Judge: Mental Health Court Bills Promising
Miami Judge Steve Leifman, a widely recognized authority on substance-abuse and mental-health issues in the criminal-justice system, closely watched two reform bills that passed the Legislature last week.
Many of the bills' provisions were developed by the Florida Supreme Court's Task Force on Substance Abuse and Mental Health Issues in the Courts, which Leifman chaired.
One proposal (HB 439), in part, could lead to counties establishing treatment-based mental health court programs and would seek to create uniformity in the programs. The other bill (SB 12) would create a "no wrong door" approach to people in crisis who need treatment for mental illness or addiction.
A judge in Miami-Dade County since 1995, Leifman was troubled by the growing numbers of people with serious mental disorders who appeared in his courtroom. In 2000, he created the 11th Judicial Circuit Criminal Mental Health Project, which diverts people with mental illnesses who don't pose significant public-safety risks into community-based treatment. Since then, more than 4,000 people have been diverted from the Miami-Dade jail, while the recidivism rate for those who complete the program after being charged with felonies is 6 percent.
The News Service of Florida has five questions for Steve Leifman:
Q: Talk about how the new legislation will work.
LEIFMAN: I was extremely pleased at the passage of the two bills --- and I think you have to look at them in tandem. You have the mental health-criminal justice bill that was sponsored by (Senate Judiciary) Chairman (Miguel) Diaz de la Portilla and (House Judiciary) Chairman (Charles) McBurney --- which is a really terrific bill that allows us to accomplish several things that we really need to do. One is it allows us to set up mental-health courts. Two, it gives permission for county-court judges to use what we call assisted outpatient treatment for misdemeanant defendants who are incompetent to stand trial. And the reason that's so extremely important is up until now, if someone was arrested on a misdemeanor, and they were incompetent to stand trial and they were refusing treatment, there was nothing the court could do. And these are usually people that have very, very serious mental illnesses. They're not necessarily dangerous to the community. But it's your very heavy homeless population that keeps recycling through the system. We had absolutely no jurisdiction or authority to help them get the treatment they needed. But with this new legislation, that now has changed.
In addition, (the bill) will expand criteria for veterans' court, so we can get more vets the treatment they deserve. And it expands something that we've been doing in Miami-Dade County for the past four or five years, and that is creating an alternative to felony competency restoration programs. So if you have an individual who is incompetent on a non-violent type felony, like a third- or second-degree charge --- it's no longer going to be necessary, once we get more funding, to send them to a forensic commitment facility that's just focused on restoring their competency. The new program we have in Miami that's been so successful not only focuses on restoring competency so the individual can be tried, but equally important, it focuses on reintegrating them back into the community.
Sadly, Florida spends about 25 percent of all its adult mental-health dollars --- that's about $135 million --- on trying to restore competency for about 3,000 people a year. While at the same time, we have between 150,000 and 160,000 people who at the time of their arrest in Florida need acute mental-health treatment. And so what's happened in Florida is the dollars we do spend, we overspend on these acute needs, instead of spending more dollars at the front end to prevent people from going into these acute systems. And this legislation, by authorizing these new programs around the state, will help us to shift some of those dollars. … I think it's going to have a huge impact.
Q: How will it dovetail with the other bill?
LEIFMAN: The second bill, which was proposed and sponsored by (House Children, Families & Seniors) Chairwoman (Gayle) Harrell and (Senate Health and Human Services Appropriations) Chairman (Rene) Garcia --- along with a lot of help from Rep. (Kathleen) Peters --- does similar kind of work on the civil side. It tries to create what we call a "no wrong door" entry for either people that need help through the Baker Act, which is involuntary commitment for mental illnesses, and the Marchman Act, which is involuntary commitment for substance-use disorders. It tries to align the law so that we can more easily help people access these systems. It helps us move them through the system more easily on the court side. And the hope of doing that is it'll get more people the treatment they need and deserve.
The legislation also does a good job of requiring the communities to develop a better continuity of care, a better continuum of care, so that when people do come into our system of care, we do a better job of following them and making sure that they get the care that they need. So that they don't just come in, get what they need, leave and never be heard from again until they have another problem. And it also really helps us focus on what we call the high-utilizer population, the population that is penetrating both of these deep-ended systems the most, whether it be hospitalization or criminal-justice involvement --- the same population tends to go back and forth on a pretty regular basis when they don't get the services they need. So this legislation helps us do that.
And I also found out yesterday --- and I was thrilled to hear this --- that there's about 65 million new dollars in both mental-health and substance-abuse treatment that was not there previously. And that could really have a significant impact. So as we realign the legislation, and begin to put appropriate dollars into the system, we should be able to get much better outcomes than we've been able to get in the past.
It was a good session. In fact, in the nine years I've been working on this, I would say it's the best session we've had. And hopefully it's the beginning of the state really paying attention to this problem.
Q: But there's more to do, right? More funding? And you were backing policy provisions that didn't make it into this year's legislation, such as including primary health care.
LEIFMAN: Yes. I think the bill that focuses on the civil side is a very good start. It's such a comprehensive bill that we're going to have to now start to implement the changes. And when you do something this complicated, there's bound to be issues coming up that we had not anticipated. So there may have to be a glitch bill next year, and we're going to probably have to start looking at ways to expand some of the services that we've identified as necessary.
I also think it's going to be important for the Legislature to begin to look at whether or not the criteria for involuntary hospitalization under the Baker Act is the most appropriate criteria. Florida is one of the few states that still just focus primarily on dangerousness to self or others as criteria for hospitalization. It's kind of old criteria, and I think there are better criteria we should be looking at that would have a greater impact. But I think part of doing that (is) you also have to have a good system of care up front. You can't just force someone to take medication and expect them to recover without the other supports in place. And I also think you want to try to have used other means to get someone to voluntarily take treatment before you get to the involuntary route. And so if we set it up right, and we adjust the criteria a little bit, I think we could have a much better system of care than we've had in the past.
Q: Do you think the results lawmakers will see from this legislation will encourage them to invest more in mental-health and substance-abuse treatment going forward?
LEIFMAN: I hope so. And I think that's part of the reason we were as successful as we were this year. Because a lot of these programs, we've been operating in Miami-Dade for the past 15 years, and we really have tremendous data showing how successful doing it the right way (is). I mean, my community, which is by far the largest community in Florida, was able to cut its jail audit almost in half by having a very robust pre-arrest program through our crisis intervention team policing and three very robust post-arrest diversion programs for non-violent individuals who get caught up in the criminal-justice system. And all four of those programs working together have shown significant, significant results.
Our jail audit went from well over 7,000 to today, less than 4,000. It enabled us to close one of our jails during one of the worst economic periods the country's had since the Depression. And while I rarely talk about cost savings, because it's usually about cost-shifting and just spending the dollars in a more appropriate place, when you actually close a jail like we did, it saved our county $12 million a year. And so that's a real cost-savings to everybody. Our felony diversion program --- which takes non-violent people charged with felonies and gets them into an entire array of services, monitors them, gets them housing, gets them their benefits --- has saved our county between 35 and 40 years of jail-bed days just in the last five years.
The Legislature has had (the Office of Program Policy Analysis and Government Accountability) come down and look at our programs and show that they are, in fact, very successful. And I think through all that data collection, we've really been able to show that this works.
Q: What are the next steps following this legislation?
LEIFMAN: We now have to set up educational training for the judges, so they can learn how to use it and use it well. And we have to make sure there's collaboration between the court and the managing entities. And there's a wonderful grant program that we set up several years ago, on a criminal-justice grant called the Reinvestment Grant, that they actually added $2 million more to. So it has $6 million in there. There's a lot of good stuff. And so we now have to train and teach all the communities how to use the legislation, how to apply for these additional dollars, and what the best practices are to get people the services that they need.
People don't understand you can't just pass a law and then expect it to happen, especially something this complicated. People now have to be taught the appropriate way to use it, so we don't wind up creating more litigation, and having people challenge it. We're going to have to do some serious judicial education in this arena. And community education --- we're going to have to teach the community to access these new services. We need to teach the managing entities and the state attorneys and the public defenders what this law means and how it operates so that we get everybody on the same page with the ultimate goal of improving our public safety, saving our taxpayers money by spending our dollars carefully and appropriately with good outcomes --- and most importantly, I think, treating people with illnesses as if they're people with illnesses and not people who are committing crimes. If we use a health-care model as opposed to a criminal-justice model, which this legislation helps us move towards, I think we're going to have much, much better outcomes, and people are going to have much, much better lives because of it.