Florida Partners in Crisis

Florida judges gain insights into mental illness and treatment options at Partners Justice Institute

In 1841, crusader Dorothea Dix sought help from the courts and legislators to end the plight of people with mental illnesses who were housed in unheated, unfurnished and foul-smelling jail cells.

Miami-Dade County Judge Steven Leifman kicks off Judicial Institute as Circuit Judges John Radabaugh and Claudia Isom listen

"Nearly 200 years have passed and our jails have once again become the primary places where people with serious mental illnesses are housed," Miami-Dade County Judge Steven Leifman said in his opening remarks at the July 12 Justice Institute sponsored by Florida Partners in Crisis.

Leifman, chair of Partners in Crisis, has become nationally known for his advocacy on behalf of people with mental illnesses caught up in the criminal justice system. Along with his work at the local and state levels, Leifman co-chairs the Judges Criminal Justice/Mental Health Leadership Initiative.

"In 1955, there were 500,000 people in psychiatric hospitals in the United States," Leifman said. "Now there are only about 40,000 hospital beds in the United States and there are 550,000 people with mental illnesses in our jails and prisons."

Leifman showed the group of 16 judges and other justice system personnel a tape of part of a Miami TV station's 2008 documentary about people with mental illnesses housed on the Miami-Dade County Jail's ninth floor psychiatric unit, called the "Forgotten Floor."

From left, clockwise, Judges John Woodard, Ronald Legendre, Marvin Gillman, Robert Williams, and R. James McCune listen to presentation on mental illness and the courts

He briefly described the various jail diversion programs underway in Miami-Dade and many other Florida counties, most of them funded largely through the state's Criminal Justice, Mental Health, and Substance Abuse Reinvestment Act Grant Program.

Research done in Miami-Dade County also documented the high cost incurred by taxpayers as a result of so-called "high utilizers" who cycle in and out of jail and treatment facilities. Targeting services to this relatively small group of people can save tax dollars and curb recidivism, Leifman said.

Learning about mental disorders and the brain's effect on behavior

Rajiv Tandon, MD

Calling the treatment of people with mental illnesses the new "civil rights frontier," Rajiv Tandon, MD, professor of psychiatry at the University of Florida College of Medicine, gave Institute attendees a briefing on what he termed "must know" facts about mental illnesses.

He explained how mental illnesses differ from neurological disorders and how they lead to a reduced capacity "to cope with ordinary demands of everyday life."

Mental illnesses are "four of the top ten leading causes of medical disorders," Tandon said, adding that mental illnesses are often lethal as they double the chances of dying of many other medical conditions.

Tandon, a nationally known author and researcher, emphasized that mental illnesses are "imminently treatable" and that "only in cases of untreated psychosis is there an increase in dangerousness."

CIT Officers: Key to successful jail diversion

Habsi Kaba

A lively presentation by Habsi Kaba, MS, MFT, Crisis Intervention Team (CIT) coordinator for the 11th Judicial Circuit Mental Health Project, gave judges some insights into how the training is conducted and its value as part of a community's jail diversion strategy.

Kaba explained how CIT training raises law enforcement officers' understanding of and sensitivity to people with mental illnesses, as well as making them aware of treatment options in the community.

That understanding is coupled with communication and de-escalation skills that enable officers to defuse many potentially violent encounters. CIT training is widespread throughout Miami-Dade County, where 3,200 law enforcement officers from various agencies have completed the classes, she said.

Kaba said the Miami-Dade County Police Department alone had 4,708 calls for a CIT officer during 2010. Of those, more than 3,300 involved someone in a mental health crisis, with 1,043 individuals diverted to treatment as a result of intervention by CIT officers.

Putting a human face on mental illness

Risdon Slate

Risdon Slate, PhD, criminal justice professor at Florida Southern College in Lakeland, told the gripping story of his longtime battle with bipolar disorder, an illness that led at one point to his being jailed.

A colleague in the criminal justice system came to Slate's rescue and got him out of jail and into treatment. But, Slate noted that many others with mental illnesses who wind up in jail may not be so fortunate and may not get the treatment they need.

Slate speaks frequently on issues concerning mental illness and the criminal justice system and shares his experiences as a crisis intervention trainer for law enforcement officers. "There is no shame in being mentally ill," Slate said. "The shame is in not receiving proper treatment."

A mother's story

Advocate Karen Levy

Joining Slate in putting a human face on mental illness was Karen Levy, a Doctor of Oriental Medicine and the mother of an adult son with schizophrenia. Levy gave judges a first-hand account of how her son's mental illness led to tragedy for him and others.

Levy said that her son did well while he was under the supervision of a mental health court and getting regular treatment. But, later, after moving to another county, he was unable to fight the paranoia that drove him to a tragic act of violence.

To help her son, Levy said she read and researched to acquire the skills to advocate on her son's behalf. Her son was eventually declared incompetent to stand trial and is now in a state forensic mental health facility where Levy said he is "doing well."

Levy now volunteers for the National Alliance for Mental Illness (NAMI) at the state and local level and has developed a series of workshops on healthy living for caregivers of persons with severe mental illness.

Judi Evans, executive director NAMI Florida, briefly described the organization's Peer-to-Peer training and its value as part of a jail diversion program. The nine-week course helps people acquire a better understanding of their mental illnesses and how to manage their symptoms and prevent relapse.

The Peer-to-Peer course is taught by a team of two trained “mentors” and a volunteer support person who are personally experienced at living well with mental illness. Evans encouraged the judges to include Peer-to-Peer as part of their mental health court and other jail diversion services.

Going beyond criminal defense

Unlike other counties, Pinellas County's jail diversion program is housed in the office of Sixth Judicial Circuit Public Defender Bob Dillinger, who sees the program as a way to reduce crime and get people into needed treatment.

The program is in collaboration between Dillinger's office, the state attorney, Pinellas County sheriff, the judiciary and local service providers. It is also supported by the Pasco County sheriff's office.

Clients in the jail diversion program receive assessments, treatment services, case management, housing and medications. The program is short-term, with a length of stay averaging from three to six months.

Public Defender Bob Dillinger

Since its inception in 2004, the program has resulted in a significant arrest reduction rate. Dillinger said the program had served 2,984 clients through the end of 2010. Prior to the program's inception, he said those clients had incurred 12,985 arrests; since the program began, arrests have plummeted to 1,677 and 1,119 people were never arrested.

Dillinger described how his office was able to start the program with funding from a federal Bureau of Justice Assistance grant of nearly $1 million. In 2005, and again in 2006, BJA awarded two other grants totaling $1.2 million to continue the program.

A state Criminal Justice, Mental Health, and Substance Abuse (CJMHSA) Reinvestment Act grant awarded to Pinellas County in 2008 also helped fund the program, along with other support from Pinellas and Pasco Counties.