Florida has one of the worst funding levels for mental health in the nation, and Duval County is last among metro areas.

True enough, but pediatrician Jeff Goldhagen says that funding is not the most important mental health priority.

”Ultimately you can have all the funding you need, but if the system isn’t working then the funding can’t be used efficiently and effectively either.”

For three years, Goldhagen and a group of community leaders have been working to create a mental health delivery system aimed at children in Duval County. A total of $9 million in funding was provided by the Federal Substance Abuse and Mental Health Service Administration.

It’s called the Jacksonville System of Care Initiative.

The goal is to improve access to mental health care, especially for children in child welfare, juvenile justice, subsidized child care and homeless systems.

This system needs to be family-driven, youth-guided and culturally responsive.

One key to the grant is that it use a public health framework. That is no accident since that is Goldhagen’s expertise as the former head of the Duval County Health Department. The pediatrician now is affiliated with UF Health Jacksonville.

Another necessity is to increase the ability to treat juveniles for mental health issues. One way that is done is training pediatricians to screen for mental health issues and then refer them to appropriate treatment.

About 40 primary care providers have been trained so far. The typical provider has been practicing for almost 17 years but received less than three weeks of training on mental health issues.

This is significant when you consider that many providers weren’t even screening for mental health issues. And if they did identify them, they may not have been tuned in to the services available.


We know the functional child poverty level is twice what the federal government says it is. Proof is that free and reduced lunch starts at 200 percent of the federal poverty level.

Why doesn’t the government change its poverty metric? Goldhagen explains it this way: Which president wants to be the first to say poverty doubled during his administration?

So close to 50 percent of the children in school are living in poverty.


The new project includes creation of a new youth council that will be given an active decision-making voice. It’s called Youth Move Jacksonville. It’s designed to empower youth who have experience with mental health, foster care, substance abuse, homelessness and juvenile justice.

The project includes a broader marketing focus. Why does mental health so easily escape public attention?

So a national nonprofit was brought in to provide expertise. The Frameworks Institute specializes in helping nonprofits communicate their issues effectively.

Often that involves the study of a community’s images, stereotypes and metaphors.

This process would include questions like these:

■ What cultural models guide the public?

■ How can an issue be reframed to lead to a different way of thinking?

One example common to the nation is “The Family Bubble.” This assumes little connection between the child and the environment outside the family circle.

The conclusion of Frameworks is that “many of Jacksonville’s residents do not envision a shared fate for the people of the city.”

“At a deep level, Jacksonville residents assume that the fates of the city’s population are largely separate.”

This is not unique to Jacksonville. It especially relates to perceptions of white and black populations.

When you think of a minority group as “the other,” influenced by a dysfunctional culture, the default solution is to “get your act together.”


Goldhagen noted that the face of poverty has changed in recent generations from old to young.

So he was asked what a youth entitlement would look like. Start with the concept that youth have a right to quality health care, good schools, safe neighborhoods and reliable housing. They are inter-related.

It would focus on fulfilling the rights of kids, he said. Youth would have a seat at the decision-making table, real power, not just tokenism.

If Goldhagen could choose one important result of this entitlement it would be “equitable access to the highest quality early learning.”

By age 4, if a child has not had access to the stimulation of active parents or excellent child care, basically “the game’s over,” he said. It’s difficult to catch up.