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The People

Steve Leifman

A Judge on the mental health frontlines in Miami

JudgeSteveLeifmanWhen Steven Leifman was elected judge he had no idea that he was also becoming “the gatekeeper to the largest psychiatric facility in Florida — the Miami-Dade County Jail.”

According to Judge Leifman of the Eleventh Judicial Circuit, there are 10 times as many people with serious mental illnesses in the Miami-Dade County Jail than in any state hospital in Florida and it is home to the largest percentage of people with serious mental illnesses of any urban area in the United States. He estimates that 20,000 people in need of mental health treatment are arrested each year in Miami-Dade County, primarily for misdemeanors and low-level felonies. The county spends $80 million a year to house and treat these people.

The topic strikes a visceral chord with Judge Leifman. When he was a 17-year-old intern for a prominent legislator in Miami he said their office received a letter from the editor of the Miami Herald about a teenager stuck in a state mental hospital. Judge Leifman, who was the same age as the patient at the time, went to visit him.

“The young man was strapped to a bed and was being injected with Thorazine. He was 150 pounds overweight and living in his own hell. He wasn’t even psychotic. It turned out that he was autistic,” Judge Leifman said. In another part of the facility, he saw six naked men being hosed off by a guard.

“Those are the men I see in my courtroom now,” he said.

To improve the broken system, Judge Leifman created the groundbreaking Eleventh Judicial Circuit Criminal Mental Health Project in 2000, which consists of programs to steer people with mental illnesses who have committed low-level offenses from incarceration and instead to community-based care.

“People are dying in jail when they could be getting the things that they need for recovery,” he said.

If a person with a mental illness is arrested for a low-level offense, he or she is diverted from jail to community-based mental health program to receive treatment and continuing care. A person who is accepted into this diversion program is provided with case management assistance and help finding housing to lower their likelihood of reoffending.

Judge Leifman’s latest undertaking is a state-of-the-art Mental Health Diversion facility that will include short-term housing, a crisis unit, rehabilitation areas, and a courtroom.

“This has been our biggest challenge. We were successful at getting the state to lease us the property and county taxpayers to pass a bond issue, but had a really hard time getting local policy makers to implement it,” he said. At one point during the discussions the project was almost derailed when Miami-Dade County said that it wanted to take the money and build a new jail. “It’s taken six years to get here,” he said. “We had a lot of challenging conversations and heavy debate to get everyone on the same page.”

The facility is expected to open in two years and when it does Judge Leifman said that it will be the centerpiece of their mental health program.

The Criminal Mental Health Project is also in the first phase of implementing an advance care technology created with the help of IBM and OTSUKA, a Japanese pharmaceutical company, that would enable jails and community-based treatment providers instantaneous access to a consumer’s history and other information, such as what treatments have worked best for that individual.

Despite Miami-Dade’s successes, Leifman said that much work remains to be done.

“There’s clearly something very wrong with a society that is willing to spend more money to incarcerate people that are mentally ill than to treat them,” Judge Leifman said.

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People with Mental Illnesses in Jails