BROOKSVILLE — A national advocacy group this year awarded a grade of D to the state of Florida for its care of the mentally ill.
The news is even worse in Hernando County, where involuntary commitments under the Baker Act, mental health hospitalizations, domestic violence incidents and suicide threats are all above state averages.
None of Hernando County's acute-care hospitals have psychiatric beds. Springbrook Hospital does, but the for-profit psychiatric facility has a high occupancy rate. BayCare Behavioral Health has just a handful of crisis stabilization beds, and they're in great demand.
Added to that, there is a shortage of psychiatrists.
"The situation for mental health care in this county is dire,'' said Judy Thompson, a board member for the local chapter of the National Alliance on Mental Illness.
It may get even worse as the county prepares to slice $75,000 from the fund that provides mental health services for the poor and uninsured through BayCare Behavioral Health.
The County Commission on Tuesday will continue budget discussions leading up to public hearings in September, and mental health funding is expected to be one of the topics.
Jean Rags, the county's health and human services director, sees the expenditure of mental health dollars on the front end as a way to avoid paying for more expensive services later.
"It's one of those little-bit-of-prevention things that saves us on our mandates,'' she said, referring to a state requirement to provide a quarter of the funding for all Baker Act cases.
"If we are not providing that (money for early mental health treatment), I feel very confident in saying that the number of people we'd be seeing in the Baker Act or in our jails would be higher,'' Rags said.
But there is a problem. The county is trying to deal with a $10 million revenue shortfall in its general fund for the budget year that begins Oct. 1. Rags was asked to cut nearly $1 million from the various departments she oversees. Discretionary money for social services is one of the few options for cuts.
It is a difficult position for Rags.
At a time when the economic downturn has shoved more residents into the position of needing assistance, social program providers are less able to meet those needs because of the budget cuts.
And not providing them might mean even more cost to taxpayers in the end.
The budget decisions that commissioners ultimately will have to make include other social services programs, on top of mental health. Also on the chopping block are funds for the county's portion of the Meals on Wheels program, health services and the Guardian ad Litem program.
"It's a very, very difficult balance, and that's what it goes back to,'' Rags said. "It goes back to government playing a role with many other resources, with many other partners.''
Mental health services
Just last week, Darlene Linville, the local NAMI chapter president, got a call from a woman with a psychiatric diagnosis who just moved to the area from out of state. She was horrified to learn that she could not get needed medications here.
She was worried for her own children.
After making phone calls to exhaust every possible solution, Linville said she suggested that the woman camp out in the lobby at BayCare until the staff could see her.
It's not the first time Linville has made that suggestion.
In the case of mental health services, the county is required to fund 25 percent of the cost for Baker Act cases, a tip of the iceberg when it comes to the community's mental health needs, NAMI officials say.
Under the state's Baker Act, a person can be held involuntarily for 72 hours of mental health examination if deemed a threat.
In the current year, Hernando County budgeted $191,526 for its share of Baker Act cases.
The total budgeted cost for services this year through BayCare Behavioral Health, formerly known as the Harbor Behavioral Health Care Institute, is $512,494.
The $320,968 difference is funding that is not mandated, but that the County Commission has historically provided. The money goes for mental health services for indigent and uninsured clients.
The $75,000 proposed reduction would come from that extra money the county has offered. It would amount to cutting off services for about 68 people.
Losing money that prevents some people from needing more expensive government services later makes little sense, Linville argues.
"We have to start taking money out of the back end of services like the jail,'' she said. "We have to take money out and put it in the front end of services, which is treatment and medication for everyone who needs it.''
Rags said she knows there is a risk that residents who need mental health treatment, but land on a long waiting list instead, may end up in hospital emergency rooms, the Health Department or the jail, but the county has to draw the line with what it can do with the resources it has.
"There is a domino effect to everything we do, but at what point do you just say we're going to pay for all of this?'' Rags said. "We can't — not and maintain lower taxes.''
Any day of the work week, someone might come through the front door of the county's Health and Human Services Department with what seems a simple issue, like not being able to pay the electric bill.
As Rags sees it, her job is to find solutions that will keep people in need from landing in a situation that requires the county to pay for more expensive services, such as an out-of-county hospital bill, a Baker Act referral, or, in the worst-case scenario, indigent burial costs.
That means her office staff must know where to go in the community to look for the resources that can help with an individual's situation and keep the person as self-sufficient as possible.
"We are not the first line of defense,'' she said. "We can't afford to be the first line of defense. Most importantly, there are other, more appropriate resources out there.''
Budgeting for the mandated programs comes down to looking at history and trying to project costs from one year to the next. In this year of budget cutting, Rags has had to budget at a rate that might not be enough to cover the bills.
If that turns out to be a reality, she said she would have to come back to the County Commission to seek additional funding.
"The board has to be aware that when the mandates increase, you have no choice,'' she said.
Other health services provided through the Hernando County Health Department have also been hit by the cuts, because a portion of the operation is funded through property taxes, and those revenues have fallen. This year, the Health Department received $1,152,861 in property tax revenue, but that will be cut by about $191,000 next year.
"They're the ones who are serving a huge portion of our under-insured and uninsured clients in Hernando County,'' Rags said, noting that qualified residents receive not just primary care from the department, but also specialty care, dental care and pharmacy services.
"There's a waiting list to get into the Health Department,'' she said.
If the wait is too long, people end up in emergency rooms or hospitals and ultimately can end up adding to the bottom line of the mandated services for which Hernando County must pay.
The Health Department is getting some federal stimulus money to help offset some of the loss. But Rags pointed out that there are always more needs than resources to meet them. That has been especially true in these trying economic times, when community resources such as faith-based organizations and other charities are strapped by a lack of donations.
"That domino effect just continues,'' Rags said. "There have been times when we tell people we can't help them.''
Meals at risk
One of the programs originally tapped for cuts may have dodged the budget ax this year. But officials who operate the largely state-funded Guardian ad Litem program are watching to see what the County Commission might do next.
The county funds one office manager for the program for $45,820, and the plan had been to eliminate the funding. At a recent meeting of the county's Budget and Finance Committee, however, County Administrator David Hamilton asked the committee to consider funding the program for another year. The program's administrator has promised to find new funding for the 2011 budget year.
The recommendation and the committee's support brought enthusiastic response from the Guardian ad Litem staff and volunteers in the audience who had come to beg that their program be spared.
The Hernando office operates with three case coordinators, one attorney and the office manager.
The majority of the work, which involves acting as guardians for abused and neglected children, is done by 112 volunteers.
The volunteers advocated for about 800 children last year. They visit with the children and go to their homes and schools to learn what they need to know to represent their interests in court, assistant director Teresa Ashcraft explained.
She said an office manager is critical to the operation because of the extensive files that must be kept as the guardians go about their tasks with each child.
"It's a massive amount of paperwork,'' she said.
And with this economic climate, she sees the need growing. As families get stressed, more children face abuse and neglect.
"Business is way too good for the Guardian ad Litem,'' Ashcraft said.
Proposed budget cuts will also have an impact on those at the other end of the age spectrum — elderly Hernando residents who are served Meals on Wheels through Mid-Florida Community Services.
Rags was forced to eliminate the county's contribution to the program, which this year amounted to $13,975. The program is largely funded by federal dollars, with some state money as well. The county's portion grew from an offer made several years ago when the County Commission voiced concern about the long waiting list.
Commissioners noted that residents in need who were leaving the hospital and needed meals only until they recuperated were often put on the long list and didn't become eligible until they didn't need the service anymore.
The county's funds were specifically used for that, according to Francine Ward, director of programs and operations for Mid-Florida, and assisted about 25 clients per quarter, Rags said.
Ward said the hope is that federal stimulus money coming into the agency will help offset some of the loss. But she also noted that the waiting list is long, and federal dollars won't fix that.
"You're losing ground all the time because more and more people need meals,'' she said. "So many people are in such critical, critical need. … It's always been hard, but it's really hard right now.''
Barbara Behrendt can be reached at firstname.lastname@example.org or (352) 848-1434.