AG’s round table focuses on mental health in the criminal justice system
For nearly two decades, Michael, a homeless man with mental-health issues, was a fixture at the same intersection in Sarasota. He regularly found himself at odds with the law.
Sarasota County Judge Erika Quartermaine called him the “face of the homeless” in Sarasota. That was until Michael finally received the mental-health treatment he so desperately needed.
“He now has, for two years, been living independently in his own efficiency where he has support, and he has a fish that he named Fish Fillet,” she recounted of Michael’s experience in her mental-health court. “It meant so much to him to have that fish.”
To see success stories like Michael’s played out repeatedly proves the value of mental-health courts, said Judge Quartermaine, speaking August 23 at the last of Attorney General Ashley Moody’s four Mental Health and Criminal Justice Round Table Summer Series. The event was held at the Florida Supreme Court and co-hosted by Chief Justice Charles Canady.
The Big Picture
If Michael shows an individual example of the value of addressing the mental-health issues of those in the criminal justice system, Miami-Dade County Judge Steve Leifman provided a larger perspective.
Diverting and treating people with mental illnesses instead of arresting and warehousing them in jail has allowed Miami-Dade County to close one of its three main jails, at a cost savings of $12 million a year, said Leifman, a recognized national expert on mental-health issues in the criminal justice system and chair of the Supreme Court Task Force on Substance Abuse and Mental Health Issues in the Courts.
And providing crisis intervention training (CIT) at each of the 36 local law enforcement agencies in Miami-Dade has nearly ended police-involved shootings. Leifman said the consequent reduction of lawsuits and related expenses has led to an improved bond rating for Miami-Dade, not to mention reduced stress and strain on officers involved in such incidents.
Round Tables Summer Series
Moody said the first three round tables dealt with law enforcement, including police mental health (there are more police suicides than deaths in the line of duty) and how the mentally ill are dealt with in the streets and in jails.
This includes the cycle of arresting the mentally ill, running them through the court system, and then releasing them back into the community without support, frequently to be rearrested, usually for minor offenses.
“This [meeting] is to talk about mental health within our courts, and what we are doing now, taking a snapshot of where we are as a state, and what we might be able to improve,” said Moody, a former trial court judge.
“There are practices in place that have gone through the trial and error process and we should learn from that.. . . There’s no need to jump in and recreate the wheel if we have a background of best practices and what’s worked and what hasn’t.”
Moody noted 24 of Florida’s 67 counties, encompassing 14 of its 20 circuits, have special mental-health courts and said: “This is the critical moment where we might see additional courts being developed and I want to make sure we’re all focusing on the best ways to do that.”
Leifman, Quartermaine, and 17th Circuit Judge Ari Porth — all of whom preside over mental-health courts — spent most of the meeting discussing efforts to address mental illness, with Leifman providing some overall statistics.
He noted when former Chief Justice Fred Lewis ordered a study 13 years ago, it found that around 2.8 million Floridians had serious mental-health problems, 61 percent were receiving no treatment, and 143,000 people with mental problems were arrested annually, many cycling repeatedly in and out of the criminal justice system that was ill-equipped to meet their needs.
While Florida’s prison population has stabilized over the past 20 years, Leifman said, the number of inmates receiving mental-health treatment is up 157% and the number experiencing serious mental-health problems is up 167%.
At the present rate, Florida will need 10 new prisons over the next 10 years just for mentally ill inmates — at a cost of $10 billion, he said.
“We need to make sure there are standards for every single court in the state so we are making sure the right people come into the courts, we get the right outcomes, and we have the technology that means. . . we can ensure we are spending the state’s dollars appropriately,” Leifman said.
“What you find if you dig through the data. . . is a very traumatized group of individuals who had very, very difficult lives,” he continued. “Ninety-two percent of all the women in jails and prisons in the United States with serious mental illnesses were sexually abused as little kids, usually at 6, 7, and 8 years old. Seventy-five percent of the men in the criminal justice system with serious mental illnesses also have serious histories of bad trauma, whether living in a home with domestic violence, sexual abuse, or living in a neighborhood that’s a war zone and seeing things that children should never have to see.. . .
“We have to start treating these illnesses as illnesses, and not crimes.”
Felony Mental-Illness Court
Porth said Broward County has had a felony mental-illness court since 1997, one of the first in the country, and it handles all such cases except those involving domestic violence and career offenders. The court has a forensic psychologist, probation officers, specially assigned assistant state attorneys and assistant public defenders, benefit specialists, including in Social Security, who can help defendants with housing, transportation, and living expenses — a critical issue, he said.
He summarized how cases are handled, treatments determined, competency addressed if that is an issue, and court supervision of ordered treatment accomplished.
“A continuing issue that we face. . . is maintaining services for participants once they are found competent, and making sure if they have been receiving case services from a mental-health agency, that those services continue regardless of the finding of competency to proceed,” Porth said. “The term ‘warm handoff’ is used to suggest there needs to be seamless transition of services for the person from a forensic setting to the community.. . . We see time and time again in court behavioral-health agencies leading a client to the finish line and dropping them just before they complete the race. We need to ensure that services that have been successful in stabilizing the client and restoring them to competency — or stabilizing them in the community — do not end because of a legal finding of competent to proceed.”
Quartermaine said the Sarasota mental-health court started with misdemeanor cases and has expanded to include felonies. She said every jurisdiction will have slightly different conditions and needs to tailor its mental-health court to those conditions.
“Homelessness and mental illness cannot be separated, they go hand-in-hand,” she said. “It’s partly because of the closure of the mental-health institutions.”
The Sarasota program is working, she said, and even people who fail to complete the full program have a lower recidivism rate. Arrests have been cut in half and the homeless population, according to the best indicators, has also been halved.
There’s also an economic incentive, Quartermaine said. The cost averages $10,000 to participate in the drug-court program, which is equal to the costs for about three months in jail and a month stay in a mental-health facility.
Mental-health courts can be effective, especially in erasing misunderstandings about mental illness, Leifman said.
“People with mental illnesses are no more dangerous than the general population” and they are less dangerous when on medication, he said. “Only about 4% are involved in violent crimes.. . .
“Recovery rates for people with mental illnesses are actually much better than for people with heart disease and diabetes. These are not death sentences. People can recover and have full and complete lives again. Just like any other illness, the earlier we identify it and the earlier we treat it, the more likely they’re going to have a full life and recovery.”
One way to get early identification is to train pediatricians, teachers, and others who have frequent contact with children to recognize the early signs of abuse or trauma that lead to mental illness later.
Better training for law enforcement also works. Leifman said Miami-Dade County has both pre-trial and post-trial intervention programs, and the former involves training police to deal with the mentally ill.
More than 6,700 police officers in the county have received crisis intervention training, more than any other jurisdiction in the country.
“We keep data on every call that the City of Miami and Miami-Dade police department CIT officers make, because they make about 60 to 70 percent of all calls countywide,” Leifman said. “Over the last eight years. . . combined. . . those two agencies handled 92,427 mental-health calls, out of those 92,427 calls, they only made 152 arrests.
“We went back and did an analysis call to arrest ratio, we wanted to see if that was the main reason we saw such reduction in arrests in Miami-Dade County and it almost lined up one for one.”
Post-trial intervention includes ensuring clients get treatment, treating ancillary physical-health problems (which most have), ensuring they take medications, and helping with jobs, transportation, and housing. It has reduced recidivism from 72 to 20 percent, Leifman said, for misdemeanors and to 25 percent for nonviolent felonies.
The programs have worked so well and saved so much money, that Miami-Dade County on its own is building a $42 million one-stop facility aimed at the mentally ill with the most acute problems.
“We really have two choices in this state,” Leifman said. “We can continue to release people from the criminal justice system without treatment or we can give them treatment. And we all know treatment works.”
Moody noted that Leifman, Quartermaine, and Porth had no prior experience dealing with mental-health issues before they became involved with mental-health courts, but brought drive and commitment to their assignments.
“If you’re considering a [mental] court, make sure it’s someone who has the personality, particular skill set. . . and that they are trained appropriately,” she said. “Do not make that decision on who will head it up lightly.”
Chief Justice Canady thanked the Legislature for funding specialty courts, including mental-health courts, and said the judicial system will remain “committed to doing everything we can to appropriately address mental-health issues in the courts.. . .
“We believe it’s the right thing,” Canady said. “It’s the best path forward for justice.”