Judge Steve Leifman Continues To Institute Reforms in Miami: Creating National Model

(11-2-18) Judge Steven Leifman, my good friend and one of the main characters in my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, has won an award from the Brain & Behavior Research Foundation because of reforms he has instituted in Miami-Dade Florida and his tireless national advocacy.

Take a moment to watch the short video about his award and you will be inspired.

He also was featured on a podcast about the steps he has taken to turn his community into a national model for jail diversion and community treatment. Here is the podcast.

CRIMINAL JUSTICE/MENTAL HEALTH

PRIORITIES AND WORK  PLAN RECOMMENDATIONS set out by Judge Leifman and community leaders.

 PROBLEM

1. Florida ranks 44^th nationally in access to mental health care[1], and, at $39.55 per capita, spending for community-based treatment ranks 49^th among all states and the District of Columbia.[2]
2. Of the 2.6 million adults in Florida with mental health problems annually, only 38.3% receive treatment.¹
3. Roughly 120,000 people with SMIs are arrested and booked into Florida jails annually.[3]
4. On any given day, there are more than 17,000 state prison inmates, 9,000 local jail detainees, and 30,000 individuals under correctional supervision in the community who experience serious mental illnesses.
5. Costs to house people with mental illnesses in Florida’s jails, prisons, and forensic treatment facilities:
   1. Jails = $340 million annually, or $930k per day
   2. Prisons = $395 million annually, or $1 million per day
   3. Forensic treatment facilities = $130 million annually, or $356 thousand per day
   4. Total cost = $865 million annually, or $2.3 million per day
6. Between 1996 and 2016, the overall inmate population in Florida prisons increased by 54%. By contrast, the number of inmates receiving mental health treatment increased by 157%. Inmates experiencing moderate to severe mental illnesses increased by 168%.
7. This year, roughly 5,600 inmates with serious mental illnesses will be released from Florida prisons, many without access to care.
8. Florida spends one fifth of all adult mental health dollars and two thirds of all state mental health hospital dollars on 1,000 beds serving roughly 2,000 individuals under forensic commitment.
9. On average, competency restoration services in a state forensic facility takes about six months to complete, at a cost to taxpayers of more than $60,000 per person.
10. Roughly 70% of people restored will have charges dropped or will accept a plea and be released to the community – in many cases with no provision for follow up services or access to basic necessities such as food, clothing, housing, or medication.

CONSEQUENCES:

The impact of failing to provide adequate community-based behavioral health treatment to those most in need is considerable:

1. Over a five year period, 97 individuals with serious mental illnesses in Miami-Dade County who were identified as “heavy users” of acute care and institutional services accounted for nearly 2,200 bookings into the county jail, 27,000 days in jail, and 13,000 days in crisis units, state hospitals, and emergency rooms.
2. The cost to taxpayers for these services was conservatively estimated at nearly $14 million with little impact on reducing recidivism and virtually no return on investment.

 SOLUTION: Maximize opportunities for diversion from the justice system for low-risk, nonviolent individuals

The State of Florida is faced with a clear choice: Continue to invest in a broken system that steers people into criminal justice and institutional involvement, or take steps to fundamentally redesign and rebuild public service systems to provide more effective and less costly treatment and prevention in the community.

Individuals with behavioral health disorders who become involved in the justice system as the result of low-level, nonviolent offenses results in enormous public health, public safety, and fiscal costs to the state and local communities. Diverting these individuals away from jails and prisons and into more appropriate community-based treatment is essential to ensuring healthier, safer, and more cost effective communities.

1. Ensure availability of evidence-based approaches, proven effective in Florida and around the country, to keep people out of the justice system, including: Crisis Intervention Team (CIT) training for law enforcement officers, mobile mental health crisis teams, pre-trial and post-arrest diversion services, intensive case management, and centralized mental health screening and assessment facilities.
2. Create a comprehensive continuum of specialized home and community-based services, including timely and accurate behavioral health screening and evaluation, designed to address the needs of people with histories of incarceration, homelessness, trauma, and addiction.
3. Ensure services are integrated across public and private agencies, and that treatment is focused on consumer recovery and choice and should include: mental and physical healthcare, case management, appropriate housing, supportive education, integrated substance abuse treatment, and psychosocial services.
4. Implement strategies to improve access to federal resources such as Social Security and Medicaid to help offset treatment costs that are currently funded exclusively by state tax dollars.
5. Create performance standards and accountability measures for service providers and communities to ensure maximum return on investment for state funded alternatives to incarceration and deep-end services.

OUTCOMES ACHIEVED:

TEXAS: In 2007, the Texas legislature rejected plans to spend $523 million on prison construction and operations and instead appropriated $241 million to expand the capacity of mental health and substance abuse treatment in the community. At the beginning of the 2007 Texas legislative session the prison population was projected to grow by 5,141 individuals by the end of 2008; however concurrent with the expansion of community-based services, the population increased by only 529 individuals during that time. Within eight years, the rate at which parole violators returned to prison had dropped by 46 percent, and the state’s crime rate was at its lowest since 1968.

MIAMI: The 11th Judicial Circuit Criminal Mental Health Project (CMHP) was established in 2000 to divert individuals with serious mental illnesses, who do not pose public safety risks, away from the criminal justice system and into community-based treatment and support services.

1. To date, more than 6,000 law enforcement officers from all 36 municipalities in the county have received 40-hour Crisis Intervention Team (CIT) training to teach law enforcement officers to more effectively respond to people experiencing mental health crisis in the community.
2. Between 2010 and 2017, CIT officers from the two largest law enforcement agencies in the county responded to 83,427 mental health calls, resulting in 15,894 diversions from jail, 47,115 individuals linked to community treatment, and just 149 arrests.
3. Among post-booking jail diversion participants, recidivism rates have been reduced by approximately 75%.
4. The average daily jail population declined from 7,200 to 4,000 inmates and the county was able to close one jail facility resulting in $12 million in annual savings.

[1] The State of Mental Health in America 2018, Mental Health America http://www.mentalhealthamerica.net/sites/default/files/2018%20The%20State%20of%20MH%20in%20America%20-%20FINAL.pdf

[2] Based on report of per capita expenditures for community-based programs, by state for 2012:

http://www.nri-incdata.org/RevExp2012/T12.pdf

 

[3] Sources of population estimates:

Population:	Total population	Est. prevalence of SMI	Est. number of people w/MI
Total statewide arrests	711,831*	16.9%†	120,299
Jail population	55,038‡	16.9%†	9,301
Prison population	99,119§	17.6%§	17,442
Probation	143,809§	16% to 27%±	21,913 to 36,978

* Figure reported by FDLE in the 2017 Annual Crime in Florida Abstract.

† Based on prevalence of serious mental illnesses among jail detainees as reported by Steadman et al (2009).

‡ Avg daily population reported by the FL Dept of Corrections for county detention facilities during June 2018.

• Population on June 30, 2016 as reported by the FL Dept of Corrections.

± Based on prevalence of mental illnesses among probationers as reported by Ditton (1999) & Crilly (2009).