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Model Mental Health Care Diversion System Started by Miami Judge

Thanks to the efforts of Florida Eleventh Circuit Court Judge Steve Leifman, Miami-Dade County is leading the way in how police and the courts deal with the mentally ill. As PLN has reported over the years, jails and prisons are the largest providers of mental health care in the U.S. [See, e.g.: PLN, June 2016, p.14].

In Miami-Dade County there are about 175,000 adults with serious mental illnesses; the county has the highest ratio of residents with severe mental health problems of any urban area in the nation. Yet only 24,000 receive care from the public mental health system.

Police encounter mentally ill people on a regular basis, and all too often the results are tragic. From 1999 through mid-2016, more than 25 people with mental health problems have died in Miami-Dade County as a result of interactions with police officers.

Dealing with the mentally ill is a national dilemma. In 2014, an estimated 1.5 million people with serious mental illness were arrested. While in many cases their offenses were directly related to their mental health condition, they were treated as criminals. As a result, people with mental illness often land in jail rather than mental health facilities where they can receive treatment.

This practice has placed a heavy burden on Miami-Dade County’s jail system. Of the 113,000 people arrested in the early 2000s, about 20 percent suffered from mental illness – which meant that around 1,700 mentally ill persons were jailed at any given time. Most would languish behind bars for months on misdemeanor or minor felony charges.

Judge Leifman, a former public defender, was exposed early in his law career to the horrors of inadequate mental health care when he interned for a state senator in 1973. A tour of the South Florida State Hospital left a lasting impression.

“It was one of those experiences that you never forget,” said Leifman. “The only thing I could think of while I was standing there was, we treat animals better at the zoo.”

His efforts to change the way the criminal justice system deals with the mentally ill went nowhere while he was a public defender, but once he became a judge in 1996 he had more clout and stakeholders began to take notice.

Leifman’s work has had tangible results. The judge advocates a systematic approach that involves a continuum of services as opposed to programs. His model includes a post-booking diversion process that allows those charged with misdemeanors to be released from jail and enter treatment.

Launched in 2000, the Criminal Mental Health Project (CMHP) lets mentally ill detainees participate in a specialized program within 48 hours after they are jailed in most cases. The program provides mental health treatment and temporary housing, as well as assistance through some social services like Medicaid and Supplemental Security Income. Prosecutors have agreed to downgrade or dismiss charges for those who complete the program.

An evaluation of CMHP found the recidivism rate for misdemeanor offenders a year after program completion was just 20 percent. By contrast, those who did not receive treatment had a 72 percent recidivism rate within a year. Even more striking, for persons involved in CMHP charged with a felony, recidivism was only 6 percent – compared to a national average rate of 86 percent for offenders with severe mental illness.

Judge Leifman has also been successful in getting police departments involved. About 4,500 officers have received crisis intervention training, which helps them distinguish between different types of mental illness so they can respond accordingly.

The result of this law enforcement participation in 2013 was only nine arrests out of 10,626 mental health calls in Miami-Dade County. The reduction in arrests allowed the county to close one of its five jails. Commensurately, the number of mentally ill prisoners in the county’s jail system dropped significantly, from 7,000 in 2008 to approximately 4,700 in 2014. Rather than making arrests, officers took people experiencing mental health problems to crisis stabilization centers.

A 180,000-square-foot, seven-story building has been signed over by the county and state for Leifman to create a model mental health treatment center. Dubbed the Mental Health Diversion Facility, it is intended to supply mentally ill defendants with a courtroom, crisis unit, rehabilitation services and short-term housing. The facility is scheduled to open in 2018.

“Treatment works; recovery is real,” said Leifman, who added the facility will “be the first of its kind in the country, a true diversion facility with all the essential elements.”

In March 2016, Florida Governor Rick Scott approved a bill sponsored by state Senator Miguel Diaz de la Portilla that established CMHP as a statewide model for other counties (HB 439, SB 604). As part of the bill, county judges were granted authority to order mentally ill defendants into treatment, effective July 1, 2016.

In recognition of his efforts to improve mental health services in the criminal justice system, in late 2015 Judge Leifman received the William H. Rehnquist Award for Judicial Excellence at a ceremony held at the U.S. Supreme Court. The award was presented by Supreme Court Chief Justice John Roberts.


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