Measure would overhaul forensic mental health system
Measure would overhaul forensic mental health system
Senior Editor
Miami-Dade County Judge Steve Leifman joked he was getting “old and gray” waiting for Florida to pass legislation to overhaul mental health services in the criminal justice system, where jails have become the largest, most expensive, and least effective psychiatric facilities.
Now in the eighth year of trying to revamp what he calls an antiquated, fragmented mental health system, Leifman said he is “cautiously optimistic” that the 2016 upcoming legislative session will pass HB 439, sponsored by Rep. Charles McBurney, R-Jacksonville, and chair of the House Judiciary Committee; and the similar SB 604, co-sponsored by Sen. Miguel Diaz de la Portilla, R-Miami, chair of the Senate Judiciary Committee, and Sen. Travis Hutson, R-Palm Coast.
On November 17, both bills passed unanimously out of the respective House Criminal Justice Subcommittee and the Senate Judiciary Committee.
“On behalf of myself as a judge, I want to applaud the really great work that Chair McBurney has put in on this important issue,” Fourth Circuit Chief Judge Mark Mahon testified at the House subcommittee. “The mental health people are overwhelming the court system, and it’s a solution whose time has come.”
Many would say the time is long overdue.
In the 2015 session, the bill to overhaul Florida’s forensic mental health system — that included about half of the issues raised by the Supreme Court Task Force on Substance Abuse and Mental Health Issues in the Courts — gained tremendous momentum and bi-partisan support, only to die during budget negotiations.
“Medicaid expansion blew everything up,” Leifman said. “At least we don’t have that going against us this year.”
This time around, Leifman said, while there are a “few little issues to resolve,” overall it is “a terrific piece of legislation. It’s broader than just creating mental health courts. It helps us get to larger issues facing the budget with mental health issues in Florida. One of the problems that we have had is Florida spends 22 percent of its adult mental health budget on 1,600 people a year.”
In introducing his bill, McBurney said it springs from a Judiciary Committee workshop last year that showed “persons with mental health issues, particularly with serious mental health issues, were overwhelming the criminal justice system. As a result, we brought in stakeholders from the criminal justice system to come and give their suggestions. We had sheriffs, state attorneys, public defenders, correctional officers, judges, specialty court judges, and juvenile judges.”
That collaboration, McBurney said, is the basis for his bill that:
• Allows counties to create and fund treatment-based mental health court programs;
• Permits a defendant with a mental illness who meets qualified criteria to participate in pretrial mental health court programs;
• Allows judges to require offenders to participate in post-adjudicatory treatment-based mental health programs if certain eligibility requirements are met;
• Creates a forensic hospital diversion pilot program;
• Expands the definition of veterans for participation in veterans courts to include those discharged or released under general discharge;
• Allows judges to require qualifying veterans to participate in treatment programs, as part of their probation or community control;
• Allows a juvenile with a mental illness to be admitted to a delinquency pretrial program for treatment purposes; and
• Allows a judge to dismiss charges against a juvenile upon a juvenile’s successful completion of the program.
There was no debate before the unanimous votes in both chambers.
On November 18 — the day Leifman was packing up his family for a trip to Washington, D.C., to receive the highest honor from the National Center for State Courts, the William H. Rehnquist Award for Judicial Excellence — he said the most significant thing the bill does “is expand a program we started in Miami five years ago.”
“Florida needs a lot more money to fix the problem, but at least this starts to put a better, smarter system in place to spend money more efficiently to deal with the problem,” he said.
The 11th Circuit Criminal Mental Health Project diverts people with serious mental illnesses who don’t pose a risk to the public away from the criminal justice system and into community-based treatment and support services.
“When I became a judge, I had no idea I was actually becoming the gatekeeper for the largest psychiatric facility in Florida. That’s the Miami-Dade County Jail,” Leifman said at a NCSC media briefing on mental health issues in the courts, held November 19 in Washington, D.C.
“It’s like watching a parade of misery every day, when you sit in the criminal division as a state court judge. And it’s frustrating, because our systems are so fragmented, so under-resourced, so outdated, that often it became an act of futility when you watch the same persons come before you day after day.. . .
“I’ve had people leave my court and be arrested within five minutes of their leaving, because they were sicker when they left than when they came in,” Leifman said.
“In Florida, and most other states, the fastest growing subpopulation in our prison system is people with mental illnesses.”
In Florida, he said, there has been a 56 percent growth rate in prisons for a dozen years. During those 12 years, he said, inmates with moderate and severe mental illnesses have grown from 7,000 to 18,000 today.
“It’s grown so fast that our Department of Corrections estimates that Florida could build 10 new prisons just to house the mental health population,” Leifman said. The cost to build and operate 10 prisons in Florida for a decade, he said, is $2.2 billion.
Yet, he said, most of the mentally ill prisoners are not committing violent or serious offenses. The average stay in prison for someone with a mental illness, he said, is two and a half to four years.Most, he said, accumulate a lot of points with misdemeanor arrests, and then pick up a third-degree felony and prison time.
“You have to ask yourself: Isn’t there something wrong with a society that spends more money incarcerating people than to treat them?” Judge Leifman asked.
“Most of our laws concerning mental health services are more than 50 years old,” he said. “They were done before microwave ovens were invented, forget computers. So they just don’t work.”
South Dakota Supreme Court Chief Justice David Gilbertson, president of the Conference of Chief Justices and chair of the NCSC Board of Directors, called Leifman “a pioneer in the field who works in the trenches.”
At the media briefing, Justice Gilbertson said: “We are here this morning to raise awareness about a crisis that is affecting our courts, our communities, and our families. The criminal justice system has become a substitute for our country’s mental health system. And courts were never designed to treat people with mental illnesses.. . . By honoring Judge Leifman, we hope to raise awareness that while the criminal justice system was not designed to treat folks with mental illness, court leaders are working on a remedy.”
And so are Florida’s legislative leaders.
As Chief Judge Mahon testified: “It’s not only, in my view, the humane thing to do, but I think at the end of the day it would be cost-effective. It will get those people out of the high-cost prison beds and jail facilities and into the mental health facilities where they can get the help they need.”
