How Miami-Dade's Mental Health Program Steers People To Treatment, Not Jail
In collaboration with 70 Million, a national podcast that examines criminal justice reforms around the country, WLRN looked at the mechanisms of Miami-Dade County's Criminal Mental Health Project.
On the third floor of Camillus House, a homeless and transitional shelter, Sebastian Londoño takes a deep breath and starts speaking to a dozen men, all residents. Londoño, a Colombian-born graduate student at Florida International University, sports a Beatles-like haircut and a stubble-bearded face.
He lets the men in on some of his darkest moments. Seven years ago he was in the midst of a psychotic episode and hadn’t slept in days when he broke into a random person’s home and began destroying everything in sight.
“The person that lived inside the apartment called the police, I was hiding in the bathroom,” says Londoño.
Police came and he was arrested and placed in county jail—in a section specifically for people with serious mental health problems. “I started having suicidal thoughts," he says. "I wanted to kill myself.”
While in jail, Londoño was referred to Miami-Dade County’s Criminal Mental Health Project, a diversion program for people with mental illnesses. Once a person agrees to enter the voluntary project, they are referred to a mental health care provider. A treatment plan is developed in coordination with the court and other social service agencies. If the person follows the treatment plan—for anywhere from six months to a year—their criminal charges are dropped or reduced.
The idea is to get to the underlying reason people with mental illnesses are overrepresented in the criminal justice system: a severe lack of access to quality and affordable mental healthcare.
The project, which has been around since 2000, has seen widespread success. Thousands of people have been helped into treatment and diverted away from the jail. At the same time, recidivism rates for people with serious mental illnesses are down and a training partnership with local police officers has helped to steer people having psychotic episode away from jail and into treatment facilities.
The men Londoño is speaking to are all facing criminal charges for a number of low-level offenses and they also have diagnosed mental health issues. They’re new participants to the project.
Jeremiah Brown, one of the men, was arrested for possession of cocaine just six days earlier.
“I needed the help. I’m here to take advantage of the opportunity and eventually have my record sealed or expunged,” says Brown. “It’s very important to living up to society, and just getting back to normal.”
In many places in the U.S., jail is the de facto landing spot for mentally ill people. The largest mental health facilities in virtually every state, including Florida, are correctional. That is the case in Miami-Dade, where on any given day, about a third of the county jail population is on psychiatric medicine.
Londoño tells the men the treatment plan turned his life around and could do the same for them.
“If you guys work as a team together and support each other, this can definitely turn into a new start,” Londoño says.
A national model
Nineteen years after its inception, Miami-Dade’s Criminal Mental Health Project is hailed as a national model for decriminalizing mental illness. Since the project started, daily inmate population numbers in Miami-Dade County have dropped from nearly 7,000 on average to around 4,000. The County was even able to close down a jail, saving taxpayers millions in operating costs.
Judge Steven Leifman, a soft-spoken administrative judge for the Eleventh Judicial Circuit Court of Florida, is the project’s architect.
Leifman remembers the exact moment he absorbed the weight of the problem.
Earlier in his career he was getting ready to hear a case for a low-level crime regarding a former psychiatrist. The man’s parents pulled him aside before the hearing, begging him to help get their some into treatment.
“They told me that their son was brilliant. He had gone to Harvard. He had a late onset of schizophrenia and he was now homeless and he was recycling through the criminal system and they just didn't know what to do anymore,” says Leifman.
At the time he thought the fix would be simple.
“I knew that if you got arrested and had a heart attack we clearly had a health care system in place for you,” he recalls. “So I assumed the same must be true for people with mental illnesses.”
During the court hearing the former psychiatrist said nothing was wrong with him, but at one point during the hearing the man went from answering Leifman’s questions to screaming and pointing at his parents in the courtroom. He accused of them of being from the CIA and said they’d come to kill him.
Lefiman ordered a psychiatric evaluation and it came back showing that the man met the criteria to be involuntarily hospitalized. But as a judge, Leifman didn’t have that authority. He had no choice but to release the man and tell him to see a psychiatrist upon release.
“While I did not agree with the law, I have no choice but to follow the law,” says Leifman. “God forbid something terrible happened to him or he did something terrible to someone else.”
That experience led him to try to create a system to assist people like the man he couldn’t help that day.
“I went back to my chambers and I got on the phone because I did not want to be in that position again and I started making calls,” says the judge.
Today, the project partners with health care providers, law enforcement, housing agencies and also helps participants apply for benefits like social security and Medicaid.
Leifman noticed many of the people cycling in and out of his court were connected to key community stakeholders, but the agencies didn’t have an intentional way to connect the dots that they were all working with the same people with the same challenges.
“Not only was [the system] designed to fail, but when we didn't provide people with treatment and services that they need we would then punish them by arresting them because they were out in the street floridly psychotic and we didn't know what else to do,” says Leifman.
Mentors and case managers
To help new participants navigate the Mental Health Court Project, they’re paired with peer specialists. Of the eight on staff, half are a graduates themselves.
On a recent morning Justin Volpe, a peer specialist, is driving around in a battered white Prius the county loans to the project. He’s part mentor, part case manager.
On this day he’s searching for someone who seems to have fallen off the radar. He regularly checks in with the people in the program and makes sure they’re sticking to their wellness treatment plan
“We’ve been looking for this guy for a little bit,” he says.
The man he’s looking of hasn’t been following his court-ordered treatment plan. If he doesn’t get back on track, the judge overseeing his case could kick him out of the program and he’ll be back to facing the criminal charges and jail time.
The man has to see a therapist and take medication regularly.
The Criminal Mental Health Project has an agreement with pharmacies for project staff to be able to pick up and deliver medicine. Volpe has several pill bottles for the man that has gone missing, but he can’t call him because the man doesn’t have a phone. That’s common among the project’s participants, he says.
“Poverty sucks, man. You don’t have a phone, you’re running around trying to hustle up money. It’s tough out there,” says Volpe. “The program is good but we’re trying to fix fragmented pieces of the system here and it’s a mess you know."
He knows from personal experience. Volpe prefers not to share the type of mental illness he suffers from, but we was in this same program 11 years ago, after he was arrested on a theft charge.
He spent time in the county jail, on the ninth floor. Back then it was known as the Forgotten Floor—a psychiatric ward that was so notorious the U.S. Department of Justice stepped in to investigate its unsafe and deadly conditions. It was eventually shuttered in 2015.
“It was crazy, people were screaming around the clock, they were handing me fistfuls of pills I didn’t know what they were,” he says. “I know that I had a cellmate that was in there for years and he had been in there for attempted murder. He had stabbed his wife with a pair of scissors.”
When Volpe was released from he got into the Criminal Mental Health Project. Six months later, he completed the program.
“I stopped doing drugs, and I started taking my medicine and I started to feel better,” he says. “It was like a miracle.”
On his graduation day the project director Cindy Schwartz brought him into her office and asked him if he would like to work with mentally ill people.
“I said, ‘That doesn’t sound really good,’” says Volpe.
Schwartz told him he could be a county employee and gainfully employed.
“I said, ‘I’m paranoid, I’m delusional.’ Cindy’s like, ‘ Ahh, you’ll fit right in,’” laughs Volpe. He’s been employed by the project for over 10 years now.
While he’s riding around, Volpe's phone is constantly ringing. A neighbor wants a referral for their son who has a mental illness. A client in the program checks in and gives him an update. This happens all the time, he says.
“It’s our job to kind of keep communication open and meet them where they’re at,” he says.
Volpe pulls up to where the man he’s looking for lives and leaves the medicine with the man’s girlfriend. A few hours later he get a call from the man telling him he got the meds.
It’s a small thing, getting someone their medicine. But a series of small things put together can add up to keep someone out of jail and help them get their life in order.
Expanding the program's impact
Judge Leifman has been traveling the country pitching the success of the program to other states, counties and cities. He has been working on a task force with the Florida Supreme Court and says that Florida is moving closer to implementing a statewide program modeled after the success of his work in Miami-Dade, slowly but surely.
But Leifman acknowledges there’s still more work to do locally.
The Mental Health Court Project commissioned a study several years ago to get a better understanding of the people who kept cycling in and out of the program without ever completing it.
“On this one piece of paper were the names of 97 people, primarily men, primarily diagnosed with schizoaffective, schizophrenia disorder, primarily homeless,” says Leifman.
Over a five year period, these 97 people were arrested 2,200 times. Collectively they spent 27,000 days in county jail and 13,000 days at a psychiatric facility or emergency room.
That “cost taxpayers $13.7 million,” says Leifman. “And we got absolutely nothing for it.”
Miami-Dade consistently ranks among the most unaffordable cities in the nation. For people who are poor, dealing with mental illness and addiction and cycling in and out of jail, the lack of housing options can exacerbate existing problems and make it almost impossible to become stable in the face of a crisis.
The next step for the project is to create a “one-stop shop” to address the needs of this specific population that has been cycling in and out.
With funding from the county and Jackson Memorial Hospital, the project is transforming a seven-story building near Wynwood. The building, a long-shuttered psychiatric treatment facility, will house mental health and other medical care providers, a courthouse and job training programs.
And it will also provide rooms for homeless and housing insecure people in the project to be to live there for up to a year at a time. Everything they need will be in one place to get them on the path to healing and recovery.
“The idea is to take this really acutely ill population and instead of just kicking them to the curb once we’ve adjudicated their case we can gently and slowly reintegrate them back into the community in recovery, with all the support and case management systems that they need for recovery,” says Leifman. “This building is keeping me really going now because that's the light at the end of the tunnel.”
Preconstruction on the new facility has already begun. The facility is expected to open within the next two years.
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