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To fix our system: Treat, not jail, the ill

Published November 26, 2007

To fix our system: Treat, not jail, the ill

Judge Steven Leifman says, "We’re where we were 200 years ago."
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Miami-Dade County Judge Steven Leifman will never forget his first visit to a state psychiatric hospital.

He was 17, an intern for then- state Sen. Bob Graham. He was there to check on a young autistic man who had been mistakenly institutionalized. He saw men in cages, people lying on the floor in feces. Animals at the zoo were treated better, he thought.

"So why not these people?" he asked. It’s a question he still asks.

Now 48, the longtime mental health advocate has been on the bench for 12 years. Leifman led a subcommittee that studied the state’s mental health system for six months. The group recently released a 170-page report that lays out an ambitious plan to help people with mental illnesses who end up in jails and prisons. Florida leaders say the changes will save money and protect the public. Leifman spoke with the St. Petersburg Times about the report and what happens next.

Why have jails and prisons become the largest community mental health care providers?

The sad irony is that we’re where we were 200 years ago. Jails are once again the primary place for people to go with mental illnesses. These people would have been in state hospitals 40 years ago. But when hospitals were shut down, which they needed to be, we really just transferred people from bad hospitals to really horrible jails. Jails are the only place where they can’t be refused. We spend $250-million a year in Florida to pay for about 1,700 inmates with mental illnesses. And it’s just to restore their competency so they can stand trial, not for treatment. At this rate, by 2015 we’re talking about spending a half-billion dollars. It meets the definition of insanity.

How can the committee’s recommendations help fix the system?

We want to stop the recycling of people in jails. The good thing is that we have the research today of how to best treat people with serious mental illnesses. With those best practices, we can come up with competent mental health and criminal justice systems. Then we look at how to pay for it, sustain it, and transfer it to the communities. We didn’t want to create a system where you only got care if you got arrested. We’ve created incentives for keeping people out of jail, for both children and adults. There’s a multi-tiered system that categorizes people with mental illnesses, targeting those at most risk.

Explain more about how much this will this cost – in time and money?

We’ll need up to $20-million up front to build the system. That includes housing, case management services and establishing the day-by-day activities. Then we’ll use the $48-million in recurring funds that the Legislature allocated (for 300 forensic beds) along with Medicaid dollars.

What happens next?

Instead of thinking of this as a criminal justice issue, we first need to think of it as a disease issue. It’s just like someone having cancer. If you catch it early, you go into recovery and it can be very treatable.