Judge views mental illness as disease, not crime

Getting cost-saving results

By Stacey Singer 
Palm Beach Post 

As a county judge, Steven Leifman spends every day grappling with a problem most people prefer to forget -- trying to heal the mental health system.

He sees its failures every day. About 30 percent of women in Florida's prisons have a serious mental illness; about 14 percent of men do, he says. Nationwide, the figures are much the same.

For decades, mostly by accident and neglect, states across the nation have been cutting community mental health services while shuttering mental hospitals. Meanwhile, they've expanded prisons. It has left the nation's criminal justice system the de facto mental health care provider, at tremendous cost.

Florida spends almost $250 million a year just to help severely mentally ill defendants become competent enough to stand trial, Leifman says. That's one-third of the state's entire budget for adult mental health services, he adds. This antiquated competency system touches only 3,000 lives a year. Meanwhile, another 170,000 defendants need mental health services at the time of their arrest.

Leifman recites those figures every time he's asked to explain what's broken about the system, whether it's to the Florida Legislature, a CNN crew, or a scientific meeting. There is a better way, Leifman says, and he has proof.

"If we would start to look at this as a disease instead of a crime -- which it's not -- if we would start to apply disease models to this problem, instead of a criminal justice model, we would get very different results," Leifman says.

Palm Beach County would benefit immensely by taking a hard look at how uncoordinated and scarce mental health services increase costs for police, courts and jails, Leifman says. So would the rest of the nation.

He speaks from experience. At 54, Leifman has spent 15 years working as a judge in Miami-Dade County, grappling with his community's mental health system for most of them. In the process, he has become a leading national voice for more effective public policy.

He didn't set out to be a mental health crusader. Short and bookish, he grew up in Miami, went to college at American University in Washington, D.C., and studied law in Tallahassee at Florida State University. He's constantly asking "Why?" and sometimes more importantly, "Why not?" Although cheerful and friendly to mayors and misanthropes alike, he privately rails against bureaucracy when he believes it does harm. To that end, he tells the story of his own final straw, the case that changed the course of his career.

In 2001, a man named Richard Beatty was before him for a minor crime. Beatty was homeless, a Vietnam War veteran who suffered from severe post-traumatic stress disorder and became psychotic when triggered. Leifman saw no point in sending the vagrant man to jail, so he released him for time served.

Not long after, Beatty knocked on the window of a restaurant a few blocks away from Leifman's courtroom. Beatty motioned with his penknife that he wanted food. Restaurant staff ignored him. He begged more aggressively. Police were called.

Lights flashing, sirens blaring, police cars surrounded Beatty. Officers drew their batons, and one hit him, trying to knock his penknife away. This triggered a full psychotic episode -- Beatty fled, believing he was in combat. The police pursued. The ensuing standoff went on for hours, shutting down roads and bridges in all directions. It ended only after police opened fire and Beatty died in a hail of 17 bullets.

The next day, Leifman and then-Miami Police Chief Raul Martinez, spoke. Martinez admitted his officers felt terrible, killing a homeless man who had served his country, a man whose first crime was hunger. But what else could they have done? Leifman told him he should reconsider adopting a proven technique called "crisis intervention team" policing.

Martinez finally did. Today, that and other initiatives are making a dramatic difference.

More than a decade later, 3,900 officers from Miami-Dade County and most of its municipalities have taken the 40-hour CIT course, spending a full week learning to recognize and communicate with a person with mental illnesses. Everyone from rank-and-file deputies to their supervisors, 911 officers and corrections officers in the jail take the class, which Leifman helps teach.

The CIT-trained officers now handle about 16,000 calls a year, de-escalating tense situations, assisting people in crisis rather than arresting them.

Miami's officers last year logged 5,000 CIT calls, said Lt. Jeffrey Locke, while arresting just 25 people. It requires a major change in approach, Locke said.

"It's gone from handcuffing the person and throwing them into the patrol car, to talking to them, walking them over to the patrol car," and perhaps taking them for a voluntary psychiatric evaluation, Locke said. "When we approach them, we say, 'We're here to help you. We're not here to hurt you. Do you want help?'"

Meanwhile, officer-involved shootings have plummeted.

"We used to average 20 or 30 officer-involved shootings a year, at least 10 of those were mental-health related," Locke said. "Since we started this, there have only been two."

As an incentive, the city of Miami's CIT-trained officers qualify for a 2.5 percent raise, while county corrections officers on the mental health floors of the jail get a 5 percent raise.

The savings to the community has been gigantic and multifaceted, Leifman said. Bond analysts were willing to raise Miami's bond rating because of the reduced liability risk. That, in turn, lowered the city's cost to borrow.

And earlier this year, Miami-Dade County closed one of its jails, its Women's Annex, because the average number of inmates fell from around 7,400 a year to just 4,800 at latest count, saving about $12 million a year.

Relentless advocate

Because of his success, Leifman was named chairman of a Florida Supreme Court task force on substance abuse, mental illness and the courts. Before that, he had served for three years as special adviser to the court. He's used the perch relentlessly to influence state policy; for example, pushing for better coordination between law enforcement and the courts.

This year, he endorsed a proposed gun-control law that adds people voluntarily admitted to mental institutions to the list of people who can't buy guns. The bill passed and is awaiting action from Gov. Rick Scott.

Another initiative Leifman championed alters how Miami-Dade courts handle people charged with misdemeanors, if mental illness is a driving cause of their crimes. It directs the defendants to treatment and care rather than jail.

Two judges preside over the special mental health docket, and most charges are dismissed if the defendants follow their social workers' and therapists' orders.

On a recent court day, Bismarck Rodriguez blew kisses to a judge who promised to dismiss his disorderly conduct charges with successful completion of a 90-day program at Fellowship House.

Rodriguez, who emigrated to Miami on a raft from Cuba in 1994, said he spends his days on South Beach. He was arrested after fighting and "scaring people," he said. On entering the courtroom, he was first asked how he was feeling.

"I'm feeling good, judge," he said, bowing. "I got no enemies here."

Treatment over jail

Importantly, on release, defendants such as Rodriguez will be connected to peer counselors who have already succeeded in the program, and linked to long-term mental health support. The recidivism rate for defendants routed through the special docket is a staggering improvement over the past. Just 20 percent are rearrested, compared with 75 percent for those handled through the regular court system.

A third program, in place since 2011, is an alternative to the state hospitals where defendants go to regain competency. So far, 80 severely mentally ill people who were deemed incompetent to understand their second- and third-degree felony charges have been routed through an inpatient stay at Jackson Behavioral Health Hospital, in a special wing called the Miami-Dade Forensic Alternative Center.

Rather than focusing on restoring competency, the program focuses on restoring health, and preparing the defendants to rejoin the community. The graduates' rearrest rate is zero, so far, and their hospitalization is costing taxpayers two-thirds of a stay at a state forensic hospital, Leifman said.

Leifman has more plans. He intends to open a secure alternative to the dark and dreadful Miami-Dade County Jail, where inmates with severe mental illness are crammed naked in airless Plexiglas cells, often three packed into a cell designed for one person. Wedged around a bare toilet, with little or no recreation or daylight, the conditions seem designed to make a sane person crazy.

The U.S. Department of Justice recently sued over the conditions. Again, Leifman brought the solution. He raised money to restore a nearby vacant state forensic hospital. It will soon be reborn as a county-run secure treatment facility, where there will be therapy, recreation, job training, sunlight, and care focused on helping inmates lead successful lives upon release.

The solution lies in keeping those people out of the criminal justice system altogether, he says.

"It's a community problem. It requires a community solution," Leifman says. "The diseases are complicated. The solutions are not."

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