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The suspect in the mass shooting at the Fort Lauderdale/Hollywood International Airport told the FBI in Alaska in November that he was hearing voices.
Anchorage police confiscated Esteban Santiago’s handgun and took him for a mental health evaluation. Police returned his gun to him in December when he asked for it.
On Jan. 6, he flew to Broward County and is the suspected gunman in a rampage at the airport that left five dead and several others injured. Days later, Democratic state legislators held a press conference in Tallahassee to argue for gun control measures and more mental health funding.
Rep. Carlos Guillermo Smith, D-Orlando, said that Republican legislators argue that the way to reduce gun violence is not through gun control but mental health care funding. But Florida, he said, has the worst record in the nation in terms of funding mental health care treatment.
"We see once again Florida is ranked 50th in the nation for mental health care funding — 50th," he said. "There is no one that is doing worse than we are when it comes to making sure we that we are providing comprehensive mental health care."
Florida is near the bottom of the pack in mental health funding, and one key ranking cited by many experts places the state at 51st in per capita spending. However, there are some caveats about the ranking.
Comparing state mental health funding
Mental health funding experts said they consider the institute’s data as the best source.
The institute collects annual data on expenditures by state mental health agencies from the states, Washington, D.C., and Puerto Rico. The total amount of expenditures is divided by the state population to compare the amount per capita.
The most recent data, for fiscal year 2014, showed Florida ranked 51st out of 52 jurisdictions for total state mental health spending — behind 49 states and Washington, D.C. — at $36.05 per capita. The Sunshine State was only ahead of one jurisdiction: Puerto Rico, at $20.22.
Florida has consistently been near the bottom of the rankings for years, said Ted Lutterman, senior director of the institute. In general, states in the northeast and northwest spend more, while southern states spend much less, he said.
One key caveat about this data: It is based on money spent through Florida’s Substance Abuse and Mental Health Office, managed by the Department of Children and Families, and it doesn’t include services paid from other sources, including Medicaid or local funds, on mental health programs.
"Those additional funding sources aren’t reported to DCF, but they’re still used within the local systems of care to treat individuals," said Jessica Sims, DCF spokeswoman.
The national research institute asks the state mental health authority in each state to provide information on all the funds used for its public mental health provider system, including state psychiatric hospitals and community providers. If another state agency uses Medicaid funds to pay for services directly and doesn’t work with the state mental health authority, then the state mental health authority will not have that data, Lutterman said.
In most states, the state mental health authority helps manage the Medicaid funds. However Florida administers Medicaid differently, Lutterman said, and therefore isn’t able to report the Medicaid data for this report.
The National Alliance on Mental Illness uses the per-capita state expenditures to compare rankings, said the alliance’s spokesman Bob Carolla.
"It reflects the relative degree of commitment to mental health by the state," he said. "Medicaid dollars compared to Medicaid dollars could be a separate indicator, except I believe it’s more problematic because of the differences that exist between the state Medicaid programs."
Florida lags behind the majority of states on Medicaid spending per enrollee and the state Legislature rejected Medicaid expansion as part of the Affordable Care Act.
Another way to examine mental health funding is to look at whether states are increasing the amount each year. The National Alliance on Mental Illness annual survey of state mental health care legislation doesn’t rank states but shows general budgeting trends. The 2015 report shows Florida maintained funding in 2013 and increased it in 2014 and 2015.
Smith said, "Florida is ranked 50th in the nation for mental health care funding."
A key source of data for ranking states on mental health spending is the National Association of State Mental Health Program Directors Research Institute. That data shows that Florida ranked 51st in 2014.
However, it is difficult to compare Florida with other states because it administers its Medicaid program differently than most states.
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Interview, State Rep. Carlos Guillermo Smith, Jan. 12, 2017
Florida Coalition to Prevent Gun Violence, Press conference, Jan. 10, 2017
State Mental Health Program Directors Research Institute, Inc. data on Henry J. Kaiser Family Foundation website, State mental health funding, 2004-2013
Florida Policy Institute, "Florida’s Provision of Mental Health Services Ranks 49th Out of 50 States," Feb. 16, 2017
Henry J. Kaiser Family Foundation, "Medicaid Per Enrollee Spending: Variation Across States," Jan. 28, 2015
Fort Myers News-Press, "Locked in: Mentally ill languish in state hospitals," Oct. 2, 2015
PolitiFact Florida, "Gov. Rick Scott shifts again on Medicaid expansion," April 7, 2015
PolitiFact Florida, "Chiles says Florida ranks 49th in per capita mental health spending," Aug. 31, 2010
PolitiFact Texas, "Sacramento Bee editorial says Texas is last in mental health care spending," Feb. 8, 2013
Interview, Craig Palosky, director of communications, Kaiser Family Foundation, Jan. 12, 2017
Interview Ted Lutterman Senior Director, Government & Commercial Research NRI - National Association of State Mental Health Program Directors Research Institute, Jan. 12, 2017
Interview, Bob Carolla, National Alliance on Mental Illness spokesman, Jan. 12, 2017
Interview, Jessica Sims, Florida Department of Children and Families spokeswoman, Jan. 12, 2017
Interview, Phil Walls, U.S. Substance Abuse and Mental Health Services Administration spokesman, Jan. 13, 2016
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