Mental Health Advocacy in Gainesville, Florida: Closing the Gaps
Since 2003, NAMI-Gainesville has been ramping up advocacy efforts to complement its ongoing public
education and family support roles. There are two elements to this: 1) advocacy to and for the general
public, to assist them in better understanding our mental health challenges and to motivate them to convey
concerns to leaders, funders, and policy makers; and 2) better coordination between mental health
providers so that each understands how the overall system works (or doesn't) and to support the interested
public in more effectively advocating for policy changes or funding increases. Florida has a woefully
under-funded mental health system. Nevertheless Alachua County has exceptional mental health services,
a populace that is supportive of doing more, and a local government with a demonstrated willingness to
participate within its capacity.
The NAMI-Gainesville chapter has not undertaken this effort alone. The Alachua County Mental Health
Coalition was formed in 2013 to facilitate inter-program communications; its members represent federal,
state, and local government agencies in addition to non-profit and private providers. The Gainesville
Opportunity Center, Alachua County's Department of Community Support Services, and others have also
staffed important aspects of this effort.
In early 2014, NAMI sponsored a Community Book Read of Peter Earley's "Crazy: A Father's Journey
Through America's Mental Health Madness." Over 300 copies of the book were distributed to
community leaders, and half participated in reading groups to discuss the book's ideas, which were lead
led by NAMI members. Mr. Earley then came to Gainesville and spoke in multiple venues, including
Psychiatry Grand Rounds at the University of Florida Medical Center.
Soon after this initial book project, two forums were held to further capitalize on the interest, and more
than 100 community leaders participated in a robust conversation that included many "peers" (people with
the lived experience of mental illness). The press coverage throughout our efforts, including numerous
editorials and columns and robust social media, has been exceptionally well informed and well received.
In early 2015, the community book read was surrounding Rosalynn Carter's "Within Our Reach: Ending
the Mental Health Crisis". More than 250 books were distributed to community leaders, and about half
of them participated in small reading groups, this time with a broader participation of Mental Health
Coalition members as leaders. In March 2015, former President Jimmy Carter, substituting for his wife,
gave an electrifying presentation to 1750 people at the UF Center for the Performing Arts on the subject
of mental illnesses.
As a result of these and other efforts so far, there has been an increase in the understanding of mental
illnesses among the general public and community leaders. It is too early to tell whether there is a
corresponding reduction in stigma among those experiencing mental illness as measured by their
willingness to seek and accept treatment.
1
Among our community's real successes is the degree to which law enforcement and the courts have
participated. The Alachua County Sheriff, Gainesville Police, University of Florida Police Department,
and Santa Fe College Police Department have each embraced "Crisis Intervention Training" and Mental
Health First Aid for their officers, 911 emergency operators, and employees to a degree that is
unprecedented in any other community. During this era of difficult police/community relations in many
other places, it offers hope. Our Mental Health Court, Drug Court, Veterans Court, and Teen Court allow
people to be diverted from the mainstream criminal justice system as long as they participate in very
active treatment programs.
The recognition of mental illness among our large homeless population is also receiving meaningful
attention, with a broad range of services now being coordinated among a coalition of non-profits and
government agencies at Grace Empowerment Center and the adjacent Dignity Village, a "one-stop"
homeless service shelter.
In April, 2015 NAMI-Gainesville in cooperation with the Alachua County Mental Health Coalition and
the UF Health Management Engineering Department, began an effort to create a "mental health map" for
the County. This map will diagram scores of providers of mental health services, and plot them according
to the range of services, types of clients, flow of funding, and other useful measures.
At the initial mapping workshop with participation from 40 providers, there were three exercises. The
first exercise had the group list all of the providers they could, and then place them within a schematic
along a spectrum of service types. The second exercise involved small groups listening to the video-taped
testimony of peers as they described their often harrowing and still ongoing voyage through the mental
health system. The third exercise involved mapping their routes on the schematic. Not surprisingly, the
workshop demonstrated that our system is so complex as to make it virtually incomprehensible for
insiders, not to mention people who are trying to navigate it while suffering from mental illness. But more
promisingly, it showed that an era of cooperation, transparency, and willingness to close the gaps is
within our reach.
Our advocacy efforts in Gainesville to improve the provision of mental health services will continue. The
next steps will include finishing of a map of our mental health landscape. Part of this effort will
necessitate collecting and crunching big data to better understand how people move through the system
and how funding flows. Fortunately, we have given voice to the observation of both providers and
consumers that our mental health care system consists of many isolated "silos of excellence." Through
this ongoing effort, we hope that gaps and overlaps, weaknesses in handing-off people from one service to
another, and the lack of evidence-based feedback on effectiveness, will all become rarities. Activities of
UF researchers are complementing community advocacy efforts. Current research projects including
documenting the value of peer support services and peer-delivered services, assessing effectiveness of
mental illnesses anti-stigma efforts in the medical school curriculum, and making discoveries and
advances in biomedical understanding and treatments of mental illnesses. While our mental health care
system may remain under-funded for the foreseeable future, we should no longer rely on this lack of
funding as the only rallying cry for mental health advocates.
2