathering.

After nine months of polishing the proposal, Leifman said there is "wide consensus among everybody that something major needs to be done. …We're getting very close to what that should be."

For instance, last session's proposal died after the House removed part of the Senate bill that would have merged what are known as the "Baker Act" and the "Marchman Act."

The Baker Act allows for involuntary examination or commitment if people are likely to have mental illnesses that pose harm to themselves or to others. The process must be initiated by judges, law enforcement officers, physicians or mental-health professionals.

The Marchman Act allows for the involuntary commitment of Floridians undergoing substance-abuse crises.

Leifman said the dual system often confuses families and law-enforcement officers trying to respond to a person in crisis.

"If you're having a psychotic episode, you're supposed to go to a crisis stabilization unit," he said. "But if you're having a drug-induced episode, you're not supposed to go to a crisis stabilization unit, you're supposed to go somewhere else. And there isn't a lot of somewhere else in the state to go. …There aren't that many, and it's hard for people to access them."

One idea being considered for the bill would create a "no wrong door" approach, such as a central receiving facility, where mental-health professionals would assess people in crisis to determine whether they're having psychotic episodes or drug-induced issues.

"And we want to align some of the legal structure, so that it's easier for people to access the court if the court needs to get involved to order treatment," Leifman said.

Leifman also supports proposals (HB 439/SB 604), sponsored by Rep. Charles McBurney, R-Jacksonville, and Sen. Miguel Diaz de la Portilla, R-Miami, that deal with mental health in the criminal justice system.

The bills would create treatment-based mental health courts and expand eligibility requirements for certain pretrial intervention programs. The proposals would also give county judges more authority to decide how to deal with people who have substance-abuse or mental-health issues.

House and Senate panels will hear the proposals for the first time Tuesday.

Even as lawmakers were working on the bills, the Tampa Bay Times and Sarasota Herald-Tribune began an investigative series on the state's mental health facilities, describing them as dangerous to patients and caregivers.

"Years of neglect and $100 million in budget cuts have turned them into treacherous warehouses where violence is out of control and patients can't get the care they need," the papers reported. "Since 2009, violent attacks at the state's six largest hospitals have doubled. Nearly 1,000 patients ordered to the hospitals for close supervision managed to injure themselves or someone else."

The question of money, in fact, hovers over all the discussion of mental health reform.

"You have a commitment from the House leaders," Garcia said. "You have a commitment from the Senate leaders. … I spoke with (Senate President) Andy Gardiner, and we're going to put extra dollars behind this --- as long as it's done in a responsible manner, I think we can get it done."

By "responsible manner," Garcia means getting the most results for the state's investment in treatment, both to save money and to keep Floridians out of jail and off the streets.

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