1. Florida Politics

Lawmakers overhaul system to create 'no wrong door' to mental health treatment

An electronic billboard at the intersection of Park Avenue and North Magnolia Drive in Tallahassee during the legislative session in January pointed out the state's low ranking in mental health funding.

An electronic billboard at the intersection of Park Avenue and North Magnolia Drive in Tallahassee during the legislative session in January pointed out the state's low ranking in mental health funding.

Published Mar. 28, 2016

TALLAHASSEE — Something Judge Steve Leifman said in his Miami courtroom made the psychologist standing before him snap.

Those aren't my parents, the psychologist — who had been calm moments earlier — screamed, pointing out the man and the woman in the back of the room who had raised him, sent him off to Harvard and worked to find him the help he needed. My parents died in the Holocaust. Those people were sent by the CIA. They want to kill me.

It was clear that the man needed help, thought Leifman. But under state law, Leifman wasn't empowered to commit him to a facility where he could be treated for a mental illness.

"It was horrifying. This was a full-blown psychotic man," Liefman said. "I had no choice but to release him."

That was 16 years ago. Now, after a series of fits and starts, Florida is finally on the brink of a historic overhaul to mental health and substance abuse treatment that supporters say will better equip the criminal justice system to handle mental illness.

What's more, advocates say, the changes could help people receive treatment earlier, addressing problems before they become more severe and reducing the strain on the state's mental hospitals. Those facilities are in the spotlight after reports by the Tampa Bay Times and Sarasota Herald-Tribune exposed them as understaffed and not having enough resources to keep up with demand.

"Hopefully, what it will do is allow people to get services earlier on," said Linda McKinnon, president and CEO of the Central Florida Behavioral Health network and a 30-year veteran of mental health treatment. "The goal is for the front door to be much earlier than the equivalent of having a massive heart attack."

The goal is straightforward: a coordinated system of services for mental illness and substance abuse, so that no matter how someone enters the system, he or she gets the immediate help needed, as well as follow-up services in the future.

"There will be no wrong door," said Rep. Kathleen Peters, R-South Pasadena, one of the Legislature's foremost advocates for mental health reform.

To accomplish that, the Legislature passed bills requiring communities to work together, bringing to the table every group that has a role in mental health and substance abuse — health professionals, law enforcement, prisons and jails, juvenile justice agencies, courts and local charities.

The Legislature also expanded options for courts to divert the mentally ill toward treatment and voted to let psychiatric nurses prescribe certain medications, addressing a nationwide shortage of psychiatrists.

But overhauling the system could take a lot of work — and a lot more money.

At the heart of the changes are Florida's managing entities, which are nonprofits that oversee state contracts in each of seven regions of the state. Lawmakers tasked them to work with the counties in their areas to create a new system for evaluating people in need.

That means creating locations in every part of the state to determine what kind of services people need — a sort of mental health emergency room to serve those in crisis, whether they recognize it themselves, are involuntarily committed under the Baker or Marchman acts, or a police officer decides it's best to bring them there instead of jail.

Providers in some parts of the state, including Tampa Bay and South Florida, already collaborate, but the changes passed by lawmakers this year require providers to bring law enforcement and other government agencies on board.

As an example, supporters often note that Orange County has a "central receiving center" in downtown Orlando, where county law enforcement officers take people they believe are in need of treatment.

The center describes itself as a "single point of entry into the mental health and substance abuse system." That's the model lawmakers want to create across the state, tailored to the needs of each area. In a rural region, for example, a handful of smaller sites with transportation agreements may be more practical than the Orlando model.

"If you have a designated receiving facility, that is the one that law enforcement know to go to," said Rep. Gayle Harrell, R-Stuart, who worked for two years to pass the overhaul.

It's an idea law enforcement officers embrace as well.

Jails are too often home to people who should be in treatment, Pinellas County Sheriff Bob Gualtieri said. It's particularly problematic in Pinellas, which has no beds funded under Florida's Marchman Act, which is used to involuntarily commit people to substance abuse treatment.

"Law enforcement officers are the least equipped to really handle these problems, and they're the ones that handle them the most," Gualtieri said. "They need to be able to take these people someplace where you have professionals."

But for the program to work, police need to be trained to respond when people are experiencing a mental health or substance abuse crisis.

Peters tells the story of a Pinellas County woman who lashed out at police while she was having a psychotic episode. But the officers, one of whom was trained for such a situation, did not fire their weapons. Instead, they committed the woman under the Baker Act and she received help.

That's what Peters and Gualtieri want to see happen across the state.

"We'll have an absolute infrastructure that will work for every door," Peters said. "And we won't be using our jails and our prisons as mental hospitals."

However, advocates say the policy changes alone won't be enough.

"There needs to be some funding," Gualtieri said.

The Legislature responded this year with $3.8 million to pay for five additional teams to provide mobile services in some counties, including Pasco and Palm Beach, a stopgap measure while the broader reforms are put in place.

Sen. Rene Garcia, R-Hialeah, the health budget chairman for two years and co-sponsor of some of the changes, said lawmakers intend to bolster mental health spending in future budgets.

"The impact is just really making it easier for families to navigate the system," Garcia said. "Then, eventually we'll come back and put more money into the system."

The state's mental health services and substance abuse budget has increased from $943 million to $1.1 billion since Scott took office. This year's budget, Judge Leifman said, includes about $65 million in new spending on mental health and substance abuse.

"That's a lot of money for us," he said. "But is it enough? No."

Roughly half of the money spent by the state on mental health goes to the state mental hospitals, which are expensive and treat the relatively few cases that are most severe. Leifman hopes that changing the system will change that statistic too.

"It's going to make treatment more available, which means we're going to treat these illnesses over time," he said, "just like the illnesses they are."

Contact Michael Auslen at Follow @MichaelAuslen.

Correction: The state's mental health services and substance abuse budget has increased from $943 million to $1.1 billion since Gov. Rick Scott took office. An earlier version of this story incorrectly reported a decrease in the budget.


  1. Visitors head to Florida's Old Capitol building on Tuesday, the first day of the annual session. The same day, the advocacy group Equality Florida denounced four bills filed by Republican lawmakers, calling them “the most overtly anti-LGBTQ agenda from the Florida legislature in recent memory.” [SCOTT KEELER  |  Tampa Bay Times]
    Most of the bills try to eliminate local ordinances, and Republicans say they’ve been unfairly labeled.
  2. Attorney Joseph Bondy tweeted this photo of his client, Lev Parnas (right) with former Florida attorney general Pam Bondi on Friday, Jan. 17. Bondi on Friday was named on of President Donald Trump's impeachment lawyers. [Twitter]
    Parnas’ lawyer tweeted out the photo of the former Florida attorney general along with #TheyAllKnew.
  3. In this Feb. 22, 2018 file photo, Florida Attorney General Pam Bondi, speaks to reporters outside the West Wing in Washington. President Donald Trump's legal team will include Pam Bondi, the former Florida attorney general, former Harvard University law professor Alan Dershowitz and Ken Starr, the former independent counsel who led the Whitewater investigation into President Bill Clinton, according to a person familiar with the matter. (AP Photo/J. Scott Applewhite) [J. SCOTT APPLEWHITE  |  AP]
    The former Florida attorney general reportedly will join former Harvard University law professor Alan Dershowitz and Ken Starr, the independent counsel who investigated President Bill Clinton.
  4. Florida Senator Rob Bradley, R- Fleming Island, watches the action on the first day of the session, 1/14/2020.  [SCOTT KEELER  |  TAMPA BAY TIMES]
    A popular bill would allow judges to dole out punishments less than the mandatory minimum sentences spelled out in state law for many drug crimes if the defendant meets certain criteria.
  5. Vice President Mike Pence take selfies with supporters after giving a campaign speech during the "Keep America Great" rally at the Venetian Event Center at St. Mark the Evangelist Catholic Church in Tampa, Florida on Thursday, January 16, 2020.  [OCTAVIO JONES  |  Times]
    ‘Come November the American people are going to have our say,’ Pence said.
  6. Rep. Stan McClain, an Ocala Republican, presents a bill that would allow Florida public colleges and universities to sponsor charter schools, during a January 2020 meeting of the House PreK-12 Innovation subcommittee. [The Florida Channel]
    Alternative authorizers have been found unconstitutional in the past. But that isn’t stopping the effort.
  7. Florida Governor Ron DeSantis, members of the Florida Cabinet, left, and the Florida Supreme Court, right, stand at attention as the colors are posted in the Florida Senate during the first day of the Florida legislative session in Tallahassee, Tuesday, January 14, 2020.  [SCOTT KEELER  |  TAMPA BAY TIMES]
    The court ruled that Amendment 4‘s “all terms of sentence” include the payment of all court fees, fines and restitution.
  8. Thousands rallied and marched from the Donald L. Tucker Civic Center to the Florida Historic Capitol to demand more money for public schools Monday, Jan. 13, 2020. Thousands of school workers from around the state thronged Florida's Capitol on Monday to press Gov. Ron DeSantis and the Legislature to more than double the nearly $1 billion the governor is proposing for teacher raises and bonuses.  (Tori Lynn Schneider/Tallahassee Democrat via AP) [TORI LYNN SCHNEIDER  |  AP]
    The PreK-12 Appropriations subcommittee cutting exercise would come in nearly 25 percent below Gov. Ron DeSantis’ proposal.
  9. Democratic presidential candidate Sen. Bernie Sanders, I-Vt.,, center, speaks as fellow candidates businessman Tom Steyer, from left, Sen. Elizabeth Warren, D-Mass., former Vice President Joe Biden, former South Bend Mayor Pete Buttigieg and Sen. Amy Klobuchar, D-Minn. listen, Tuesday during a Democratic presidential primary debate hosted by CNN and the Des Moines Register in Des Moines, Iowa. (AP Photo/Patrick Semansky) [PATRICK SEMANSKY  |  AP]
    The candidates’ proposals reveal differences in how they plan to approach the issue.
  10. Vice President Mike Pence points to supporters before speaking during a campaign rally at the Huntington Center, Thursday, Jan. 9, 2020, in Toledo, Ohio. (AP Photo/Tony Dejak) [TONY DEJAK  |  AP]
    Vice President Mike Pence will take the stage in New Tampa, at the Venetian Event Center at St. Mark the Evangelist Catholic Church, at 1:30 p.m. It wasn’t planned that way.