Center for mentally ill arrestees proposed again
The Gainesville Sun - 9/16/2018
Sept. 16--In June, a third of Alachua County Jail inmates were getting psychotropic drugs for mental health disorders such as bipolar disorder, schizophrenia or borderline personality disorder. And those were just the inmates getting medicine.
It does not include inmates who are mentally ill but not taking medicine, inmates with personality disorders requiring mental health services, inmates who have a brain syndrome from alcohol or dementia, or inmates who require suicide precautions and follow-up mental health services.
That's a lot of people. It's costly for the county, which must pay for their care. It causes jail crowding. And most importantly, it locks up some people who need services but are jailed because law enforcement has no other place to take them.
So local government officials, advocates for mental health treatment, police and others joined to try to create a central receiving facility as an alternative to jail for mentally ill people who commit minor crimes. It also could be used for people with substance abuse issues, which can be linked to mental illness.
The effort ultimately fizzled, advocates said, because Gainesville's hospitals were not willing to contribute money or staff even though it would save them the cost of treating mentally ill people brought by police to their emergency rooms.
Now, discussions have started again thanks to the availability of a former state facility near the jail that is no longer being used. But that may fizzle too because a major participant -- Meridian Behavioral Health Care -- believes the receiving facility should be on its property.
Judy Broward, executive director of the Gainesville chapter of the National Alliance on Mental Illness, or NAMI, said a facility is needed regardless of where it is.
"A big part of the model is to have a place for police to take people besides jail and a crisis stabilization unit. There are not enough beds in CSU here -- that's part of the problem," Broward said. "Police have to take them somewhere and the jail is it. They don't want to take someone who has a mental illness to jail but they have no choice."
Law enforcement officers said encounters with people having some sort of mental health episode are a daily occurrence.
In some cases police are called to respond specifically to someone because of his or her mental illness. Other times, police respond to incidents and then discover the people have a mental health issue.
If police believe they are dangers to themselves or others, they can be involuntarily taken to a crisis center for evaluation under the Baker Act.
Some mentally ill people warrant incarceration for serious crimes. But others could be better served at a place to get connected with mental health options. Instead, they too often end up in jail as well.
"These calls for service come in multiple times a day, every day. It's happening all the time," said ASO Sgt. Brett Rhodenizer. "Many folks we see we already know on a first-name basis. We know those who are struggling. If we can de-escalate a situation, we will. But if it reaches a point where they are a threat to themselves or to others, or they have committed a crime, our discretion is limited and we have a duty to act to protect everyone at that point."
Central receiving facilities as an alternative to jail or a Baker Act are increasingly common nationwide. The Florida Legislature in 2016 allocated money to several communities that developed plans for facilities and came up with matching money from local government, nonprofits and hospitals.
Alachua County Commissioner Robert Hutchinson, a longtime advocate of a receiving center, said early discussions were promising with Meridian taking the lead.
Meridian already has a crisis stabilization unit, provides psychiatric services, drug rehab, group therapy and other programs.
Commitments for money came from the city and county along with Meridian. But Hutchinson and Broward said UF Health Shands Hospital and North Florida Regional Medical Center could not be convinced of the project.
"What didn't happen, and what really needs to happen, is that the two hospitals didn't step up," Hutchinson said. "There is an initial expense of getting it up and operating and then ongoing operational expense. Some of it is billable to Medicaid, which Shands can do. So how much of it is new money and how much would come from existing sources is hard to say."
Broward said the effort fell about $100,000 shy of what was needed to get the facility started. She said advocates could not convince the hospitals to participate.
"It almost came into being but getting the hospitals to understand that they would save money -- people with mental illness end up in their emergency rooms and lots of time don't have insurance -- didn't come about," Broward said.
NFRMC said in a statement that it supports programs for those with mental illness but did not address why it did not support a central system.
"While we didn't participate in funding a central receiving facility, North Florida Regional Medical Center is firmly committed to serving those in our community who have mental health needs," the statement said. "Over the past several years we have invested heavily in our areas of expertise by expanding our Partial Hospitalization Program as well as our Intensive Outpatient Program. We also have a psychiatric teaching program at our facility, this allows us to train future psychiatrists which will help address the growing demands for mental health services here in our community."
The Sun was unable to get comment from Shands specifically regarding a central facility.
Since 2016 the Legislature has not allocated more money but statutes with guidelines and requirements for central receiving facilities are on the books.
A revival of talks for a facility is now underway because of the availability of the Seguin Unit on Northeast 39th Avenue near the jail. Seguin was run by the Florida Agency for Persons with Disabilities to house people who were determined by a judge to be permanently mentally unfit to participate in their criminal trial.
Seguin was operated with the adjacent Tacachale Developmental Disabilities Center and was closed last year after Hurricane Irma. Tacachale Administrator Michael Mayfield said residents of Seguin are now in a secured site at Tacachale.
Under state rules for surplus property, colleges and universities get first dibs on acquiring vacant buildings.
So some advocates are hoping to reach agreement with UF to get the building and lease it for a nominal fee for a central receiving facility.
"The county sponsored a tour a month or so ago with a bunch of mental health professionals and we all looked at each other and said 'Central receiving facility,'" Hutchinson said. "It already has a sally port where cops can bring people in. It's got a place for a clinic, dorms, a kitchen. It's old and run down but it's right on the way to the jail."
But Meridian, which would operate the central system, is not a fan of Sequin.
Meridian President Maggie Labarta said it makes more sense to have the facility at Meridian on Southwest 13th Street and Williston Road. It already has a crisis stabilization unit, staffing for mental health and substance abuse, and other services.
The Seguin building would need a lot of renovation to turn it into a central facility, particularly with the addition of a crisis stabilization unit, which would boost the costs, Labarta added.
Meridian would be unable to staff a facility at Seguin if it provided only services below crisis stabilization, Labarta said. If the central facility was at Meridian, staff members who handle Baker Act cases could also see police drop-offs.
Meanwhile Meridian is beginning to plan for a facility, including expanding its crisis unit, should the legislature provide another round of money.
"We have decided to take a small leap of faith to get our facilities lined up to better accommodate it if they do (expand funding) and reconfigure our staffing," Labarta said. "Our agenda is to see if we can do it minimizing non-Meridian cash or in-kind local matches, which is often a real challenge."
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