Budget Cuts Hit Mentally Ill

That's partly because there aren't enough beds to keep them, even if doctors think they should stay. Between 2001 and 2005, while the state's population increased 9.4 percent, involuntary examinations in Florida jumped 35 percent. At the same time, the number of psychiatric beds decreased drastically: In 1998, there were 45.8 beds per 100,000 people; in 2006, that number dropped to 21.8. So patients such as Jeffrey wind up back on the street, with little or no follow-up care.

Leifman doesn't know Kathryn or the specifics of her case, but her son's story rings true. "She has been failed, but not necessarily by Citrus," he says. "She's been failed by a system that doesn't work. We don't have a mental health system."

Kathryn and Jeffrey Fernandez had difficult, troubled lives. Kathryn was 18 when Jeffrey was born; he had been conceived while she was underage. Jeffrey's father, she says, was a Hialeah Police officer who walked out shortly after she gave birth. Four years later, Kathryn wed Richard Mario Elejalde. The marriage lasted 11 unhappy years. Her husband eventually went to jail; they officially divorced in 1988.

For much of that time, Jeffrey wound up in the care of Kathryn's aunt as his mother struggled with drug addiction and mental illness, including bipolar disorder. "I've been diagnosed with all kinds of crap," Kathryn says. Over the years, she has been arrested a dozen times for nonviolent crimes including theft and drug possession.

Jeffrey, meanwhile, married at age 21, but quickly separated from his wife. He took the 2002 death of his grandmother, Kathryn's mom, particularly hard. When Kathryn's aunt, who had largely raised him, passed away less than a year later, he was devastated. He became depressed, Kathryn says, taking to alcohol and crack cocaine. He lost his job as a parking attendant and bookkeeper at Jackson Memorial Hospital.

In 2003, Jeffrey called his mom in a panic. He couldn't pay rent for his apartment in Overtown, he said. Kathryn moved in with him but found out he hadn't paid the rent for months. The pair became homeless.

"I was scared — I didn't know how to be homeless," she recalls. "But I wanted him to be okay, so I said, 'It's going to be okay.'" For a few weeks, they slept in Bicentennial Park and showered and ate meals at shelters. Jeffrey eventually heard about a job repairing the interiors of airplanes in Texas, and left town to take it.

Things seemed to be getting better. Kathryn found a room in a small house in Hialeah. Jeffrey, homesick, returned and moved in with her. He took a job working in a junkyard, and the two shared some semblance of stability. But he continued to use drugs. On September 9, 2006, police came to the house after Jeffrey struck his mother several times on the back of the head and right eye after she wouldn't give him money. Kathryn told police she had refused, knowing he wanted the money for drugs. Jeffrey was arrested for simple battery. The charge was eventually dropped.

Despite all the problems in Jeffrey's life, Kathryn was shocked when her son declared he felt suicidal. "He had never talked about suicide before," she says. When she called the police to have her son committed, she hoped it would mark a new chapter in his life, that he might finally kick his drug and alcohol habits. When he came back three days later, though, she was crestfallen.

"The psychiatrist told him: 'Just quit drinking and doing drugs, and you'll be okay,'" she claims.

"What can you do with someone in three days?" asks Judy Robinson, president of the Miami chapter of the National Alliance on Mental Illness, as well as the parent of a son with mental illness. She's heard stories like Kathryn's before. "If this young man was the type of person who has a drug problem, and he was not being adequately treated for both the addiction and the mental health problem, and he was not in a place that was secure long enough to begin to work with him, that is a problem," she says.

But while Robinson is sympathetic to Kathryn's plight, she says it's not necessarily fair to blame Citrus or any other hospital. "The whole system needs to be gutted," she says. "It doesn't meet the needs of this population. We keep doing band-aid fixes, and nothing happens.... The feds are threatening to cut mental health case work completely, and these people can't navigate the system on their own. They just can't."

The Florida House recently approved an $8 million pilot program to divert patients from hospitals to lower-cost community care programs. Leifman's task force pushed hard for the bill's passage, but it failed in the Senate owing to the budget shortfall. Still, Leifman is hopeful the bill will pass in the next legislative session.

Until then, the cuts continue. Just a few weeks ago, Kathryn Fernandez got a call from a Department of Children and Families therapist who had been coming to see her. "She said she had to close her cases," Kathryn says vaguely. "It had something to do with government money, I don't know what."