If EverBank Field held a representative population of Jacksonville residents, about 16,750 of the seats would be occupied by a man or woman with a mental illness. Remove the tarps from the upper decks and the number would jump to about 21,000.
Family impact, stigma, criminality, affordability, politics, barriers to services, and suicide unfortunately tell the story of a mental health network that struggles to meet the needs of the community.
Mental illnesses, including anxiety and depression, are estimated to affect 1 in 4 adults. That would mean about 205,000 residents of Jacksonville are suffering.
And that’s not counting families and friends who are often collateral damage of a broken system.
The tentacles of mental illness are long and pervasive.
Norma Basford sees the family impact every day as she mans a help line at Jacksonville’s chapter of the National Alliance on Mental Illness.
People talk about waiting lists that are months long. About costs they can’t afford. About shame and how hard it is to share their problems. About trouble with police. About the ever-present threat of suicide.
Basford knows the stories. She has lived them herself.
Her son has bipolar disorder, obsessive compulsive disorder and anxiety. Almost 30 years ago, her then 15-year-old son talked to his friends about suicide. The friends told Basford and her husband Hayes Basford.
She called what happened next a “mega roller-coaster ride.”
“One day it was great,” Hayes Basford said. “The next day it was hell.”
Bipolar disorder is characterized by drastic mood swings. Hayes Basford said his and his wife’s emotions began to mirror their son’s.
Norma Basford said she became depressed trying to find help that didn’t seem to be available.
“The problem is that people that have this in their families suffer in silence because of the stigma,” she said.
John Boggs knew something was different about his now 26-year-old son Parker from just about the moment he was born, he said. He didn’t like to communicate and Boggs thought it might be autism.
About the time Boggs’ son became a teenager, they went to a doctor, who crossed autism off as a possibility.
It took eight years before Boggs finally had a name to describe his son’s problems: paranoid schizophrenia.
Eventually, Boggs and Parker moved so the other children could have a normal life. The family fracture brought an end to the Boggses’ marriage of 29 years.
“You disagree on what the problem is and what the solutions are,” he said. “I did miss a lot. … I always thought the solution was just over the horizon.”
Parker is now living in Missouri with his mother.
“I don’t know what tomorrow brings and I don’t know what’s possible,” Boggs said. “My goal is for him to reach his potential and live as independently as he can, but also that he doesn’t hurt anybody. I think that’s what scares everybody.”
Stigma is the lowered eyes in a psychiatrist’s waiting room, hoping you don’t see anyone you know. It’s the hushed voices or even silence when the topic pops up in polite company.
“But you have to live with it every day,” Boggs said. “… It’s this huge elephant in the room that nobody talks about because of stigma.”
Parker refused to go to school after he fell behind in his classes and would punch holes in walls. His behavioral problems drew stares from people in public.
Boggs, who is vice president of the Jacksonville chapter of the National Alliance on Mental Illness, said nobody knows the answers, so parents start to think “maybe it’s your fault.”
Stigma creates barriers to care, said Denise Marzullo, president and chief executive officer for Mental Health America of Northeast Florida.
People deny their problems and isolate themselves rather than admit they have a mental illness, she said. Or people tell them to suck it up and move on.
But it’s not that simple, Marzullo said.
“The truth is, and we really try to help people understand, is that it is an illness,” she said. Just like a broken arm or cancer, mental illness should be treated by professionals.
“People aren’t blamed for having breast cancer like they are blamed for having a mental illness,” she said.
At any given time, well over half of the inmates at Duval County’s Pre-Trial Detention Facility have some form of mental illness, said Tara Wildes, director of the Jacksonville Sheriff’s Office Department of Corrections.
She said some estimates put that number as high as 80 percent, making the jail the largest provider of mental health services in the community.
The reasons the mentally ill end up in prison vary from major offenses such as murder, but also minor offenses like trespassing.
“But substance abuse stands out [as a main culprit],” she said.
Many abuse illegal drugs or alcohol because they self-medicate, she said. After they reach the jail, other drugs replace illegal medication.
Between 10 and 20 percent of the inmates in the jail receive psychotropic medications, Wildes said.
On average, the cost to house a person in the jail is about $60 a day, Wildes said. If the mentally ill inmate received treatment outside the jail, it would cost about $16 a day, she said.
The majority of the time the person is involuntarily committed under the state’s Baker Act, under which he or she is observed for three days, then released. Follow-up care is sporadic and dependent on the patient.
Arrests factor into stigma as finding a job becomes harder after criminal charges are filed.
“Going to jail in general has a real effect on your future,” Wildes said, “whether you have a mental illness or not.”
Steven Cuffe, a professor and chair for the University of Florida College of Medicine Jacksonville said he receives about $60,000 from the city to pay for out-patient services for those who don’t have insurance or resources.
That results in a waiting list of about three months for non-urgent care, he said.
The most cost-efficient services are preventative care, such as therapy. But with current funding levels, those services aren’t readily available at UF Health Jacksonville, the main provider of health care to Jacksonville’s poor.
“Most of the funds are expended for in-patient hospital stays,” he said. “… For patients who have imminent risk, we try to squeeze them in and see them as soon as we can.”
Patients with Medicaid also have limited access to mental health services because of how the government reimburses funds. Few hospitals accept Medicaid, Cuffe said.
Boggs has private insurance, but still has paid about $250,000 out of his own pocket for his son’s care and legal trouble, he said.
Even with private insurance and financial resources, the right services for his son have been difficult to find, Boggs said.
“He is getting help, but I’m not sure if it’s the right help that he needs,” he said.
Funding for mental health services comes from federal, state and local levels.
Tina St. Clair, executive director at LSF Health Systems, manages the state and federal funds for mental health and substance abuse services for 23 counties including Duval, Nassau and St. Johns.
LSF Health Systems is one of seven managing entities created by the Legislature.
“In the state of Florida, the numbers don’t look good,” she said about funding. Only Idaho and Texas provide less money for mental health.
The national average is about $121 per person. Florida receives about $40 per person.
“We are underfunded and often the services that are in our community, our consumers have shared with us, don’t meet their needs,” she said.
For 23 counties, LSF Health Systems receives about $66.7 million from the state and about $25.9 million from federal funds.
Duval County Public Schools spends about $31 million on mental health services every year, according to school district figures.
Superintendent Nikolai Vitti said the real number is closer to $35 million to $40 million.
One-half of all chronic mental illness begins by the age of 14, and about 20 percent of youths 13 to 18 years old experience severe mental disorders a year, according to the National Alliance on Mental Illness.
“Public education was never funded to deal with this issue,” Vitti said.
He said many of the behavioral problems and safety concerns in Jacksonville schools can be linked to mental health issues.
If the school district received additional mental health funding, Vitti said the first place it should go would be to train employees how to identify and address mental health issues.
He would also like to see “wrap-around” services that would improve the communication with the community’s mental health providers.
“So you are dealing with the whole family instead of just one individual in that family,” Vitti said.
The school system could use more social workers and, ideally, have one guidance counselor for every 100 students, he said.
Vitti said the school system has addressed some of the issues with grants, but that’s not ideal.
“Grants fill gaps,” he said. “… The problem is grants go away.”
St. Clair said advocacy on the issue of mental health helps affect change. She wasn’t talking only about more funding, but about how those dollars are spent, she said.
“I would encourage everyone to write letters to your legislators, go to meetings with your legislators,” she said. “Make them understand in your community that funding mental health services and getting people into treatment is a priority.”
A good case manager will help navigate where services can be found, said Jim Clark, chief executive and president for Daniel Improving the Odds for Kids, a mental health provider for children.
The waiting list for community mental health services is extraordinary — often with lists in the thousands, he said.
“We see people who have to go through so many gauntlets before they are able to get the actual care that they have,” he said.
In one of the programs at Daniel, children on average have gone through 10 other placement centers.
“Before we can accept them into a residential program,” he said, “they must have failed twice at a secure psychiatric facility.”
Insurance companies often take the least costly care option first, he said.
He said that isn’t the best strategy for treatment.
“What happens is, it increases their trauma,” he said. “So by the time they come to us, they think, ‘OK, I can try to cut myself now and move to the next place.’ ”
Clark said he believes the mental health care system is too focused on cost saving and should focus more on services that produce results.
“I think the philosophy should be the right care for the right child at the right time, not the least expensive care prior to the more expensive care,” he said.
Suicides have increased by 13.2 percent in the last five years, according to the Jacksonville Community Council Inc.
In 2012, 151 Jacksonville residents killed themselves. That same year, 106 people died as a result of stabbings, shootings and other homicides.
Both are tragic and preventable. But homicides and murders attract much more attention.
Suicide is the 10th leading cause of death in America and third leading cause of death for people between 15 and 24, according to the National Alliance on Mental Illness.
And more than 90 percent of those who die by suicide had one or more mental disorders, according to NAMI.
Basford said her son still sometimes thinks about suicide even though he has a good job, has been married and has a daughter. Hayes Basford attributes his son’s improvement to when he admitted he had a problem and wanted help.
He said his son found the right psychiatrist, the right medicine and sees a mental health counselor.
“Now, he’s very responsible and works and is a very good daddy,” Hayes Basford said.
“Things aren’t perfect,” Norma Basford said, “but they aren’t perfect for anyone.”
Derek Gilliam: (904) 359-4619