The Definition of Insanity Film Documents The Success Of Judge Leifman’s Reforms In Miami Dade
(12-7-20) Miami Dade Judge Steven Leifman is my choice for the most impactful player in mental health during 2020.
For a decade, Judge Leifman has worked tirelessly to reform how our criminal justice system interacts with individuals with mental illnesses. He has traveled across the nation educating judges, prosecutors and defense attorneys about the so-called Miami Model that has become the gold standard in our nation for reducing violence, unnecessary arrests, and inappropriate incarceration. The model encourages recovery, reduces stigma, and gives individuals hope.
Judge Leifman’s approach has a proven and impressive track record.
Changing Police Culture
The model’s pre-booking program involves training law enforcement officers throughout the county in Crisis Intervention Team (CIT) policing. This training teaches officers to better recognize and respond to individuals experiencing psychiatric emergencies by de-escalating the situation and transporting the individual to a treatment facility rather than taking them to jail. People who may otherwise be arrested for non-violent offenses are diverted to crisis units to receive treatment instead of being arrested.
Officers who once arrested individuals in crisis and charged with felonies for such minor acts as spitting at them, now take pride in ignoring such abuse because they understand the actions come from an individual who is not thinking clearly.
To date, more than 7,600 officers who serve in Miami-Dade County’s 36 municipalities and in county public schools have received CIT training. Over the past 10 years, officers from the two largest police departments have responded to more than 105,000 mental health crisis calls that resulted in over 18,000 diversions to crisis units and only 198 arrests.
Judge Leifman receives award for his mental health advocacy from U.S. Supreme Court
The average daily census in the county jail system dropped from 7,200 to 4,000 inmates, one jail facility has been closed resulting in a savings to taxpayers of $84 million to date. The total number of arrests each year fell from 118,000 to 53,000 last year. Additionally, there has been a precipitous reduction in police shootings and excessive use of force. Injuries among people with mental illnesses and law enforcement officers have also been significantly reduced.
Post-Booking Diversion Program
Serving individuals with serious mental illnesses charged with misdemeanor and less serious felony offenses who are booked into the jail, the post diversion program works with the stakeholders from the jail, the courts, and the community mental health system to screen and assess individuals referred for diversion, facilitate admission from the jail to community-based treatment settings, assist with discharge planning and linkages to housing, treatment, and support services, and monitor ongoing access to care and criminal justice system involvement.
Among individuals charged with misdemeanors, recidivism has been reduced from 75 percent to 20 percent annually. Individuals participating in the felony jail diversion program demonstrate reductions in jail bookings and jail days of nearly 75 percent pre-versus post-program enrollment, with those who successfully complete the program demonstrating a recidivism rate of just 25 percent.
Since 2008, the felony jail diversion program alone is estimated to have saved the county roughly 31,000 jail days or nearly 84 years of jail bed days. With the dollars Leifman’s program has saved the County, the community is building the first of its kind mental health diversion facility. This medical home will offer all the essential elements of recovery for the most acutely ill in one location, including housing and a courtroom. It is expected to open next Fall.
Heavily relies on Peers
The program’s “secret sauce” is its heavy reliance on peer support. Judge Leifman’s leadership skills are what enabled him to bring all stakeholders together and get them working together.
Judge Leifman was responsible for getting me into the horrific Miami Dade Pre detention Center whose barbaric conditions are documented in my book, CRAZY: A Father’s Search Through America’s Mental Health Madness.
It was during my ten month long visits to that jail that I came to deeply admire Judge Leifman as a jurist and person. His saw first hand how broken our system was when he was 17 years old and working as an intern in Miami for then U.S. Sen. Bob Graham. The senator received a letter about alleged abuse of a young man at a local state psychiatric hospital. Leifman was sent to investigate and found the man in four point restraints and more than a hundred pounds overweight because of injections of Thorazine being given to him without his consent. Turned out, the man wasn’t mentally ill. He had autism.
In 2000, then a judge, Leifman was shocked when a homeless Harvard educated psychiatrist appeared in his court. His family had been trying unsuccessfully to get him help because he had been diagnosed with schizophrenia. At first, the doctor seemed fine, causing Leifman to wonder if the parents were over-reacting. That was before, the doctor had a mental breakdown in the courtroom. Leifman was unable to help him because of inadequacies in our system and the man disappeared. Twenty years later, neither the judge nor the man’s parents know what happened to him.
Determined to make a difference after witnessing “revolving door” in his courtroom
Both Judge Leifman and I had an opportunity to testify before Congress about the staggering number of individuals with mental illnesses flowing into our jails and prisons. He pointed out that people with mental illnesses in the United States are 10 times more likely to be incarcerated than hospitalized. They are 19 times more likely to find a bed in the criminal justice system than at a state civil hospital.
Annually, more than 1.7 million people with serious mental illnesses are arrested. On any given day, there are about 380,000 people with Serious Mental Illnesses (“SMI,” defined to include schizophrenia, schizoaffective disorder, bi-polar disease, major depression and PTSD) in jails and prisons and another 574,000 are on probation or under community control.
A survey of 1,400 families completed by the National Alliance on Mental Illness found that forty percent of their loved ones with SMI had been arrested one or more times. Approximately twenty percent of all jail and prison inmates have a diagnosable SMI, fourteen percent of men and thirty-three percent of women, often due to trauma.
Drugs and alcohol also account for a significant part of this problem. Sixty-five percent of all inmates in jail and prison in the United States have a diagnosable substance addiction and eighty-five percent of all inmates in jail and prison meet the criteria for substance abuse.
Judge Leifman explained that aside from the enormous human cost of using the criminal justice system as the de facto mental health and substance use primary point of “treatment”, the fiscal impact to the government and taxpayers is astronomical, providing few if any measurable positive outcomes.
Cost of locking up individuals in crisis
Judge Leifman reports that Miami-Dade County currently spends $636,000 dollars per day or $232 million dollars per year to warehouse approximately 2,400 people with serious mental illnesses in its jail. Comparatively, the state of Florida spends $47.3 million dollars annually to provide mental health services to about 34,000 people in Miami-Dade and Monroe Counties, leaving almost 70,000 people in these two communities without access to any mental health services.
Put another way, taxpayers pay $100,000 a year for each person with a mental illness in jail, with no positive impact, but allocate only $1,400 a person to treat those with mental illnesses to help them maintain stable lives and contribute to their families and communities and zero is spent on a large number of struggling individuals who get who nothing at all by way of services. This makes absolutely no sense.
“Arrests and incarceration should be the last resort for people with serious mental illnesses,” Judge Leifman told me once. “Tinkering with the existing system will not improve access to care or quality of care and it certainly will not improve the poor outcomes we see today. We need a new vision and a new approach.”
For the past four years, Judge Leifman has been working with the Community Psychiatry Section of the Group for the Advancement of Psychiatry (GAP) to develop a model crisis response system for the United States. This model will be published later this year by the National Council for Behavioral Health.
The judge and I serve on the board of the Corporation for Supportive Housing (which works to create housing for those most in need) and on the federal ISMICC panel that advises Congress about mental health matters. Working with him is simply inspirational.
He was not only the most important advocate during 2020 in mental health but he will continue to be a champion for reform during the years to come.
We are all benefiting from his leadership, passion and creativity.
Thank you judge!
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