Florida leaders consider better approaches to handle the mentally ill’s revolving jail door

Court officials in Miami-Dade County have identified 97 people who, far gone into mental illness and substance abuse, together have spent 27,000 days in jail and 13,000 days in psychiatric facilities during the past five years. The cost to taxpayers: $14.7 million.

These are the faces of the mental-illness crisis in Florida’s criminal justice system. Their illnesses lead them into mostly petty crimes that repeatedly land them behind bars, where too many languish without effective treatment and re-offend soon following release.

These sufferers are not usually dangerous – they commit only 4 percent of violent crime. Only 6 percent of the people involuntarily committed for treatment under the state’s Baker Act pose threats to other people. More often, they are a risk to themselves.

“We have to start treating these illnesses as illnesses – and not crimes,” said Miami-Dade County Judge Steve Leifman.

Miami-Dade founded the nation’s first “problem-solving court,” focused on drug abuse, in 1989. Problem-solving courts mix criminal justice with specialized therapy. Leifman is a key figure in this effort.

His county is investing $42 million on what Liefman called a “one-stop shop” for pre- and post-trial detainees that offers psychiatric, primary care, dental, and ophthalmic treatment, tattoo removal, job training, and trauma services. It’ll house a courtroom, too.

The county can afford it, Leifman said, because its criminal diversion and treatment programs have drastically cut misdemeanor re-offenses from 72 percent to just 20 percent.  The county’s inmate population dropped from 7,300 to 4,000 – enough that the county closed one of three county jails six years ago, saving $12 million a year. The homeless population fell from 8,000 to 1,000, he said.

A solution for Florida?

Can the example set by Miami and a few other cities spread statewide? That was the focus of a final roundtable discussion held by Republican Florida Attorney General Ashley Moody this month in Tallahassee to delve into how Florida’s criminal justice system treats people with mental illness.

“This is the first time this has been looked at as a comprehensive whole,” Moody told a group of trial judges from throughout the state, who assembled in a conference room in the Florida Supreme Court along with Supreme Court Chief Justice Charles Canady to learn the latest developments in problem-solving courts.

“The recommendations that are coming out of this may end up being presented as some sort of legislative change request,” Moody said,  “but we’ll have to do that after taking the information we have learned, digesting that, and working with leaders throughout the state.”

The problem boils down to trauma. According to Leifman, 92 percent of all the women in America’s jails and prisons were sexually assaulted as children, and 75 percent of the men suffered physical or sexual abuse or grew up in “war zone” neighborhoods. Combat veterans are also at risk. (So are cops, many of whom served in the military).

Trauma can produce physiological changes in the brain that underlie post-traumatic stress disorders, and that can lead to violence or self-medication.

The problem is exploding

An estimated 134,000 people with mental health problems are arrested in Florida each year. On any given day, Liefman said, more than 60,000 are jailed or under correctional supervision.

These prisoners are suffering from serious mental problems – bipolar disorder, schizophrenia, major depression. But their crimes are not necessarily serious – typically, they serve less than four years. They cycle in and out of the system because they don’t receive proper therapy.

“The cost is outrageous,” Leifman said.

Florida spends $2.3 million each day “to warehouse people with serious mental illnesses in our criminal justice system.” Yet these offenders can face re-arrest almost immediately following their release “because there’s no warm handoff” to community assistance programs, he said.

“Our system, unfortunately, aside from being under-resourced, is painfully fragmented and very difficult to access,” he said.

Among states, Florida ranks 49th in the amount it spends per person on mental health services.

“Just moving us to the middle of the pack would probably save money,” Leifman said, “because you would stop this rotation of so many people. And the more times someone gets arrested, the greater the risk he or she will be rearrested.”

One thing is sure: the population of offenders who need mental health services has exploded during the last few decades. Between 1996 and 2013, the number of prison inmates receiving mental health treatment increased by 157 percent, and the number with moderate to severe mental illnesses increased by 168 percent.

“It’s growing so fast in Florida that if we don’t start to do more … Florida is going to need to build 10 new prisons over the next 10 years just to handle its mental health growth,” Leifman said. That, he said, would cost more than $2 billion.

“If we reallocated a lot of those dollars at the front end, we could keep most of these people out,” he added.

A different approach

Judge Ari Porth presides in Broward County’s felony mental health court – the first of its kind in the nation. It hears cases involving defendants deemed incompetent to stand trial and steers them into treatment in the community, hospitals, or criminal forensic facilities, he said.

As with other problem-solving courts, proceedings are a collaboration between the judge, prosecutors, defense attorneys, counselors, and peer counselors – people who have been through the system and are certified to advise new defendants. These defendants are closely supervised to make sure they take medication and otherwise abide by court orders. They also get help with housing and employment.

Porth, too, emphasized the need to continue care following release. “But we see, time and time again in court, behavioral health agencies leading the client to the finish line and dropping them just after they complete the race. We need to ensure that services that were successful in stabilizing the client and restoring them to competency, or stabilizing them in the community, do not end simply because of a legal finding of ‘competent to proceed,’” he said.

Where Florida Attorney General Moody can help, Porth said, is encouraging state attorneys and public defenders to staff treatment courts with “experienced and thoughtful attorneys who can work collaboratively,” and to seek out grants to finance these programs. Canady, meanwhile, could encourage local chief judges to place jurists “that have a great deal of patience.”

Judge Erica Quartermaine had been on the Sarasota County Court for about a month when a jail warden informed her about a mentally ill inmate who’d been held for 45 days for the crime of pulling a fire alarm. He’d already been involuntarily committed twice and there was no place to send him other than a cell. To combat cases like this, she created Sarasota’s Comprehensive Treatment Court.

Again, the emphasis is on cooperation between public defenders, prosecutors, and the sheriff’s office. The court mainly targets  homelessness – Quartermaine said USA Today deemed the area “the meanest city to the homeless population,” in 2008.

Sarasota’s comprehensive treatment court cut the county’s arrest and homelessness rates in half, Quartermaine said. The program helps participants devise mental health plans and financial plans, including applications for government benefits. Participants have to stay drug- and crime-free while enrolled. Sixty-five percent graduate, Quartermaine said.

The average cost per participant is $10,000 – a bargain compared to $345 per day in a correctional crisis stabilization unit or standard jail.

“The numbers speak for themselves, but the individual stories are amazing,” she said. One man, “truly the face of homelessness in Sarasota,” who lived on the same street corner for 20 years, now lives in an efficiency apartment with a pet fish named Fish Filet.

Miami-Dade judge Liefman said: “We really have two choices in this state.”

“We can continue to release people from the criminal justice system without treatment, or we can release them with treatment. Treatment works, and we can see the results every single day.”

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