If passed, the Florida Senate’s big-government “DCF Accountability Act” would mean a big step backward for mental health

by | Jan 27, 2020

Twelve years ago, Republican lawmakers in Florida championed an initiative to reduce the size of state government and make the state’s mental health and abuse services more effective and responsive to local needs. But this week, the Florida Senate is considering legislation that would reverse course and create a new office at the Department of Children and Families with a $13.5 million budget and would require over 100 new employees to operate.

The move would be a major step backward for the state, which has traveled this path before. Prior to 2008, Florida’s Department of Children and Families, the agency responsible for the welfare of hundreds of thousands of children and families across the state, had direct responsibility for contracting with hundreds of different mental health and substance abuse services to provide care.

Lawmakers at the time were concerned with wasteful spending and duplicative services, and proposed a decentralized system that pushed contracting authority to local communities who better understood their particular needs. Testimony from then-State Senator Ronda Storms, a Republican from the Tampa area, made the case for an improved, decentralized system to the Governmental Operations Committee:

“DCF must negotiate and monitor over 600 separate provider contracts with community agencies. At the community level, there is no single entity responsible for creating a single system of care from independently operated services. There are costly, duplicative, and regulatory functions being carried out because state purchasing and monitoring is not coordinated. It is expected that managing entities will increase the integration of substance abuse and mental health services for consumers with co-occuring disorders.” 

Storms’ testimony at the time carried the day, and the proposal ultimately became law. For the past 12 years, it has helped significantly reduce costs for taxpayers while improving the efficiency of substance abuse and mental health services across the state.

Florida currently has managing entities in place with a regional presence – seven in all – that currently run the program with thorough systems in place to assess providers and ensure that they meet criteria provided by both the Legislature and the Department with adequate accountability and reporting. When a program is not functioning the way it should, these managing entities can hold providers accountable and ensure that corrective action plans are quickly developed to get the programs back on track.

The “new” proposal, SB1326, known as the “DCF Accountability Act,” would do away with the regional system and would reverse course to bring Florida back to a system that was scrapped more than a decade earlier.

 

 

 

4 Comments

  1. Lonnie Mann

    I have to wonder if the author read the bill before publishing this article. Section 9 does not do away with Managing Entities but does give DCF the capacity to measure their performance, support performance improvements and as a last resort discontinue contracting. The notion that the State should just “put money on a stump” and go away is not a plan.

    Fact is, Florida’s state mental health system has been a long standing “straw man”. ripe for criticism by legislators. If you go down to the Florida archives and look at state hospital superintendents’ reports from the late 1800’s, they mostly consist 0f recitations of how cheaply they are run- an appeasement to the State Board of Institutions. This shameful tradition continues with Florida consistently having the lowest state per capita ependiture for mental health services. Even Alabama and Mississippi do better.

    Now, this may not cause anyone pain until it is your grandchild that needs help.

    Over the years the state has continuously cut mental health budgets to the muscle while attempting to compensate by legislating feel good reorganization schemes – District Mental Health Boards, DCF District Offices, Managing Entities and Blue Ribbon Commissions (that are summarily ignored by lawmakers).

    The fact is the Department has been givenDCF a Yugo, entered them with great expectations in the Gran Prix, and then expressed anger and astonishment at the outcome.

    What we learn from history is that we do not learn from history!

    Reply
  2. Brian Burgess

    Lonnie – thanks for the insightful comments, I don’t disagree that lawmakers are guilting of pursuing new reorganization schemes, my point is that this new one is just the latest flavor.

    Further, the article doesn’t state anywhere that managing entities would go away. It does, however, take exception to the idea that a new layer of bureaucrats, funded by $13.5 million in state funds, is a necessary expansion of state government.

    Surely we don’t need to add a new layer of bureaucracy – better to spend the money directly on those who need it than hiring more state workers, no?

    Reply
  3. Nancy Eisele

    You are spot on. The funding level for Mental Health and Substance Abuse services will not allow for a positive outcome in this state. Debating the organizational pattern for the SAMH office whether it is a DCF regional office or local Managing Entity, they just become the fall guy for the failure of a underfunded system.

    Reply
  4. Lonnie Mann

    Brian, thanks for your response. I am pleased that anyone who “buys ink by the barrel” or anyone else for that matter, is interested in public mental health.

    In the next to last paragraph of your article you say “Florida currently has managing entities in place with a regional presence.” Later you say “The “new” proposal, SB1326, known as the “DCF Accountability Act,” would do away with the regional system.” This certainly gives the impression that they are being done away with.

    Regardless, I certainly agree that entities closest to the people being served are most likely to make the best decisions about the array of evidence based and promising interventions that are needed and who can best provide them. So, decentralized is good, mostly. On the other hand, local entities can become entrenched and subject to parochial interests and non arms length transactions that ultimately short- change consumers.

    Measuring mental health services and entity performance is not widget counting. It is complex. But the presence of an overarching statewide accountability structure and system of metrics to compare managing entity performance is not wild and crazy. Most state agencies have this capacity. Measure twice and cut once. Shoot, there are probably as many people manning a Burger King as there are state level mental health evaluator positions at DCF.

    I don’t see setting off improved evaluation capacity against direct services outlay.

    That said, what would be so terrible if Florida’s per capita mental health outlay moved up five spots to 45th in the Country?

    Reply

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