Behavioral Health is the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Behavioral health is a fundamental part of the overall well-being of any individual, though it has been historically treated as a category separate from primary care. The result of this perspective on behavioral and mental health as “separate” from the “whole” person is most obvious in the manner in which providers are compensated for care. Thus, many health insurance programs, for example, do not include mental health coverage as part of the whole package. One of the obvious consequences to such a policy is that individuals who suffer from mental illness and/or substance abuse may not have ready access to health insurance and/or treatments which may be available to help them lead healthy lives.
Thus, lack of insurance and the prohibitive costs for treatment are two key barriers to care, though there is a host of other barriers faced by vulnerable populations, including lack of good transportation and childcare, lack of culturally competent and geographically accessible care, and a fragmentation of the mental health safety net. The stigma of living with a mental illness and/or substance abuse diagnosis is also a great barrier. All too often, mental illness has been stigmatized as a character flaw, rather than the serious disease it is. The result of this stigma is that many people withdraw from work and social activity and do not seek adequate treatment.
Miami-Dade County has the highest percentage of people living with mental illness of any other urban center of the United States. One in four inmates in Florida has a serious mental illness, according to a report by Partners in Crisis, a local coalition of advocates whose mission is to promote access to quality services, treatment, and support for children and adults who face the challenges of mental illness and/or substance abuse. In effect our jails have become, by default, the psychiatric hospitals because there aren’t enough resources available for the mentally ill in our communities. The result for Miami-Dade County has been that community mental health centers, hospitals and substance abuse and general health service providers have been fragmented and uncoordinated, making the system all the more difficult for patients and their families to navigate.
In spite of the difficulties, different groups are seeking out solutions and looking for ways to increase access to timely and quality care. Here are a few examples:
In 2005, Mayor Carlos Alvarez called a year-long Task Force devoted to Mental Health Care for Miami-Dade County. The Task Force began meeting in the fall of that year and will conclude in the fall of 2006 with both policy and programmatic recommendations stemming from the Grand Jury Report of 2004.
Partners in Crisis started the Criminal Mental Health Project, a program that includes collaboration between Crisis Intervention Teams who train police officers to handle calls involving those with mental illness. Notable progress has been made with new medications and treatment planning. When combined with some level of support or treatment, medications can stabilize people living with mental illness, allowing them to be productive in our society. Miami-Dade still, however, needs more funding to increase access to inpatient and outpatient treatment. Services for all must be available on demand in communities, not just in our jails and prisons.
The South Florida Mental Health Association works in strategizing and developing work plans to address the different issues that Miami-Dade faces through research, education and advocacy.
But, there is still road to travel. Indeed, by criminalizing mental illness, we do nothing to ensure care for people in need and instead further fragment an already exhausted system.