Since a college internship assignment in 1973 that sent him to a state psychiatric hospital to investigate an autistic man being treated inhumanely, Steve Leifman has made it his life’s work to help people with mental illnesses. Now, an Associate Administrative Judge in the County Criminal Division of the Eleventh Judicial Circuit of Florida, covering Miami-Dade County, Judge Leifman’s name has become synonymous with the movement to keep people with mental illnesses out of jail and into appropriate medical and psychiatric treatment. In 2000, he created the 11th Judicial Circuit Criminal Mental Health Project, which includes pre- and post-arrest diversion programs for people with serious mental illnesses. The Project has become a national model for handling people with mental illnesses in crisis, and Judge Leifman has spearheaded efforts to bring to Miami-Dade County, the first-of-its-kind Mental Health Diversion Facility, expected to open next year.
His work has relied heavily on data and data analysis to tell the story of positive impacts that his initiatives have had on Miami-Dade County’s criminal justice system and those with mental illnesses living in South Florida.
To learn more about these positive outcomes and how data has helped him shape his successful programs, I sat down with Judge Leifman and asked him to share his insights.
HM: How do you summarize the problem our society is facing when it comes to mental illness?
SL: We have a mental health crisis in the United States. While the U.S. has 4 percent of the world’s population, we have about 25 percent of the world’s inmates. Much of this is due to untreated mental illnesses and substance use disorders. Sadly, because of an under-resourced and fragmented system of mental healthcare, people with mental illnesses are ending up in the criminal justice system rather than in treatment. Additionally, the lack of understanding and the stigma associated with mental illness make it difficult to access high-quality care. Just like you can’t tell someone who broke their arm to “get over it”, combating mental illness is not a choice, it’s physiological. We have to start looking at these illnesses through a different lens and start applying a population health or disease model, rather than expecting the criminal justice system to help them. Furthermore, we need to move upstream and start screening kids in middle school for adverse childhood experiences. We know that kids who have serious trauma will likely develop a substance use or mental health disorder.
HM: What current systems are in place to deal with mental illnesses?
SL: The biggest problem in mental health is that no one entity is really accountable for taking care of these individuals. One person with a very serious mental illness accesses numerous resources in the community and often the most expensive acute systems of care. Most of the money we spend related to mental illnesses is wasted in institutional settings such as jails, hospitals, and competency restoration facilities. We do very little to get ahead of a crisis or help manage the Illness. An individual with a psychiatric disorder often also has primary health issues and sometimes a co-occurring disorder – meaning they have both a serious mental illness and a substance use disorder. They often encounter law enforcement, the courts, paramedics, etc., and no one person or system is managing that person’s illness or health. Half of the people with serious mental illnesses are homeless at the time of arrest and 75-80 percent of them have a co-occurring disorder. They often self-medicate with serious illegal substances that lead to addiction. They’re not bad people, they’re sick people. The mental health system is a difficult system of care to access, even if you don’t have a mental health disorder. We should be treating mental illnesses like any other illness, such as cancer, where you get care regardless of your ability to pay. Even if you have insurance, it’s often difficult to get adequate mental healthcare and even more difficult to get long-term care because the parity laws have not been applied very well.
HM: What is our lack of planning for these individuals costing us?
SL: Aside from the enormous human cost of using the criminal justice system as the de facto mental health system, the fiscal impact to the government and taxpayers is astronomical, providing few if any measurable positive outcomes. Miami-Dade County, for example, currently spends $636,000 dollars per day – or $232 million dollars per year – to warehouse approximately 2,400 people with serious mental illnesses in its jail. Comparatively, the state of Florida spends $47.3 million dollars annually to provide mental health services to about 34,000 people in Miami-Dade and Monroe Counties, leaving almost 70,000 people in these two communities without access to any mental health services. Put another way, taxpayers pay $100,000 a year for each person with a mental illness in jail, with no positive impact—but allow only $1,400 a person to treat those with mental illnesses to help them maintain stable lives and contribute to their families and communities—with zero for a large number who get nothing. This makes absolutely no sense!
HM: What is the solution?
SL: We need to do several things. First, we need to screen people for trauma and mental illnesses much earlier, so we can keep people out of the acute systems of care and in recovery. Second, we need to revamp our crisis-care response system, which I’ve been working on with the Group for the Advancement of Psychiatry (GAP). Third, we also need to modernize both our civil commitment laws and our criminal laws as they pertain to people with mental illnesses. Our current civil commitment laws are about 50 years old and don’t reflect modern science, research, and medicine. Our criminal laws should require the diversion of people with mental illnesses who pose little public safety risk to the civil system and others on non-violent charges should be diverted into treatment and monitored by the court. Fourth, we need to establish police pre-arrest diversion programs like Crisis Intervention Team (CIT) programs that train law enforcement officers how to identify an individual in mental health crisis, de-escalate the situation, and take the individual to treatment rather than jail. Finally, we need to adequately fund mental health like other major illnesses and improve access to care by eliminating the fragmentation in the system.
HM: Aren’t you involved with a training program for law enforcement officers?
SL: Yes, we have more than 7,500 officers trained in a program called Crisis Intervention Team (CIT) policing at every police department in Miami-Dade. We keep data on all of the CIT calls made by the Miami-Dade Police Department and the City of Miami Police Department. From 2010 through 2019, those two departments combined handled 105,268 mental health calls but only made 198 arrests. In fact, since CIT was fully implemented in Miami-Dade the number of arrests in Miami-Dade County fell from about 118,000 to 53,000, reducing the number of jail inmates from about 7,300 to 4,000, allowing us to close one of our three jails at a cost savings of $12 million per year. That’s an actual cost savings of $84 million to date. Plus, the City of Miami Police Department has significantly reduced its number of police-involved shootings by almost two-thirds since we employed Crisis Intervention Team policing.
HM: How do you see data analytics playing a role in the intersection of mental illness and criminal justice?
SL: I don’t think there is a way to really get our arms around this problem without analytics — the systems are just too complicated. That’s where the information and approach to data that programs like yours are so critically important to helping us manage this population, particularly in this environment. With enough data, we might be able to get ahead of crisis situations. For example, I’m very interested in seeing how analytics can help us identify patterns to see how we can get ahead of a crisis before someone gets arrested, hospitalized, or resulting in treatment through an acute and expensive setting that usually has horrible outcomes.
HM: Do you think enough data exists to help find solutions?
SL: I really do. The problem is capturing the data from so many data streams. Additionally, the lack of standardized assessment tools and the fact that people with serious mental illnesses often move from provider to provider makes it a challenging environment to get people the services that they need when they need it. We need technology that follows these individuals, so we can get ahead of a crisis before one occurs. This approach allows them an opportunity to live a life in recovery with hope and real opportunity. That’s where data analytics and predictive analytics can play such an important role.
HM: What’s your ideal data analytics system to address the mental health illness problem in our community?
SL: First, we need to use data to help us develop better and more effective treatment protocols. Second, we need to manage this population that often moves through so many different systems of care that often fail to share data. Third, we need to use data to scale successful models of care to other communities. We know for instance, that people with serious depression have better recovery rates than people with heart disease and diabetes. But we wait so long to help individuals get treatment, much of their lives are unnecessarily wasted. We also know that for some people with psychotic episodes, the longer they go untreated the greater chance that permanent brain damage may occur. Therefore, we are contributing to the problem by not getting ahead of it and treating people when they need to be treated. As a result, their deficiencies become so great they end up needing longer-term institutional care. Since that longer-term institutional care rarely is available, individuals with untreated serious mental illnesses recycle through the acute systems again and again. With good data and good analytics, we could help avoid this cycle of despair.
HM: What are you optimistic about?
SL: We’re now building the first-of-its-kind Mental Health Diversion Facility in the United States. Named the Miami Center for Mental Health and Recovery, this one-stop-shop facility will be a medical home providing both mental health treatment and primary health treatment, along with dental and eye care. In addition, the facility will have a crisis stabilization unit, a short-term residential facility, a day activity program to teach self-sufficiency, a culinary supportive employment program, a courtroom to manage both civil and criminal cases, and 200 beds of housing. Aside from counseling and psychosocial services, trauma treatment will also be available. Instead of just throwing people back to the street without adequate treatment, we will gently re-integrate people with these serious mental illnesses back to the community with all of the support they need to maintain their recovery. By offering this level of service and care, we will finally be able to have a system that improves public safety, saves money, and provides people with serious mental illnesses the opportunity for recovery and a life with hope and dignity.
HM: I find it ironic that the criminal justice system — the one we probably fear the most — is the one that’s really going to save the day here.
SL: You raise a really good point. We’re trying to keep people out who don’t need or deserve to be here. Most of the reform in the country in this area is coming through the Judiciary. We see these poor souls every day, and nobody wants to just kick them back out to the curb. The vast percentage of people with mental illnesses who get arrested are arrested on low level of offenses and are released relatively quickly, which results in them recycling through the system multiple times. Often, it’s not that they don’t want treatment, it’s just the system beats them up so badly they give up on life and don’t care about anything anymore. The more data we have that show what helps people recover, the better all of us are going to be.
Visionaries like Judge Leifman recognize the value of using data to pinpoint and solve problems in a meaningful, efficient, and effective way. Spatially Health, with its expertise in data analytics and predictive modeling, is poised to help Judge Leifman, as well as healthcare providers and payers, and governmental entities and nonprofit organizations address real-world issues and make a positive impact. To find out more, contact us.