Flagler's high suicide rate linked to lack of services

BUNNELL — Flagler County has the highest suicide rate in the state, and local advocates believe they have found a possible link to how services are funded and provided.

In 2017, the latest year for complete data, there were 31 suicides in Flagler County. That’s a rate of 29.2 per 100,000 people, according to the Florida Department of Health. Suwanee County actually shares that rate, though the number of suicides there was 13. By comparison, Volusia County had 123 suicides, a rate of 23.4.

Both Flagler and Volusia are part of a cluster of counties with high suicide rates that includes Putnam, Marion, Lake and Brevard counties.

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Dr. Deanna Oleske addressed Flagler’s disproportionate numbers during last week's meeting of the county's Public Safety Coordinating Council. She said that upon becoming an associate medical examiner for Flagler, Putnam and St. Johns counties in 2016, she noticed that “something was going on in Flagler.”

“You are more likely to die from suicide in Flagler County than die from a motor vehicle accident,” she told members of the council.

She pointed out that the county's suicide rate was greater than the combined rate of deaths due to drowning, accidental overdoses, poisons and fire.

The preliminary numbers do not look good for 2018. That year, there were 29 suicides in Flagler. In 2019 so far, there have been nine.

With an eye on the cluster of high suicide rates in six contiguous counties, members of the Flagler Lifeline Suicide Prevention Planning Committee are seeking answers.

“A lot of times it comes down to: Follow the money,” said Colleen Conklin, Flagler County School Board vice chair and a member of the committee.

But following the money is no easy task. According to Flagler Cares executive director Carrie Baird, who with Conklin presented their findings to the committee, said specific figures for Flagler County aren’t available due to the way that funding is used.

No funding comes directly to Flagler County, she said. Federal funds for mental health services in Florida are first dispensed to the state Department of Children and Families, which then divides that money between seven service areas across the state.

Five of the six counties in the high suicide cluster are in a 23-county service area managed by Lutheran Services Florida. That area roughly corresponds to the northeast region, but not exactly. It overlaps five counties in Central Florida and does not include two counties in the northeast.

Lutheran Services Florida dispenses the money to individual service providers, all with headquarters in counties other than Flagler.

And that’s where advocates believe the problem may lie. Lutheran Services Florida lists seven agencies providing mental health care services to Flagler County residents who lack the insurance to seek out their own providers. There are three in Daytona Beach and one each in St. Augustine, DeLand, Clearwater and Fernandina Beach.

“They’re providing the services primarily where they’re located, but they’re utilizing Flagler County needs,” Conklin said. “The fact that Flagler County is No. 1 (in the state) in suicides, that shows a need, and that agency can say, ‘We will offer our services to Flagler County residents.’”

Only two of the providers list specific mental health services within Flagler County itself. SMA Healthcare operates a Crisis Triage and Treatment Unit in Bunnell, where there is a suicide prevention person onsite. Mental Health America of East Central Florida lists a drop-in center in Palm Coast.

To access services from other providers, Flagler residents must travel to their offices.

Volusia County, which is in the suicide cluster, shares the same providers as Flagler, though four of them are located in Volusia.

Making matters worse, Conklin said there is only one mental health care provider in Flagler County that accepts Medicaid.

Conklin said she has heard from several people who have been unable to access mental health care for a loved one and had to travel out of the county for services. That can be a problem for economically challenged residents — the very people least likely to have adequate insurance — who have no transportation to those areas.

“We think it’s only appropriate that if you’re going to say you’re going to use Flagler County needs, that in your service contract, you say you’re going to expend X percentage of those dollars only on Flagler County residents,” Conklin said.

She also urged action on the local level but cautioned County Commissioner Joe Mullins, who chairs the coordinating council, that “it’s going to require dollars and effort and focus.”

Inability to access services is not limited to Flagler County or the counties around it. According to a 2018 report by Mental Health America, Florida ranks 44th in access to mental health care. The Sunshine State ranks ninth in adults with mental illness reporting unmet need.

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