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Judge Calls System's Treatment Of Those Who Have Mental Illnesses 'The Definition Of Insanity'


A well-known associate administrative judge in Florida believes the U.S. judicial system falls short when it comes to people with mental illness who are convicted of crimes. It sends them to prison, the worst possible place. Then when they don't get better and commit another crime, it puts them in prison again. He calls this cycle the definition of insanity, and that's the title of a documentary about his work that premieres on PBS stations next week. The film is produced and directed by Gabriel London. And Judge Steven Leifman, who began the Miami-Dade County Criminal Mental Health Project, joins us now from Miami. Your Honor, thanks so much for being with us.

STEVEN LEIFMAN: Thank you very much.

SIMON: There's a real intersection, if I might use that statistically safe term, between people who were in the criminal justice system as defendants, arrested, and people with mental illness, isn't there?

LEIFMAN: There is. About 40% of all people with serious mental illnesses at some point are going to come into contact with the criminal justice system. And so on any given day in the United States, there's about 400,000 people with serious mental illnesses behind bars, either in jail or prison, and another 800,000 under some type of correctional supervision.

SIMON: And what does the Criminal Mental Health Project try to do?

LEIFMAN: What we recognize is that, No. 1, this population is no more dangerous than the general population. Many of these people can lead, you know, really good, healthy lives with the proper treatment. Recovery rates for people with these illnesses are actually better than for people with heart disease and diabetes. It's just that they're not getting access to treatment. And so what we did is we put together a summit in 2000 and I think one of the nice things about being a judge is that people come to your meetings when you invite them, whether they want to be there or not. So I invited all the traditional and nontraditional stakeholders who really are not used to working together on issues like this. You know, the criminal system's adversarial for good reason.

SIMON: I was going to point that out, if I may have the effrontery to try and point out anything legal to a judge, but I say this as an old crime reporter. There is great trust in the fact that the judicial system is adversarial in that if you have the prosecution present its strongest case and the defense present its strongest case, justice is served.

LEIFMAN: And that works relatively well in a traditional system, but when you have someone that's there because of an illness, the only thing that we're dealing with at that point is whether they're guilty or not guilty or if there's enough evidence to convict them of what they've been charged with. We're not doing anything to deal with their underlying illness, which is contributing to their arrest.

SIMON: How did you get prosecutors on board?

LEIFMAN: Very slowly. The way we got them on board initially is we agreed that we would start with only nonviolent misdemeanor cases, so quality-of-life offenses, you know, urinating in public, that kind of stuff, trespass. And within a year, the recidivism rate dropped so significantly. We were able to show the prosecutors that by getting people treatment, we were going to get much better results.

SIMON: What's the recidivism rate? It says 25% in the film.

LEIFMAN: Yeah and it's about 20% in the misdemeanor and it's about 25% in the felony because the program now has been expanded to nonviolent felony cases.

SIMON: Yeah, and 25% represents an improvement, doesn't it?

LEIFMAN: Oh, it's significant, down from about 70%. And as a result, what we're doing now is for the last group that we have not been able to help as well, they've just been too sick for too long and there's a lot of evidence that for people that have been on the street for decades without treatment, there's probably a certain level of permanent brain damage. And so there's just no capacity anywhere in the country to provide them the level of treatment that they need. So we're in the process now of building the first-of-its-kind mental health diversion facility. And the idea is to have all those essential elements in one place, so it will be a medical home.

SIMON: Has this pandemic changed the way you have to do business?

LEIFMAN: Significantly. Court is closed right now except for essential cases. And so my staff are monitoring this population out in the community, but we don't really have court to report right now, so we're doing our best to just help this population make sure they're getting the services while this is going on and helping them stay healthy away from the virus and staying on their treatments so they stay healthy with their mental health issue.

SIMON: The nicest moment in this film about your work, to my mind, is when a man named Trevor gets a round of applause in court after he's tested drug and substance abuse free for - I forget how many, I think eight months - even gets a hug from the judge. He's working, going to school, doing well and he says of your program, there are people here who are trying to be something that you never had in your past. Boy, that just bowls you over when you hear that. Nobody had ever bet on him before.

LEIFMAN: It's powerful.

SIMON: Yeah.

LEIFMAN: He makes that comment that he had never been diagnosed or treated. You know, instead of just blaming people for their behavior, when we ask, maybe, what's causing it, we can get a significantly improved outcome and help them change their behavior and help them lead healthy and, you know, lives that they're contributing to society with.

SIMON: Judge Steven Leifman, who began the Miami-Dade Criminal Mental Health Project. Gabriel London's documentary, "The Definition Of Insanity," runs on many PBS stations next week. Your Honor, thanks so much for being with us.

LEIFMAN: Thank you.

(SOUNDBITE OF TONY MORALES' "YOU'RE REAL") Transcript provided by NPR, Copyright NPR.