Budget Cuts Hit Mentally Ill

As the state budget sinks, Florida's indigent mentally ill descend even further.

Kathryn Fernandez doesn't leave home much. She rents a tiny room in a tiny dilapidated Hialeah house overrun by cats and garbage. Her bedroom is somewhat cleaner but acrid with the smell of smoke. Half-empty packs of Broncos litter the floor, and the walls, which she painted pink a few years ago, have faded to a fleshy gray.

A few months ago, Kathryn managed to leave the house and headed downtown to file the necessary paperwork to change her last name from Elejalde — that of her former husband — to Fernandez, her maiden name, as well as the name of her son Jeffrey.

"I want to make sure they bury me next to my son," she told New Times over the phone that day. Her words came out like molasses from the bottom of a jar because of the Xanax, an anti-anxiety medication she was taking. "I'm just getting ready to be with him."

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Last October, Kathryn woke to find Jeffrey gone. The two had shared the room, sleeping on opposite sides of the mattress in the corner. She noticed his cross pendant, which she had given him, lying on the floor, and knew something was wrong. She made her way into the back yard, where she found Jeffrey dead, hanging from the mango tree. He had used a garden hose.

In the days that followed, Kathryn says, she attempted suicide herself — first in the same way as her son and then with pills. "I just did not want to live without my son," she explains. But since that morning, she's been able to get on with day-to-day life, albeit slowly. Meanwhile, at least some of her pain has turned into anger.

A week and a half before his death, Jeffrey had told his mother he was feeling suicidal. "We called the police," Kathryn recalls. Jeffrey was taken to the Citrus Mental Health Network in Hialeah and committed. He spent 72 hours there and was released. He took the bus home. Six days later, he was dead. Kathryn says Citrus failed her. (A representative of Cirtus did not respond to several voicemails left by New Times.)

"He came in on Saturday and they let him out on Monday," she says. "The psychiatrist told him that if he just quit doing drugs and drinking, he'd be fine. Well, six days later, I found my son hanging. I think that story needs to be told."

She's not the only one. Advocates for the mentally ill have clamored in recent years for a complete overhaul of the state's mental healthcare system, which they say is woefully inadequate. Last November, a mental health subcommittee of the Florida Supreme Court released a report lambasting the poor state of mental health treatment in Florida. The mentally ill, the report said, "are now forced to seek services from an inappropriate, fragmented, and unwelcoming system of community-based care." But despite such a dire assessment, recent budget cuts have hit the already-weak mental health system hard. A few weeks ago, the South Florida Evaluation and Treatment Center, a facility operated by the same company that runs Citrus, announced it would lay off 170 employees after the state legislature decided to cut off funding and close the facility.

"You have no idea," says Miami-based Associate Administrative Judge Steve Leifman, who chaired the group that issued the report. Leifman, an advisor to the Supreme Court on mental health issues, has become an outspoken advocate for reform. "The system's insane.... We ignore [the mentally ill] and push them under the rug, the insurance companies ignore them — but it's costing money, and it's costing lives."

From the early 19th Century to the middle of the 20th, mental health treatment meant hospitalization. Abuse was common, and care was enormously expensive. By the Fifties, when the first psychotropic drugs became available to treat mental illnesses, there was a movement to replace hospitals with community-based providers, allowing patients to live in their home communities again. In 1963, President Kennedy signed a $3 billion authorization to support such a transition — but after his assassination, the money was never appropriated.

Only half of the solution was ever implemented: Hospitals were emptied and shut down, but the broad, community-based care that was supposed to replace them never materialized. In its place is a flimsy patchwork of institutions, most of them chronically underfunded. The mentally ill often wind up imprisoned or homeless.

And while Florida is among the top states in spending money on jailed inmates with mental health problems — most of it geared toward restoring them to enough mental competency to face a judge — the National Association of State Mental Health Program Directors' Research Institute ranks Florida 48th nationally in spending on mental health for the general public.

The result, Leifman says, is a system that spends hundreds of millions of dollars on short-term care for inmates and emergency cases at the expense of long-term care for people getting by in daily life; crisis trumps prevention. One symptom of this is an increase in involuntary commitments under the Baker Act.

Passed in 1971, the Baker Act gave rights to people who were involuntarily committed to hospitals. But without funding for long-term treatment, some of those rights became potential flaws: today a patient committed involuntarily might be kept only 72 hours, unless a doctor petitions the state to commit the patient longer. Many patients who are involuntarily committed find themselves back on the street when their mandatory 72 hours are up.

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