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Duval tries to improve system for mentally ill ; Miami-Dade has had some successes; local officials pay a visit

Florida Times Union
Oct 25, 2014

Inmates wore clothes that would not rip. Others were naked.

When there were two people in a cell, one slept on the floor.

Welcome to the ninth floor of Miami-Dade County jail where routinely about two dozen people diagnosed with mental illness are on suicide watch.

Gone are cotton jumpsuits because they too easily can be made into a noose. Gone are high bunks, also proven to be a hazard after a mentally ill detainee jumped from one and broke his neck.

Earlier this week, two Duval County judges, Jacksonville mental health professionals, an assistant state attorney, the jail director and other community leaders toured the facility.

The visit came on the heels of a 26-week community study conducted by the Jacksonville Community Council Inc. examining problems in Northeast Florida's mental health system. The findings of that project will be made public Tuesday.

The group from Jacksonville went to Miami to see how mentally ill inmates are handled there and members arrived with plenty of questions.

How did Miami-Dade close an entire jail, saving about $12 million in the process? How did it reduce worker compensation claims from police officers by about $8 million over eight years?

Why did its bond rating improve after a drop in police shootings involving mentally ill residents?

What's different about Miami and can it be applied to Jacksonville?

The difference isn't in the detention process, but in a commitment to programs that get mentally ill defendants treatment, said Miami-area Judge Steve Leifman, an expert on mental health in the criminal justice system. The Duval County jail and the Miami- Dade County jail operate in similar ways.

Jailed individuals with mental illnesses are classified and separated from the general population if needed. Both jails use similar techniques to handle mentally ill inmates.

Tara Wildes, Jacksonville's director of corrections, echoed an often-repeated saying Sheriff John Rutherford uses when talking about the mentally ill in detention centers. "Jail isn't a therapeutic place," she said.

She led a tour of the Pre-Trial Detention Facility to some of the 15 people before the group traveled to Miami. The only real differences in the two facilities are the architecture and paint color.BEGINNING STEPS

Leifman began the transformation of Miami's mental health system about 15 years ago after an outburst by a defendant in a psychotic state inside his courtroom.

The first step was to map out how the mental health system and the courts intersected.

They didn't.

Miami-Dade is home to about 3 million people with 9.1 percent of the population diagnosed with schizophrenia, bipolar disorder or major depression. The county has the highest density of mentally ill individuals in an urban population in the country, according to information supplied by the court.

That's about 175,000 adults and only 1 percent of that population receives treatment in the public mental health system.

The 11th Judicial Circuit (composed of Miami-Dade) Criminal Mental Health Project began in 2000 with a grant program aimed at nonviolent defendants charged with misdemeanors and diagnosed with a serious mental illness.

Most people in the program were arrested on minor charges like theft of food, trespassing or public drunkenness.

In Miami-Dade, all defendants are screened for mental illness when booked into jail. Defendants who meet requirements for the misdemeanor jail diversion program are transferred to a community- based crisis stabilization unit within 48 hours.

About 300 inmates in Miami's court system annually seek placement in the program. About 75 percent of the participants are homeless.

The program links participants with community treatment and housing services. After completion, the charges are usually dropped.

Leifman said most charges - before the program began - resulted in time served and release without treatment of the underlying problems. He said the program cut inmates' recidivism rate from 75 percent to about 20 percent.

"We used to have an entire wing at the jail for people with misdemeanors," he said. "When I was there the other day, there was one person in the wing."

The diversion programs and increased police training improve interactions with the mentally ill. That allowed Miami-Dade to close one of its jails, saving about $12 million, Leifman said.EXPANSION With the success of the misdemeanor program, Miami-Dade expanded the Criminal Mental Health Project to include lower-level felonies.

Leifman said the felony program is estimated to have reduced the time mentally ill defendants spend in jail by about 16,200 days. That equals about 44 years.

Another program takes defendants deemed incompetent for court proceedings and places them into a Miami-Dade forensic hospital that prepares the participant for re-entry into society.

Leifman criticized the manner in which the state currently restores competency to defendants. Basically, about one-third of the state's mental health dollars for adults - about $200 million - is spent on about 3,000 people.

The average cost per person for taxpayers is about $60,000.

"The worst part of that is that 70 percent get out and either have their charges dropped, get credit for time served or probation and have very little if any access to treatment, so we spend all this money to dump them back into the streets," he said.

The Forensic Hospital Diversion Program takes non-violent defendants charged with second- or third-degree felonies and provides residential treatment and community reentry services. The program also continues to follow the patients after they are released.PROGRAM BENEFITS

Miami-Dade's mental health project also focuses on crisis intervention teams and has trained about 4,300 police officers over 14 years.

The effort led to a drop in worker compensation claims as police dealings with people displaying signs of mental illness became less explosive. There are fewer physical altercations and fewer shootings, Leifman said.

He said before the training was used by all county law enforcement, there were about eight to 10 fatal shootings a year involving people with a mental illness. He said in the last six years there have been about four fatal shootings involving that population.

A former Miami mayor informed the judge that at the city's bond review, all the rating agency officials wanted to know was how the city reduced its police shootings. Leifman said litigation and settlements were costing taxpayers hundreds of millions of dollars.

In Jacksonville, every new officer receives crisis intervention training.DELEGATION REACTION

Fourth Judicial Circuit Judge Karen Cole organized the delegation that traveled to Miami because she believes the area's court system could be better when dealing with the mentally ill. She said in Jacksonville mentally ill defendants, especially ones charged with low-level misdemeanors, aren't identified by the courts or directed to services.

"As a result, the individual is caught in a revolving door between community and jail," she said. "... The underlying mental illness is not addressed, and taxpayers continue to pay the cost of incarcerating individuals who instead need mental health services."

Chief Judge-Elect Mark Mahon went with the delegation. He called the trip eye-opening. "They look to see if the crime is a symptom of mental illness, instead of whether a crime was committed by someone with a mental illness," he said.

After that determination is made, the defendant is taken out of an expensive jail cell and placed in a mental health setting, he said.

"Certainly everyone in Jacksonville should try to emulate some of the things that are going on in Miami,"

Cole said while Jacksonville does have a mental health court, its diversion programs aren't as developed as what the delegation saw in Miami. Officers have few options because pre-arrest diversion programs are nonexistent.

Basically, police can choose to take no action, return the mentally ill person to his or her family, arrest them or hospitalize them under the state's Baker Act, she said.

But the Baker Act - used by law enforcement to involuntarily hospitalize people who present a threat to themselves or others - can usually hold an individual a maximum of three days. Few people hospitalized under the act follow discharge recommendations to take prescribed medications or to follow up with a community mental health provider, she said.

"The need for effective mental health services extends beyond the criminal justice system," she said. "Judge [David] Gooding recently saw a teenage girl in court ... who had been Baker Acted 60 times," she said. "Plainly, we need to do better by such children and adults."

The delegation plans a meeting soon to discuss how to implement some of what they saw in Miami.Derek Gilliam: (904) 359-4619

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