Budget Cuts Hit Mentally Ill
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."
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.
That's partly because there aren't enough beds to keep them, even if doctors think they should stay. Between 2001 and 2005, while the state's population increased 9.4 percent, involuntary examinations in Florida jumped 35 percent. At the same time, the number of psychiatric beds decreased drastically: In 1998, there were 45.8 beds per 100,000 people; in 2006, that number dropped to 21.8. So patients such as Jeffrey wind up back on the street, with little or no follow-up care.
Leifman doesn't know Kathryn or the specifics of her case, but her son's story rings true. "She has been failed, but not necessarily by Citrus," he says. "She's been failed by a system that doesn't work. We don't have a mental health system."
Kathryn and Jeffrey Fernandez had difficult, troubled lives. Kathryn was 18 when Jeffrey was born; he had been conceived while she was underage. Jeffrey's father, she says, was a Hialeah Police officer who walked out shortly after she gave birth. Four years later, Kathryn wed Richard Mario Elejalde. The marriage lasted 11 unhappy years. Her husband eventually went to jail; they officially divorced in 1988.
For much of that time, Jeffrey wound up in the care of Kathryn's aunt as his mother struggled with drug addiction and mental illness, including bipolar disorder. "I've been diagnosed with all kinds of crap," Kathryn says. Over the years, she has been arrested a dozen times for nonviolent crimes including theft and drug possession.
Jeffrey, meanwhile, married at age 21, but quickly separated from his wife. He took the 2002 death of his grandmother, Kathryn's mom, particularly hard. When Kathryn's aunt, who had largely raised him, passed away less than a year later, he was devastated. He became depressed, Kathryn says, taking to alcohol and crack cocaine. He lost his job as a parking attendant and bookkeeper at Jackson Memorial Hospital.
In 2003, Jeffrey called his mom in a panic. He couldn't pay rent for his apartment in Overtown, he said. Kathryn moved in with him but found out he hadn't paid the rent for months. The pair became homeless.
"I was scared — I didn't know how to be homeless," she recalls. "But I wanted him to be okay, so I said, 'It's going to be okay.'" For a few weeks, they slept in Bicentennial Park and showered and ate meals at shelters. Jeffrey eventually heard about a job repairing the interiors of airplanes in Texas, and left town to take it.
Things seemed to be getting better. Kathryn found a room in a small house in Hialeah. Jeffrey, homesick, returned and moved in with her. He took a job working in a junkyard, and the two shared some semblance of stability. But he continued to use drugs. On September 9, 2006, police came to the house after Jeffrey struck his mother several times on the back of the head and right eye after she wouldn't give him money. Kathryn told police she had refused, knowing he wanted the money for drugs. Jeffrey was arrested for simple battery. The charge was eventually dropped.
Despite all the problems in Jeffrey's life, Kathryn was shocked when her son declared he felt suicidal. "He had never talked about suicide before," she says. When she called the police to have her son committed, she hoped it would mark a new chapter in his life, that he might finally kick his drug and alcohol habits. When he came back three days later, though, she was crestfallen.
"The psychiatrist told him: 'Just quit drinking and doing drugs, and you'll be okay,'" she claims.
"What can you do with someone in three days?" asks Judy Robinson, president of the Miami chapter of the National Alliance on Mental Illness, as well as the parent of a son with mental illness. She's heard stories like Kathryn's before. "If this young man was the type of person who has a drug problem, and he was not being adequately treated for both the addiction and the mental health problem, and he was not in a place that was secure long enough to begin to work with him, that is a problem," she says.
But while Robinson is sympathetic to Kathryn's plight, she says it's not necessarily fair to blame Citrus or any other hospital. "The whole system needs to be gutted," she says. "It doesn't meet the needs of this population. We keep doing band-aid fixes, and nothing happens.... The feds are threatening to cut mental health case work completely, and these people can't navigate the system on their own. They just can't."
The Florida House recently approved an $8 million pilot program to divert patients from hospitals to lower-cost community care programs. Leifman's task force pushed hard for the bill's passage, but it failed in the Senate owing to the budget shortfall. Still, Leifman is hopeful the bill will pass in the next legislative session.
Until then, the cuts continue. Just a few weeks ago, Kathryn Fernandez got a call from a Department of Children and Families therapist who had been coming to see her. "She said she had to close her cases," Kathryn says vaguely. "It had something to do with government money, I don't know what."
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