Commissioners to consider new approach to addressing mental health crises
And is a special mental health tax district the best way to pay for it?
When, on March 23, Sarasota County Commissioners resume their consideration of a special mental health tax district, they will have a new option on the table for how the funds it could raise might be spent.
This week, former Sarasota County Sheriff Tom Knight – now the president and CEO of First Step, Sarasota’s behavioral health and addiction facility – released a report urging expansion of a pilot program initiated last October to address the problem of law enforcement and first responders managing people in severe mental health crises.
The pilot, funded in part by the Gulf Coast Community Foundation, created a “behavioral health response team” (BHRT) of trained mental health counselors to respond to emergency situations within 60 minutes, 24 hours a day and seven days a week.
The death last August of a 63-year-old mentally ill woman, who was shot and killed by a Sarasota County Sheriff’s Office deputy after her family called 911 for assistance, was “the one that put me over the top,” Knight said, prompting him not only to vie for the position at First Step, but to make one of his first priorities facilitation of an alternative for families who need immediate help for a loved one in crisis.
The BHRT has also begun working proactively by identifying individuals who have been frequently been Baker Acted (involuntarily taken into custody for a psychiatric assessment) in the past and contacting their families to develop a “safety plan.” Through Sarasota County Schools’ Student Assistance Program, similar support has been offered to at-risk students and their families, which Knight says has played a role in a major reduction in student Baker Acts this academic year.
“It’s where we need to go – toward prevention and intervention rather than reaction,” said Knight, who accepted the position with First Step in November after declining to pursue a fourth term as sheriff.
During the first four months of the pilot program, the BHRT handled 80 calls, diverting 86 percent of those in crisis from hospitals, jails or involuntary psychiatric admissions. The just-released report proposes an expansion of the team from 6.5 to 8 full-time employees at an annual cost of just under $1 million (offset, in part, by $291,000 the state has committed for a “mobile response team”).
The proposal also envisions adding, at a future date, a regional crisis call center, one of the three core elements – along with mobile response team and crisis stabilization center -- of a comprehensive crisis system as defined by the federal government’s Substance Abuse and Mental Health Service Administration (SAMHSA).
Although he is not opposed to a mental health tax district, Knight doesn’t think creating one is essential to underwrite the BHRT. He believes commissioners who, at a retreat last December identified mental health as one of seven funding priorities for the county, could budget for the crisis stabilization system out of ad valorem taxing. Sarasota County budgeted more than $9 million this year for mental health services.
“If you have the special district, everyone will want to create revenue for their own organization or needs,” he said. “You have to define where the money’s going to go. And there’s a point where you will get push back.”
One of the objections to the special tax district voiced at the December retreat by Christine Robinson, president of The Argus Foundation, was that there was no strategy for how the funds raised would be distributed nor any proven programming in place to provide assurance that the money would be effectively spent.
“The creation of a district is occurring prior to the creation of a program,” Robinson said then. “Not having these things in place has the potential to take funds from where it’s really needed, and place it into what is popular at the moment … We believe that the process, protections and measurables should be done first and then decide if the general fund or a taxing district will work with what you created to protect mental health.”
But Jon Thaxton, director of community investment for the Gulf Coast Community Foundation, which has advocated for creation of the tax district, says crisis response is just one of the community’s mental health service needs and that a tax district is very much “still on the table.”
“The bottom line is about assisting lower income households with their unmet mental health needs,” Thaxton said. “The [tax] district is an ideal way to do it and I have advocated all along that the best approach is incremental, where we start small and demonstrate to taxpayers our good stewardship of these additional funds.”
The current proposal, “could be a first step in the implementation schedule,” Thaxton said.
“A program with a community approach that has demonstrated its efficacy, maybe we start with that small piece as proof of concept as we work out a process for the funds that would come from a mental health tax district.”
Other communities have taken alternative approaches to addressing mental health emergencies, such as pairing mental health counselors with police officers on patrol. But Knight, who spent 34 years in local law enforcement, says that idea would be a hard sell to local law enforcement agencies.
“Cops have two options – Baker Act them, or arrest them and the bulk will get arrested because it’s easier,” he said. “Cops are conditioned to resolve crises with handcuffs. That’s what they do and that’s what they’re trained to do. And they aren’t going to go for the idea of having mental health workers riding in cars with them.”
His 11 years as sheriff -- during which time he created multiple rehabilitation, recovery and reintegration programs in the jails but encountered “push back internally on everything I created” – tell him the system he proposes would be “a better fit” for the Sarasota community.
That it represents just a first step in addressing the community’s mental health needs – “an evolution, not a revolution” -- is obvious. But “thoughtful, strategic investment on the front end almost always saves what we pay reluctantly on the back end,” Knight said, and if Governor Ron DeSantis, who has cut the state mental health funding, isn’t going to do it, “we have to keep it local.”
“This cracks the door to mental health funding and I believe if they fund it, there will be huge community support,” he said. “I see our society and this country realizing we’re going to have to start doing more.”
Thanks for laying all of this out!
The concept of a special district is not new, but it is so necessary if we are to address all facets of mental health in our homes , schools, and community. The vital work of First Step is one slice of a much larger pie of services, starting with proactive programs for at risk children and working its way up to crisis response. There are certainly many options for designing a system that demonstrates excellence in stewardship for fund disbursement as well as methods fir reviewing metrics and outcomes as criteria for continued funding. There are many of us who have seen the gaps and failures of the current service system up close snd personal. Advocates, professionals without agency affiliations snd other stakeholders can surely avoid the turf wars that seem to be of concern. Much effort was put into envisioning what this might look like when work groups brainstormed over creating the best possible designs for our youth via the Here4YOUth project. I hope there will be support for the mental health district. We can’t move forward effectively without it.