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December 1, 2013
Stop treating mental illness as a crime

By Jan Pudlow
Senior Editor

When Steve Leifman became a judge, he had no idea he was becoming the “gatekeeper of the largest psychiatric facility in Florida.”

And, he said, “unfortunately, that’s the Dade County Jail.”

Now, Leifman — associate administrative judge of the Miami-Dade County Court Criminal Division and chair of the Florida Supreme Court Task Force on Substance Abuse and Mental Health Issues in the Courts — continues his crusade to stop treating mental illness like a crime.

Those efforts include the creation of Florida’s 19 mental health courts, with the first one in the U.S. in Broward County. It’s Judge Leifman’s personal opinion that legislation is needed to change the Baker Act to give judges on the civil side more authority to keep the mentally ill involuntarily hospitalized longer.

Talking to the Senate Appropriations Subcommittee on Criminal and Civil Justice, Leifman played the sobering video by CBS Channel 4 TV in Miami called “The Forgotten Floor,” where four to five men with mental illnesses are locked in a cell built for one, pacing and shivering as they wait their turn to sleep on a cold metal bed, some locked up for months.

“It’s a bad secret and a sad secret,” Judge Leifman says in the video.

In the years since that 2006 video, the secret has been told and told again, as the criminal justice system struggles to deal with nearly 180,000 people a year who need acute mental health treatment at the time of their arrests.

On November 6, Leifman told the senators that he believes the Baker Act, the process for involuntary civil commitment, needs to be changed to give judges more authority to help mentally ill people get treatment in order to keep them out of the system’s jails and prison cells. Instead of just gauging “imminent danger to self or others,” Leifman suggests the standard should include treatment options.

“Florida is one of four states left that has an extraordinarily high standard to involuntarily hospitalize, meaning that, in order for the court to order someone into treatment, they have to meet criteria which say they are imminently dangerous to themselves or others.

“Dangerousness is a standard that was developed in the 1700s,” Leifman said. “We need to really consider treatment, not just dangerousness, because most of them aren’t dangerous in that capacity, like we think. Most of it is going to be suicide. . . . If they are hitting the system again and again, the court probably needs greater authority to be able to keep them in longer. And then, when they are ready to come out, have a system of care around them that is going to prevent them from escalating and decompensating. And we don’t have that.”

Now, Leifman said, when the mentally ill leave the hospital and go back out into the world, “they go under the same bridge where they were living, and the same police officer picks them up, and it just keeps recycling. . . .

“If you want to have a system that people don’t need to get arrested, you need to look at the Baker Act,” Leifman said. “We’re finding all kinds of research that we didn’t even know 10 years ago. There’s a lot of data that suggests that people who go untreated for several years are getting permanent brain damage. There are huge implications, both legally and medically, that we need to start to consider.”

Judge Leifman said the Supreme Court task force has not come out with recommendations, and that it will be a long process.

“But personally, and this is not speaking for the court, we need to have better wrap-around services for that 20 percent,” Leifman said, referring to 20 percent of people who are Baker Acted and come back “again and again and again. And there’s a huge correlation between people who are Baker Acted more than twice and people getting arrested. It’s between 80 and 90 percent. We need to be doing more on the civil side, so that they don’t come into the criminal side.”

To understand the enormity of the crisis, Leifman hit the senators with some astonishing numbers:

“On any given day, we have 18,000 prisoners, 10,000 local detainees, and between 25,000 and 40,000 on probation and community control with a serious mental illness in Florida. And this year, we are expecting 7,000 inmates with serious mental illnesses to be released from the prison system,” he said.

“The consequences of untreated mental illness are overwhelming. As a result, we’ve seen homelessness increase; we’ve seen police injuries increase; we’ve seen police shootings with people with mental illnesses increase.

“We are wasting critical, critical tax dollars in the way we do things. And in some ways, we’ve made mental illness a crime. Last year, the police in Florida actually initiated more Baker Act cases than the total number of arrests they made for robbery, burglary, and grand theft auto combined,” Leifman said.

The Florida Mental Health Institute at the University of South Florida is doing a study in Miami-Dade County, where there is the highest incidence of mental illness of any urban area in the United States, at almost three times the national level, Leifman said.

About 9 percent of the general population in Miami-Dade County suffers from a serious mental illness, he said: around 170,000 adults and 55,000 children.

“We wanted to see how we could do a better job to wrap our arms around this population to make sure that they weren’t continuously reoffending,” he explained.

Through blended computer sites, FMHI has looked at criminal records, Baker Act records, and Medicaid records to size up who is most involved in the criminal justice system in Miami-Dade County.

“To my shock, they sent me a list of 97 individuals. These 97 individuals, almost primarily men, almost all diagnosed with schizophrenia, over a five-year period were arrested 2,200 times. They spent 27,000 days in the Dade County Jail, 13,000 days at some type of crisis center or psychiatric facility.

“The cost to taxpayers was $13 million. And we got absolutely nothing for it! Ninety-seven men! I guarantee these 97 are in every single community in Florida. The key is for us to figure out how we target these high utilizers who are killing our deep-end system. This is the reason we need problem-solving courts — to really attack that problem.”

If you think that’s bad, Leifman said, here’s the story on the forensic hospital side. Florida spends between $200-$250 million a year — almost a third of its adult mental health dollars — to restore competency for about 3,000 people.

“It’s growing so fast that, if we don’t do something to change this system, by the year 2027 we will need to spend about three quarters of $1 billion to try to restore competency to 3,000 people,” he said

Of those whose competency has been restored, he said, 70 percent are coming back to the local jail.

“These 70 percent have three things happen to them: They either have the charges dropped because the witnesses have disappeared, after you have spent $60,000 to $70,000 on them; they get credit for time served, because we are trying to get them through the criminal justice system, and they walk out the front door without any access to treatment; or, three, they get put on probation and maybe get some access to treatment.”

As one of Leifman’s colleagues often says: “It meets the definition of insanity.”

“We keep doing the same thing again and again, and we expect a different outcome,” Leifman said. “It’s not working.”

In Florida’s state prisons, the mental health population grew by 160 percent between 1996-2012, compared to the overall non-mental health population growing by 56 percent.

“We went from about 6,700 inmates 10 years ago with serious mental illnesses to almost 18,000 this year,” Leifman said.

“It is growing so fast that it is now projected that if we don’t do something to change the trajectory, over the next 10 years this number will be close to doubling. And it will cost Florida almost $3.5 billion over the next 10 years just to house people with mental illnesses in the prison system....”

But Leifman had some good news. Through the Mental Health Substance Abuse Reinvestment Grant, Leifman said, more than 4,000 police officers have been trained in what is called Crisis Intervention Team Policing. Out of 10,000 mental health calls, law enforcement only made 27 arrests.

Sen. Rob Bradley, R-Orange Park, chair of the subcommittee, said: “The Baker Act and the fact that we are in the minority with regard to involuntary commitment is something I was not aware of until today. That seriously needs to be addressed.”

Judge Leifman responded: “It always has to be a balance, and we have to protect people’s individual rights. But the thing that we didn’t know when these laws were written is that some people may be getting permanently brain damaged because we are waiting so long to treat them. We’ve got to do it carefully. This is a long process. I am not coming in here saying we need to do something now. It has to be very, very well thought out. But there are other states that are starting to address it differently, and I think there’s no reason we shouldn’t be doing it as well.”

[Revised: 07-08-2014]