Settlement Could Offer More Options For People With Mental Illness

The state Department of Children and Families has agreed to settle a lawsuit brought by Disability Rights Florida and move toward providing more options for people who are mentally ill to live in their communities instead of in state mental hospitals.

The advocacy group sued the department on the grounds that Florida was violating the Americans with Disabilities Act by not providing enough community placements for people who were ready to be discharged from mental hospitals overseen by DCF.

"We noted that there were individuals in there who were declared ready for discharge, yet they weren't being discharged because there was nowhere for them to go," Molly Paris, a Disability Rights Florida staff attorney, said. "The lawsuit was an effort to get the state to provide more resources in the community."

Paris said that in 2013, advocates noticed a pattern at Florida State Hospital in Chattahoochee, Northeast Florida Hospital in Macclenny, and the South Florida State Hospital in Pembroke Pines.

People would be discharged from the hospitals to the community, she said, and often were placed in assisted-living facilities, which Paris described as "like a mini-institution. …That's not really normalization. That's not like living in the community."

"They were kind of set up for failure," she said. "They weren't given a lot of support, a lot of services --- and then before you know it, they're back in the hospital."

The settlement came as Gov. Rick Scott calls for more coordination and better streamlining of the state's mental-health services. Last week Scott said he'll propose more than $19 million for mental-health and substance-abuse treatment in his recommended budget for the fiscal year that will start July 1 --- including $12.8 million for community behavioral health services that help people transition from state facilities to their communities.

Scott also signed executive orders in July and earlier this month creating pilot programs in Broward, Pinellas and Alachua counties to conduct inventories of all state programs that address mental-health needs.

Department of Children and Families spokeswoman Michelle Glady said the budget items were developed several months in advance of the settlement agreement.

The settlement requires the Department of Children and Families to ask the Legislature for funding for a pilot program that would make better use of what is known as the Florida Assertive Community Treatment program to serve more people with varying degrees of needs.

Currently, FACT teams provide intensive wraparound services --- counseling, case management, housing, medication and transportation. But not everyone who transitions from a mental hospital to community-based care continues to need all those services.

"A review of the FACT discharge data has shown that very few FACT participants ever leave the program as a result of increased stability and subsequent transition to a lower level of care," said the settlement agreement.

It also noted that the Department of Children and Families "hypothesizes (this) may be occurring because FACT participants who clinically and functionally are ready for lower levels of care may nonetheless not be transitioned because they risk losing their housing subsidy."

By the terms of the settlement, participants in the pilot program will receive vouchers allowing them to buy services and community supports, including rental assistance. The department will provide an assessment tool to determine the extent of their needs.

According to the department, the average cost per year of treating someone at a civil state mental health hospital is $103,437, while the average cost per year for FACT services in $12,540.

Currently there are 31 FACT teams across the state, each mandated to serve no more than 100 people. Each FACT team includes a psychiatrist, a peer specialist and a team leader, along with an independent advisory committee to help the team develop resources in its community.

Under the settlement agreement, Paris said, the pilot program will be launched in Duval and Hillsborough counties.

"None of this is going to happen overnight, but it's a start," she said.

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