Changes are needed in how our judicial system treats the mentally ill

By Jorge Reyes

Not long ago, I had a chance to meet Judge Steven Leifman, a circuit court judge who is also an advocate for the mentally ill inmates. In a speech in 2007 he said, "When I became a judge I had no idea that I was becoming a gatekeeper to the largest psychiatric facility in the state of Florida - the Miami-Dade Jail." And since that time, indeed he has.

Judge Leifman was instrumental in drafting and presenting a massive report to judges and legislators titled "Mental Health: Transforming Florida's Mental Health System" about mentally ill patients and how they have become the forgotten few in our legal system.  The 170-page report is hair-raising.  It highlights in detail how the legal system treats under its case mentally incompetent defendants. 

The report itself was so grim that a local TV station reporter, Michelle Gillen, did an investigative documentary called "The Forgotten Floor."
Here are some statistics taken right out from the report:

"On any given day in Florida, there are approximately 16,000 prison inmates, 15,000 local jail detainees, and 40,000 individuals under correctional supervision in the community who experience serious mental illness (SMI). Annually, as many as 125,000 people with mental illnesses requiring immediate treatment are arrested and booked into Florida jails. The vast majority of these individuals are charged with minor misdemeanor and low level felony offenses that are a direct result of their psychiatric illnesses. People with SMI who come in contact with the criminal justice system are typically poor, uninsured, homeless, members of minority groups, and experience co-occurring substance use disorders. Approximately 25 percent of the homeless population in Florida has an SMI and over 50 percent of these individuals have spent time in a jail or prison.

"A 2006 report by the National Association of State Mental Health Program Directors (NASMHPD) Research Institute reported that the State of Florida ranked 12th in the nation in spending for forensic mental health services. Today, this estimate is likely to be considerably higher as this ranking did not take into account the state’s investment earlier this year of more than $16 million in emergency funding allocated by the Legislative Budget Commission and the addition of $48 million in annual funding to add 300 desperately needed treatment beds to the overflowing forensic system. Individuals ordered into forensic commitment are now the fastest growing segment of the publicly funded mental health marketplace in Florida. Between 1999 and 2007, forensic commitments increased by 72 percent, including an unprecedented 16 percent increase between 2005 and 2006.

"To put this in a more acute perspective, the State of Florida currently spends roughly a quarter of a billion dollars annually to treat roughly 1,700 individuals under forensic commitment; most of whom are receiving services to restore competency so that they can stand trial on criminal charges and, in many cases, be sentenced to serve time in state prison. Furthermore, the treatment provided in Florida’s forensic hospitals is funded entirely by state general revenue dollars, as Federal law prohibits Medicaid from providing payment for psychiatric services rendered in such institutional settings. As a result, the state is investing enormous sums of taxpayer dollars into costly, back-end services that may render a person competent to stand trial, but will do nothing to provide the kind of treatment needed to facilitate eventual community re-entry and reintegration.

"Roughly 150,000 children and adolescents, under the age of 18, are referred to Florida’s Department of Juvenile Justice (DJJ) every year. Many of these youth have been impacted by poverty, violence, substance abuse, and academic disadvantage. Over 70 percent have at least one mental health disorder, with females experiencing higher rates of disorders (81%) than males (67%). Of youth diagnosed with a mental health disorder, 79 percent meet criteria for at least one other co-morbid psychiatric diagnosis, the majority of whom (approximately 60 percent) are diagnosed with a co-occurring substance use disorder."

These are just some of the highlights of the report. There is more, much more, and the more you read it the more alarming this issue will be to you, too.

I ask you to read it for yourself.

Changes are obviously needed, and fast. The problem is that at a time when there are so many budget cuts across a wide variety of services and programs, I feel that the report will simply be an irritant to our legislators who are fully aware of the problem, yet are unable to do much to lead by example and do the right thing.

To read or download the report, please click here: http://www.floridasupremecourt.org/pub_info/documents/11-14-2007_Mental_Health_Report.pdf