Jails as Psychiatric Facilities: Addressing Mental Illness in the Justice System with Judge Steve Leifman

Judge Steve Leifman, associate administrative judge of the Miami-Dade County Court Criminal Division and presiding judge of its Criminal Mental Health Project, has worked at the intersection of mental health and the criminal justice system in Miami-Date County for decades. In this podcast, he outlines the challenges of addressing the high occurence of mental illness in Miami’s courts and prisons, the fraught history of incarcerating those with mental health needs, and ways in which the justice system can change its response to those living with mental illness. AVNI MAJITHIA-SEJPAL: Hello and welcome to the New Thinking podcast. This is Avni Majithia- Sejpal from the Center for Court Innovations. Today, I’m joined by Judge Steve Leifman who is the Associate Administrative Judge at the Miami-Dade County court in Florida and the presiding judge of Miami’s Criminal Mental Health Project. Welcome to our podcast, Judge Leifman. JUDGE STEVE LEIFMAN: Thank you very much. MAJITHIA-SEJPAL: I wanted to start by talking about Miami. The statistics say that Miami has a very large population of people dealing with mental illness, almost 10%, which is more than any other urban community in the U.S. You have said that the county jail serves as the largest psychiatric facility in the state of Florida. Why do you say that? LEIFMAN: Miami-Dade County has a very high prevalence of mental illness, as you’ve stated, with any urban area in the United States. That really comes from a couple factors. One, we start with our own norm of mental illness such as probably 3 to 5%. Then we pick-up a couple percent from our weather. A lot of times family members or people with mental illnesses, they don’t want to be in Chicago or New York during the cold winters and so they end up coming out to south Florida to escape the bad weather. Then also during the Mariel Boatlift in the ’80s, Castro literally emptied all the psychiatric facilities onto the boats, so the people that were actually fleeing for political freedom from Cuba. Between the other factors and our own norm, it’s a very, very high prevalence. Unfortunately, Florida also is very poor in its funding of mental health issues depending on the data anywhere from 48 to 50th per capita in mental health funding. Only about 1% of the people in the county who actually need services get access to the services that they need and so there’s a large unmet need. Many people, unfortunately, will end up in the acute systems of care which sometimes means the Dade County jail. MAJITHIA-SEJPAL: When we say mental illness, what are we talking about? LEIFMAN: We are not talking about sociopaths. We are talking about people that have been diagnosed with an organic brain illness such as schizophrenia, bipolar disorder, or major depression. MAJITHIA-SEJPAL: Then I wanted to ask you about the 11th Judicial Circuit Criminal Mental Health Project which you helped to establish in the year 2000. What’s the history behind it, why was it created, and what does it do? LEIFMAN: It actually started as a result of a case that I had in 2000 where I had a defendant who turned out to be a Harvard educated psychiatrist who had an onset of schizophrenia and had become homeless, and was recycling through the criminal justice system. It was really pretty traumatic for all of us involved in the case. He had a full blown psychotic episode in my courtroom and it was an eye-opener into how inadequate our community mental health system was as well as the court’s response for people with mental illnesses. If you had a serious mental illness and you were arrested on a low-level misdemeanor charge, the court on the vast majority of cases, we were just releasing people back to the street telling them to go see a psychiatrist for competency restoration. We are putting people who are very ill back out on the street without any access to treatment and so I was able to bring together a meeting of all the traditional and non-traditional stakeholders. We literally mapped out how our criminal justice system intersected with our community mental health system and frankly it didn’t. I think once we had mapped it out and realized how poor of a response we had, we had an obligation and a responsibility to make some significant change. It was for everybody’s sake to improve public safety, to spend our tax dollars more efficiently, and equally important to help people who have illnesses have access to recovery. We decided we needed a two-part approach. We needed to stem the flow of people coming into the system that were coming in unnecessarily and we also needed to have an approach where people that did penetrate the criminal justice system so that we could get them out if it was an appropriate thing to do. We created a very expansive, what’s called, Crisis Intervention Team Police Program. Over the years, we have actually trained over 4700 police officers including every single agency in Miami-Dade County and it has made a startling difference. Between 2010 and 2015, we handled 48,669 mental health calls and only made 109 arrests. It had a significant impact on the reduction of our jail. It actually helped us close one of our jails. We also realized that we also needed to set-up post arrest diversion program. We initially set-up a misdemeanor diversion program whereby any individual with a serious mental illness who’s arrested for a misdemeanor, if they meet criteria for involuntary hospitalization, generally within 3 days, we have them diverted from our jail into one of our community crisis stabilization units. We reset the case for a couple weeks. During that period, A, we allow them to become more stable, but at the same time my team is working on lining up their benefits, finding them housing, getting all these supports in place that people need for recovery and it’s been phenomenally successful. Our recidivism rate dropped from over 70% to about 20% today. Our state attorney allowed us to expand it to our non-violent felony cases. We put into play about five years ago, a felony diversion program and that program has a recidivism rate of only about 6% for those that complete the program which is about 70%. The program alone has saved the county between 35 and 40 years of jail bed days. When we set-up the third program, that diverts people from competency restoration hospitals and keeps them in a local facility. Instead of just [inaudible] on the restoring competency, we actually focus on reintegrating them back into the community. MAJITHIA-SEJPAL: Would you say that deincarceration is the way forward? LEIFMAN: I think jail should be the last resort for people with mental illnesses. It shouldn’t be the first entry point for people with mental illness, which it has become. Our jails have become the de facto mental health facilities all around the country and it’s really not fair. Most of these individuals have serious trauma issues and arrest often re-traumatizes them. Their lives are generally so fragile to begin with that even a day in jail can help further the stigma against them, sever ties from employment, from housing, from family, and make it even that much more difficult for them to reintegrate. Now there are some people that do commit crimes that are offensive enough or dangerous enough that need to be in bars, so the program really is about identifying the people that don’t need to be in jail and making sure that we get them out. One of the things that we do now is we use a risk assessment tool. We evaluate everybody that comes to our program and line-up the right services for each individual. The key is to really understanding what the individual needs, doing our best to line-up the right services for that particular individual, and then help reintegrate, reassociate them back into the community. If you do that with all the supports and services that they need, this population can do very well. In fact, what most people don’t understand is that, number one is, people with mental illnesses are no more dangerous than the general population and on medication they’re actually have a much lower propensity for any violent crimes than people without mental illness. Sadly, they’re much more likely to be victims of violent crimes than perpetrators. The other thing I don’t think people understand is that most people with mental illnesses have much better recovery rates than actually people with diabetes and heart disease. The key to these illnesses just like most illnesses is identifying them early and treating people early. I think the problem arises when we ignore the problem and we see people who have been sick for many years, and have had many psychotic episodes. What we’re trying to do in our community as well is working with our school system now to educate all of our teachers so that they can do a better job identifying kids that are showing signs and symptoms of mental illness so that we don’t wait for them to grow-up in our system to try to get them access to treatment at a much earlier stage. We look at this as not as a court problem or a c...