Judge Steve Leifman doesn’t think it should be that way. Since his earliest days on the bench, he’s been trying to change a system that makes no sense to him. He’s been trying to change what he sees as an illogical, ineffective, inhumane and unnecessarily expensive approach to handling nonviolent offenders who have mental illnesses.
Later this year or possibly early next year, a new facility will open that’ll be the first of its kind in the state. The Miami Center for Mental Health and Recovery will offer psychiatric treatment and a range of other services to stabilize people with serious mental illnesses who keep revolving through the criminal justice system at great cost to taxpayers. Other places in Florida will be watching closely to see how well it works — or if it works.
“We all have the same problem, so everybody’s watching,” says Leifman, a longtime Miami-Dade County judge who’s been working for more than a decade to bring the mental health center into existence. “We just had a bunch of county commissioners and judges from Broward County spend a few hours with us. We’ve had people from Jacksonville. We had a huge delegation from Orlando come down.”
Miami-Dade County is working with Miami’s Eleventh Judicial Circuit on the 208-bed mental health center, which will be an alternative to jail. It will focus on people who are the heaviest “users” of mental health services and the criminal justice system in Miami-Dade County. Many of them are chronically homeless and abuse drugs and/ or alcohol. Many have been diagnosed with schizophrenia, bipolar disorder or other serious mental illnesses. Judges will be able to send defendants who are accused of misdemeanors or low-level felonies to the facility.
Jailing someone is expensive, and jailing the same mentally ill person again and again is needlessly expensive, Leifman says. The idea here is to set up a “one-stop shop” where these people can get all the services they need to stay out of trouble, and they can do it all under one roof.
That means getting psychiatric, medical, optical and dental care to stabilize them. It means getting doses of injectable antipsychotic medication. For job training, they’ll be able to learn culinary skills in an on-site kitchen. They’ll get help accessing any government benefits they qualify for. They’ll be able to appear in a courtroom on-site. They’ll even be able to get any distasteful tattoos removed that might prevent them from finding work.
“It’s not a pie-in-the-sky idea. This is a science- based program,” says retired Circuit Judge Jeri Beth Cohen, president of the board for the Miami Foundation for Mental Health, which is the philanthropic arm of the mental health center. “We know that integrated care and one-stop shopping and a compassionate, sensitive environment leads to recovery.”
The immediate goal will be to serve about 9,000 clients a year.
Seven-story sanctuary
This will all be happening in a seven-story state building in Miami that’s been newly renovated. It’s just west of I-95, south of I-195 and north of Jackson Memorial Hospital. It used to be a state facility for restoring mental competency to accused felons who were awaiting trial. The state was no longer using it and is leasing it to Miami-Dade County for 99 years for $1 a year. Through a bond issue, the county paid for the building’s renovation, which cost about $50 million. The publicly owned Jackson Health System chipped in as well.
This has been a long time coming. The first steps toward this goal were taken 24 years ago, when the Eleventh Judicial Circuit in Miami launched something called the Criminal Mental Health Project in 2000. This came after a case Leifman had in his courtroom where the defendant turned out to be a Harvard-educated psychiatrist who had late-onset schizophrenia. The man had become homeless and was cycling through the criminal justice and mental health systems.
“He had a full-blown psychotic episode in my courtroom. And because the charge was so minor, I had no authority to get him treated,” Leifman recalls. The man met the criteria for the Baker Act, which meant a mandatory psychiatric evaluation within 24 hours, but nothing more. “His case really was a window into everything that was wrong with both criminal justice’s response to people with mental illnesses and the community mental health system,” Leifman says. “He ended up having to be released without any treatment or services and totally disappeared. It turned out that there were a lot of cases like this.”
So the courts in Miami set up a diversion system in which judges started diverting non-violent suspects with mental illnesses or substance abuse disorders into treatment and support services in the community rather than jail.
“Frankly, it far exceeded our wildest expectations. The number of arrests in Dade County as a result of the project went from 118,000 a year to about 53,000,” Leifman says. “Our jail audit (its population) went from about 7,400 to 4,400. The county closed one of its three main jails, so far saving the county about $131 million.”
However, there was still a percentage of the mentally ill population that they just couldn’t seem to reach. “So the building was born,” Leifman says.
About 10 years ago, the judicial circuit’s Mental Health Project worked with the Florida Mental Health Institute at the University of South Florida and identified 97 people in Miami-Dade County who were showing up in jail or getting Baker Acted the most.
“These were 97 people, mainly men, mainly diagnosed with a psychotic disorder and primarily homeless. These 97 people over five years had been arrested 2,200 times, spent 27,000 days in the Dade County Jail, 13,000 days at a psychiatric facility, cost taxpayers tens of millions of dollars — and we got nothing for it,” Leifman says. They recently updated the numbers and found that the same 97 people had been arrested about 4,700 times and had spent 97,000 days in the Miami-Dade Jail since 1985.
“What we realized is that there is a smaller cohort of individuals that are killing the entire system — everywhere,” Leifman says. “This is not a Miami-Dade problem, it is an entire Florida problem. I guarantee that whenever I go to a community, whether it’s Tampa or Tallahassee or Jacksonville, everybody knows their 97.”
So, how to reach those 97? By putting everything they need under one roof and requiring that they show up for treatment. That’s the plan, anyway. The Jackson Health System will be contracted to help run the place. The only locked part of the facility will be a section where people taken into custody under the Baker Act will stay.
Miami-Dade commissioners are slated to vote on an annual budget for the center soon. Leifman says one thing that will help balance the mental health center’s budget is that, unlike in a jail, many of the health care services being offered can be charged to Medicaid.
The federal government has been leaning on Miami-Dade to improve the way it deals with the mentally ill. As recently as 2008, conditions in Miami-Dade’s jails were so bad for the mentally ill that the federal Department of Justice launched an investigation. The DOJ found that guards routinely physically abused inmates for behavior that was symptomatic of their illnesses. In 2013, the county agreed to a federal consent decree requiring a number of fixes, including a renewed commitment to build this long-awaited mental health center.
In any case, the Miami Center for Mental Health and Recovery is specifically designed not to look like a mental hospital.
“We did not want it to look like an institution. There’s very little linoleum, and it’s mostly tiles and woods. We smoothed out most of the cinderblock. There are no primary colors,” Leifman says. “In the United States, we send the mentally unwell to the most disgusting places possible, and you can’t wait to get out of there. But we need this population to want to stay long enough to get treated, so we really went out of our way to build it in a way that is very warm and welcoming.”
