With any change in state policy there is always unintended consequences. Jacksonville is home to a large population of persons who have a serious and persistent mental illness. Some of these people with the greatest needs are persons with schizophrenia.
It is estimated by researchers that 44% of all cigarettes sold in the United States are sold to people with mental illness. Studies show that persons with mental illness spend 27% of their income seeking tobacco products. It is well known there is a strong connection between schizophrenia and how nicotine works in the brain. The nicotine provides brief alleviation of psychotic symptoms or voices and can help improve memory for persons with this disabling condition.
In Florida there are 5379 individuals with a mental illness who are reported to live in a state licensed limited mental health assisted living facility. Many of these residents have a primary diagnosis of schizophrenia and 90% are addicted to smoking or nicotine products.
For most of these people the terrible consequences of nicotine addiction include cardiac problems, COPD, bladder cancer and a host of other complications. It seems to make sense, just raise the price and they will quit. This is a case of easily said than done.
Even though residents will seek to quit smoking and we get them started on the nicotine patch, because of the diminished insight that accompanies schizophrenia many will keep on smoking cigarettes in addition to using the nicotine patch, a very dangerous combination. Often once the physician knows they are doing both they will discontinue the patch out of caution.
For many of the state funded residents who reside in Florida's licensed limited mental health assisted living facilities they received $9.28/day from Medicaid to help pay for their care and services they need and they received $54/month in a personal needs allowance that is to pay for dental care, vision, clothing, shoes and personal care products.
At our facility we have a tobacco resale license which allows us to purchase cigarettes from a wholesaler. We will purchase the cigarettes each month on behalf of the residents, for what we consider to be a month's supply would generally be $38/month at wholesale prices. This provides enough tobacco for 4 cigs per time four times per day.
The new federal cigarette tax will pay for children's health insurance will exact a significant toll on persons with mental illness. According to our sources the average cost of cigarettes will increase by $6/carton and so what use to cost $38/month will now be around $56/month just for cigarettes. The next proposed wave of taxes from the state will drive up costs another $10/carton for a total of $86/month.
Recent DCF data demonstrates clearly that stable housing and stable services are keys to keeping people with schizophrenia, for instances of 5329 mentally ill residents who were reported living in an ALF only 26 per year get charged with a crime and sent to an expensive ( $140,000/bed) forensic mental health treatment facility.
By contrast if you are enrolled in one of Florida Assertive Community Treatment Teams which serve 3200 adults you have 200 per year headed to forensic care costing taxpayers $28 million.
It is well established fact that when persons with schizophrenia re psychotic and aggressive having available a small supply of cigarettes can help everyone stay in control and avoid someone getting hurt. When you think about the problem this can create, Florida spends $250 million each year caring for the mentally ill who have committed a crime, 48% of the people charged in FS 916 are charged with battery on a law enforcement officer.
Absent doing nothing here is a description of the unintended consequences, as the price of cigarettes go up, residents will only be able to purchase a smaller quantity, residents who have higher demand for cigarettes will start to engaged in "panhandling" behaviors, they will commit petty crimes that include stealing cigarettes from local stores or friends. The utilization rates of hospital emergency rooms, already "psychosis" is the number three diagnosis seen in Florida's hospital emergency rooms.
You will likely have people decide they would prefer to get their nicotine needs met and will elect to live at a homeless shelter, take up housing in an unlicensed assisted living facility where there is no supervision or will seek housing in settings that could be best described as unstable. This all creates a tsunami for state budget planners and new dangers for patients and families.
Douglas D. AdkinsExecutive DirectorDayspring Village, Inc.PO Box 1080Hilliard, Florida 32046
Friday, May 1, 2009
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