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Florida Jails: State’s Largest Mental Health Providers

Florida Jails: State's Largest Mental Health Providers

by David M. Reutter

Florida's policy of allowing mentally ill citizens to languish without treatment until they have encounters with law enforcement has turned the state's county jails into the primary provider of mental health services. This has created fiscal and overcrowding problems, which in turn force mentally ill prisoners to live in punitive environments that worsen their condition.

According to the National Alliance for the Mentally Ill (NAMI), Florida is in a state of crisis, with 23 percent of prisoners held in county and city jails having a mental disorder. The actual number may be higher. Anywhere from 70,000 to 90,000 people with mental problems are arrested in Florida each year.

Despite that fact, Florida ranked 48th nationwide in per capita spending for mental health treatment. As with all crises, this one did not occur overnight. In fact, it is the culmination of policies implemented in the 1950?s to "deinstitutionalize" the mentally ill by closing psychiatric hospitals and discontinuing state-paid treatment and care.

Many mentally ill defendants are found incompetent to stand trial, which has caused a serious dilemma for Florida's Department of Children and Families (DCF). Under Florida law, once a circuit court enters an order finding a defendant "incompetent to proceed or not guilty by reason of insanity," DCF must take custody of the defendant within 15 days to provide "appropriate treatment or training."

On April 25, 2006, a Broward County Circuit Court judge labeled jail prisoner Cory Itson, 27, legally incompetent and "an IMMINENT THREAT to himself and others." Itson's public defender, Anne Blanford, said her client was "clearly delusional," shouting obscenities in a bare cell when she tried to visit him in May 2006.

Two Broward County judges ordered DCF and the jail's medical provider, Armor Correctional Services, to treat Itson pending his transfer to a mental health facility. "It makes me sick to think what he's going through," said Cory's mother, Rachel Itson. "He needs medication, but he's not getting it. They're treating him like a dog."

DCF claimed it "attempted to comply" with the court orders to place Itson in a forensic hospital, yet missed a deadline to do so. "The department is not acting in bad faith -- we do what we always do," explained DCF attorney Douglas Greenbaum. Apparently, however, what DCF always did wasn't good enough.

By December 2006, there were nearly 300 prisoners awaiting beds in treatment centers after being found incompetent. The situation received widespread attention when Florida's Third District Court of Appeals entered a ruling on December 6 that affirmed a Miami-Dade trial court's order requiring DCF to take custody of three jail prisoners. See: Hadi v. Codero, 955 So.2d 17 (Fla.App. 3 Dist. 2006).

In that case, Dr. Joel Dvoskin testified that the deplorable conditions in unit 9C of the Miami-Dade County Jail, where the prisoners were housed, fell "below standards of care for any reasonable mental health practitioner." Moreover, Dr. Dvoskin stated the "conditions in unit 9C would likely exacerbate the symptoms of serious mental illness," and opined, "The longer a person is confined to 9C, the more treatment would be required to restore him to competency to stand trial."

The conditions were so bad that they reduced then-DCF Secretary Lucy Hadi to tears when she toured the unit. Despite previous arguments that her agency didn't have financial resources to remedy the problem, she pledged DCF would spend $5 million to create 85 new treatment beds for mentally ill defendants. That didn't impress a Pinellas County judge, however, who in October 2006 levied a $80,000 fine against Hadi and threatened her with six months in jail on a contempt charge for failing to move ten prisoners into treatment programs pursuant to a court order.

Hadi announced her resignation two months later; that same week, in December 2006, the Advocacy Center for Persons with Disabilities filed suit against DCF, seeking to force the agency to comply with state law by removing 300 mentally ill prisoners from county jails statewide.

With the pressure reaching a crescendo, Florida's Legislature responded by giving DCF $16.6 million to throw at the problem. The increased funding enabled DCF to open 239 new beds in secure mental health hospitals, 340 beds in less secure areas and 70 beds in community-based centers. DCF now has 1,700 beds available statewide to treat mentally ill prisoners, and has contracted with GEO Care, a subsidiary of private prison operator GEO Group, to operate two treatment centers that were converted from former correctional facilities.

From January to May 2007, 613 prisoners were admitted to DCF hospitals and another 340 were restored to competency and sent back to jail. On May 9, Hadi's replacement, DCF Secretary Bob Butterworth, announced during a court hearing that the backlog of mentally ill prisoners awaiting transfer to treatment facilities had been cleared. While DCF may have eliminated the waiting list and is now able to take prisoners within 15 days of a court order, that does nothing to address the fact that the state's jails are overloaded with mentally ill people.

"Florida's jails are the largest providers of mental health and are dramatically overcrowded," said Representative Loranne Ausley (D-Tallahassee). Which begs the question of whether many of those people in jail are really criminals, or are simply unable to cope in society without supervision and treatment.

"I can show you a percentage in the Polk County Jail who are not intentional criminals," Polk Co. Sheriff Grady Judd acknowledged. "They are just really, really mentally ill."

In 2006, NAMI gave Florida an overall grade of C-minus for its mental health system. "By necessity, the criminal justice community has become one of the most visible mental health advocacy communities in Florida," NAMI stated.

Such concerns spawned Partners in Crisis, a statewide group of law enforcement and mental health advocates. "Mentally ill people don't belong in jails and jails are poorly equipped to deal with mentally ill people," said Circuit Judge Charles Curry, who helped form a Partners in Crisis chapter in Polk County. "We need an environment where they're housed so we can ensure they take their medicines, where we can protect them from society and society from them."

The problem is that until recently, and only after being forced to confront the issue, Florida lawmakers and DCF officials considered jails to be a suitable environment for the mentally ill.

Sources: The Ledger, St. Petersburg Times, Sun-Sentinel,, WMFE, Florida Capitol Report,,, Miami Herald

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Related legal case

Hadi v. Codero