Judge Faces the Challenge of the Criminalization of Mental Illness
Miami, Florida is famous for its sun, sand and sea. Less commonly known is the fact that it hosts the highest percentage of people with a mental illness of any urban area in the U.S.—three times the national average, to be exact. While 9.1 percent of Miami-Dade county’s general population has a serious mental illness (disabling disorders that prevent a person from consistently holding a job or caring for themselves without assistance), antiquated procedures that favor arrest over re-integration of people into society often exacerbate the situation, giving rise to a full-blown crisis. In effect, and entirely by default, the criminal justice system has become greater Miami’s mental health system.
When Steven Leifman became a county court judge in 1995, he inherited this legacy—one, remarkably, that made him gatekeeper to the largest psychiatric facility in the state of Florida: the Miami-Dade County Jail. The same can be said for the largest jails in Los Angeles, Chicago and New York: each houses more mentally ill people—relatively few of whom are receiving care—than any other institution in their respective states. In the past 10 years, this segment of the prison population has risen by over 170 percent.
“Judges tend to see people with more psychiatric illness than psychiatrists do these days,” Judge Leifman said on a recent episode of the Public Television series Healthy Minds, hosted by BBRF President Dr. Jeffrey Borenstein. Judge Leifman explains that many are brought to court by police because of so-called quality-of-life offenses (e.g., urinating in public, disorderly intoxication) or low-level felonies. The problem in Miami and in other large urban centers in America is that in the wake of de-institutionalization—the push that began in the 1970s to shutter state-run mental institutions— hundreds of thousands of people who once would have been taken in to such custodial facilities have been on their own. To the extent they are unable to care for themselves, these people, particularly those who are severely mentally ill, have become involved in the criminal justice system that was not designed to handle them.
It has been estimated that on any given day in this country some 550,000 of the 2.2 million inmates in our jails and prisons are suffering from a diagnosable mental illness. That number is almost precisely the number of people housed in state-run psychiatric hospitals in the U.S. in the years just before de-institutionalization began.
After being shaken by the experiences of some of the mentally ill defendants in his court, and coming to appreciate the lack of understanding and training among those who staff the criminal justice system, Judge Leifman set out to spur reforms.
About 15 years ago, he organized a Technical Assistance Summit where he invited various stakeholders, including law enforcement personnel and judges, to map out how criminal justice intersected with community mental health. Realizing that the current procedures in place were making the problem worse, the group decided to design a criminal justice model that made jail the last resort, and not a point of entry into mental health care.
Judge Leifman envisioned a reform program that would help people reintegrate into society by helping them with housing, relationships, and health care—especially mental health care. The program was so successful that the number of mentally ill people in jail in Miami-Dade dropped by half, with very low recidivism rates. Over the past five years, the program has expanded into non-violent felony cases, with a recidivism rate of only six percent.
Another initiative Judge Leifman helped to develop was a police training program, which has so far trained over 4,600 officers in Miami-Dade in how to identify someone with a mental illness, how to de-escalate situations involving public disturbances by mentally ill individuals, and where to take them instead of putting them in jail. The program also helps officers understand themselves and their own emotions, including traumas and other difficulties that may have occurred in their own families. According to Judge Leifman, this training has drastically reduced police injuries and police shootings of people with mental illness.
Judge Leifman’s model is simple: instead of sending people with low-level felony offenses (such as cocaine possession) to a prison cell or a hospital, send them instead to a facility which emphasizes treatment, restoration and reintegration into the society’s mainstream. It’s about one-third cheaper, one-third quicker, and has a near-zero recidivism rate, he says. Tested in Miami Dade, the model approach has been such a phenomenal success that the state of Florida is looking to expand it on a state-wide basis.
Judge Leifman’s latest project is a $22 million, first-of-its-kind “forensic diversion facility,” set to open in two years. The 180,000-square-foot building will consist of a crisis unit, a short-term residential unit, a courtroom, a day activity program, a primary health care unit, and a kitchen with a culinary supportive employment program. The building is designed to gently reintegrate individuals into their communities.
With the support of the American Psychiatric Association Foundation, the National Association of Counties and the Council of State Governments, Judge Leifman is trying to bring Miami-Dade’s humanitarian approach to the rest of the nation—to make it a model for how society should respond to the very real problem of seriously mentally ill individuals getting in trouble with the law.
In 2012 Judge Leifman received the Foundation’s Productive Lives Award. This Award was established to acknowledge the challenges, hope and the capacity for families and individuals to persevere and live productive lives with the help of science, family, friends and compassionate efforts of responsible civic and corporate leadership.
— Written By Fatima Bhojani and Peter Tarr, Ph.D.