Flagler has the highest suicide rate in the state, but a shortage of providers and funding to care for people with mental health care concerns.
Flagler County had the highest suicide rate per capita of any county in the state of Florida in 2017, and has been among the highest in the state for years. Meanwhile, it has consistently ranked near the bottom statewide in terms of availability of mental healthcare providers, particularly for patients on Medicaid.
Now, the situation has worsened: One of the only two mental health care facilities in the county that accepted Medicaid switched to self-pay-only, leaving patients who can't afford to pay out of pocket scrambling to find someone who can treat them and reauthorize prescriptions that could cause withdrawal symptoms if stopped suddenly.
"They’re showing up for their regular, scheduled appointments to get this medication ... and they’re being told 'Oh, we can’t see you today unless you have $60 cash,'" said Jill Crawford, a former patient at the facility, known as the Flagler Mental Health Center.
Rhonda Harvey, the chief operations officer at Stewart-Marchman-Act Behavioral Healthcare — now the only mental health facility in the county that accepts Medicaid — called that displacement of patients "a crisis," and said the county has an urgent need for more funding for mental health care.
"It’s just really distressing to see the number of people that are feeling hopeless, helpless and with no choice other than suicide," she said. SMA recently received a federal grant to fund a suicide prevention effort, she said, and Flagler will be one of the counties involved. "But it is an overwhelming challenge," she said.
Crawford was one of several people who contacted the Palm Coast Observer and reached out to community organizers saying they were Medicaid patients at the Flagler Mental Health Center, couldn't be seen, and were worried about running out of medication.
The Flagler Mental Health Center has not responded to requests for comment. But a sign posted on the facility's door stated that the facility is now not accepting insurance. The business' registered owner — Dr. Joseph Comfort, an anaesthesiologist, who went by the name "Duke" — died in late January.
Some patients said they had showed up for their regular appointments and found the facility closed, with a lock on the door. Later, the facility reopened, but was only accepting cash.
Now, people are able to pay with credit cards, but still can't use Medicaid or insurance.
One local pharmacist posted on Facebook in early March, "Thoughts on Flagler Mental Health Center locking its doors...suggestions for patients?"
That prompted more than two dozen comments, including by frustrated patients who said they'd called the facility and found the phone line cut off. Its main phone line, posted on its website, was not in service.
Some patients, including Crawford, reached out to School Board member Colleen Conklin, who's helped lead efforts to increase mental healthcare awareness and availability in Flagler.
Conklin was in Australia when Crawford contacted her, but quickly responded, Crawford said, and began trying to organize resources, as did Carrie Baird, the executive director of Flagler Cares.
"I”m concerned about very vulnerable people who have been taking psychiatric drugs for a very long time," Baird said. "Some of those medications they’ve been taking are dangerous to just stop taking cold turkey."
Baird, working with the Department of Children and Families, compiled a one-page list of resources for displaced patients (see sidebar).
Crawford, seeking resources for herself and a friend who'd been a FMHC patient, called around and was repeatedly directed to SMA Behavioral Healthcare. SMA serves the north-central Florida area and has a branch in Bunnell, on Justice Lane.
But when Crawford called in February and said she was running out of medication and needed reauthorization, a receptionist at SMA told her SMA wouldn't be able to schedule an appointment for her with someone with prescribing ability until April, she said.
"Stewart-Marchman — I’m glad they're there, but there’s nowhere you can go in (a medication) crisis," Crawford said. "The best course of action right now, if I were in crisis, I would pay $60 to go to Flagler Mental Health Care." She noted that some people just can't do that. Crawford said she's since switched from Medicaid to private insurance, and has more options.
"It certainly doesn’t sound as efficient as I would like to think, but she may very well have been told that," said Harvey, the SMA Behavioral COO. "It depends on how she presented and if there was a sense of urgency. Typically, if we have to establish a new patient, that takes a little longer, but typically that’s three to four weeks out."
SMA has now carved out time to see displaced Flagler Mental Health Center patients more promptly, Harvey said.
"We have set aside specific walk-in times where people can come in and be seen immediately," she said. (See sidebar.)
There's one potential problem: SMA Behavioral Healthcare doesn't prescribe some of the medications that the Flagler Mental Health Center prescribes, including benzodiazepines — a class of drugs that includes Xanax and Valium and is used to treat anxiety, panic attacks and insomnia — and medical marijuana.
"If [displaced patients] are needing help for a psychiatric disordered but they’re not currently on one of those meds, then we can enroll them and see them pretty quickly," Harvey said. If they need benzodiazepines, she said, "then we’ll connect them with a care coordinator," who can help direct them to someone who could prescribe the medication.
Currently, Harvey and Baird said, the quickest route for patients who need benzodiazepines seems to be through Impower, a Central Florida-based nonprofit that can prescribe those medications and has psychiatrists who can quickly see patients by Telehealth — that is, over a secure internet-based connection — to reauthorize meds, and has been reporting a wait time of one to two days.
"If people are overwhelmed and intimidated by that process, of tele-psychiatry, that’s really the purpose for a care coordinator," Harvey said. "Just knowing where to turn, what person to call. It’s not intended to add another level of bureaucracy to the process: It’s meant to be short term; it’s just meant to make sure people get linked to services."