Mental health in the courts: Could this finally be the year?

Mental health in the courts: Could this finally be the year?

Senior Editor

When it comes to financing the care and treatment of its citizens with mental health problems, Florida has almost nowhere to go but up.

In a ranking of 52 states and territories, Florida ranks 50th, according to Miami-Dade County Judge Steve Leifman. If the state added $1 billion to its mental health expenditures, that would raise it to only 32nd on the list.

And while there have been some innovative pilot programs that offer hope, the state continues to waste much of the money it does spend, Leifman told the Florida House Judiciary Committee, which held a workshop on mental health and criminal justice issues February 18.

He observed that if the people with physical ailments were treated the same as those with mental illnesses, “there would be lawsuits and criminal indictments. It still stuns me that it’s OK to discharge people with serious mental illnesses into homelessness, and that’s basically what we do. And then we don’t understand why they end up in the criminal justice system.”

This was not the first time Leifman has testified before the Legislature, but there was some indication it may have a larger effect this year. Committee Chair Rep. Charles McBurney, R-Jacksonville, started the meeting by saying, “I expect it will generate discussion amongst legislators and stakeholders for possible legislative reforms.”

And committee member Rep. Gayle Harrell, R-Stuart, chair of the Children, Families and Seniors Subcommittee of the Health and Human Services Committee, said she planned to hold a hearing on the issue with an eye toward producing legislation this year.

Leifman led off the meeting and cited four factors as “drivers” to creating mental health treatment problems in the state, including the low expenditures for community mental health. Effective use of the money spent is complicated by having a system that is fragmented and difficult to use, especially for people with mental health problems. The other three factors, he said, are:

* Much of the money that is spent is wasted. One third of the state’s entire mental health budget for adults — about $200 to $210 million a year — is spent on 2,500 people in an attempt to restore their “forensic” mental competency so they can stand trial. That’s more than any other state, and only three other states have more than 400 patients in such expensive treatment. Yet 70 percent of those who have their competency restored will have the charges dropped, be sentenced to time already served, or get probation. And there is little or no follow-up treatment for them once they are released. Meanwhile, the 150,000 to 160,000 people arrested every year in the state with serious mental problems will receive inadequate treatment.

“We keep doing the same thing again and again and expecting a different outcome,” Leifman said. He noted an alternative pilot program in Miami-Dade is about one-third faster and one-third cheaper. Between 1996 and 2012, the population of Florida’s state prisons grew by more than 50 percent, but the number of inmates with serious mental problems grew three times as fast. It could cost the state $2.5 billion over the next 10 years to build prisons for inmates with mental health problems.

* Medicaid funding for mental health problems is based on a 1950s notion of providing only “medically necessary services” — usually medication — which is less than the comprehensive approach needed and winds up cycling people through the system again and again. But it doesn’t treat the post-traumatic stress disorder for many of the 92 percent of women in prison who were sexually abused as children and the 76 percent of men in prison who have some sort of trauma in their backgrounds. “We need treatments to deal with trauma,” Leifman said.

* Involuntary commitment laws, including the state’s Baker Act, are based on 1700’s common law and have the goal of protecting the community rather than helping the mentally ill. Frequently, Leifman said, the incarcerated person gets evaluated, gets a prescription, and then is released in 72 hours with no follow-up, even to ensure they will take the prescribed medication.

Leifman said there are alternatives that work. He said the pilot program in Miami-Dade has reduced its jail population from 7,800 to 4,400, has reduced injuries to police by the mentally ill, and has reduced injuries to the mentally ill by police. Recidivism on misdemeanors by those with mental problems has dropped from 72 to 20 percent, and the program is being expanded to those charged with nonviolent felonies.

He said better training for police, diversion programs for those facing less serious charges, a less fragmented system that’s easier for those needing help, monitoring in schools to identify children with mental health problems (70 percent of those in the juvenile justice system have mental health issues), effective case management, housing, and treatment beyond handing out a prescription can all make an effective system.

Leifman called for diverting some of the money from the forensic treatment to diverting and treating the mentally ill when they are arrested for minor offenses. The assistance system also needs to be easier for those people to use, recognizing they may be homeless, have difficulty with transportation, and have other issues.

“People really don’t want to be sick. People really don’t want to be on the street. But the system is so unwelcoming, that is where they prefer to be,” Leifman said.

Seventh Circuit State Attorney R.J. Larizza and Sixth Circuit Public Defender Bob Dillinger said there are attempts to address mental health issues when their offices confront them, but much more needs to be done.

Larizza said better programs are needed to determine when those arrested have mental health issues and to treat them once that determination is made. He added that the priority for prosecutors remains protecting public safety.

Dillinger said diversion programs have proved effective, but there are too few of them. He said one such program in his circuit has proved 90 percent effective. He also said children with mental health problems in the justice system is a growing problem and is inadequately addressed. He noted one problem to help children who are committed under the Baker Act closes for the summer when schools close, even though it is full for the rest of the year.

“We need to do something. It is a threat to public safety to have people who are not being treated, and it is unfair to people who could benefit from being treated,” Dillinger said.

Pinellas County Sheriff Bob Galtieri said better training for his deputies has dramatically reduced problems when they are called to incidents involving the mentally ill, but added in most cases there is no program or follow-up care for those people. He added the biggest need is for “navigators” who can steer people through the mental health system and the programs in place to help them.

Okaloosa County Court Judge Patt Maney talked about how the traumatic brain injuries he sustained in Afghanistan helped him understand the need for expanding the use of veterans’ courts because of the special physical and mental challenges many veterans face. He has formally had such a court since legislation passed authorizing them in 2012.

“You can function, you can look normally, you can talk normally, but sometimes when you get injured there’s a little piece that doesn’t work right,” Maney said. “The veterans’ courts work because they’re designed around the basic drug court model.. . . It’s outcome-based. The veterans’ courts work because they key to the military identification of the defendant.”

The committee also heard from officials from the Department of Corrections and the Department of Juvenile Justice on their mental health programs in its almost three-hour meeting.

“Obviously we’re looking at possible legislative reform, and I look forward to having some input,” McBurney said as the meeting adjourned.