The New England Journal of Medicine (NEJM) recently published a feature which brings the state of local US jails to light. It states that 16.9% of the detainees suffer from a serious mental illness, accounting to nearly two million people. Florida’s Miami Dade County, which has the highest rate of mental health sufferers, has come up with a special initiative to tackle this problem.
They aim to provide treatment services to those who have been imprisoned as well as reduce the number of people with mental illnesses in jails and ‘expand the capacity to divert individuals from the county jail into a seamless continuum of comprehensive, community based treatment programs that leverage local, state and federal resources’.
Many other companies and institutions have also tried to fight for the rights of mental health sufferers but Miami Dade is the only one with a 15-year detailed plan, with an aim to improve the conditions and provide mental health services. Judge Leifman, the creator of the Eleventh Judicial Circuit Criminal Mental Health Project (CMHP), in his statement to the Supreme Court of Florida expressed, ‘When I became a judge, I had no idea I would become the gatekeeper to the largest psychiatric facility in the State of Florida’.
The 11th CMHP was established in 2000 and helps these prisoners to get the right they deserve, so that they don’t just die in jail with no one looking after them. It involves pre-booking and post booking jail diversion periods. In the pre booking section, mentally ill people who have been arrested for minor offenses are taken to crisis units to receive treatment. Up till now, 4,600 law enforcement officers and 36 municipalities and country schools who have undergone rigorous training of up to 40 hours, are appointed to recognize signs of mental illnesses and pacify the violent behaviors of the offenders.
The post booking period comprises of identifying people suffering from acute distress, who have been taken into the county jail. Here, they are screened for eligibility, after which the judges transfer them to a crisis unit from the jail where they are provided treatment and case management assistance. All the participants are examined using evidence based tools for possible criminal tendencies or risk factors.
With the help of the South Florida Behavioral Health Network and other community based service providers, arrangements for ongoing treatment and housing are looked into for those who show progress. The patients are monitored at all times by case managers for one year, after which they are allowed to apply for federal entitlement benefits. In the beginning, the CMHP did not look into minor offenses such as non-violent felonies and only stuck to major crimes and misdemeanors. However, in 2008, the post program increased in size and began to include these defendants too, in order to ensure that they do not have any history of violence or cannot be a source of threat to the public.
In just five years, around 50,000 mental health crisis calls have been addressed from the two largest police departments, resulting in 9,000 diversions and only 109 arrests. Moreover, the average daily census in the county jail has shown a dramatic jump from 7,200 to 4,000, with a complete shutdown of one jail and considerable reduction in fatal shootings and injuries of mentally ill people. Participants who have been imposed with charges of minor felonies have shown 75% less jail bookings and jail days after they were enrolled.
It is important to note that the participants’ own will and motivation is extremely essential in the case of receiving treatment. Equally important is meeting the criteria passed on by the civil commitment laws. Diverted individuals who fail to meet the criteria are ascribed to referrals and linkages for follow-up care.
Apart from that, Leifman has been a leader in bringing the legislature to pass a law designed to serve the mentally ill for the first time in 41 years, as well as allotting a space of 18,000 square feet specifically for the purpose of providing treatment. Leifman stresses on the importance of building this treatment center by saying, ‘It shouldn’t have taken this long to get this facility open. Countless people have died waiting for this building to open.’
Miami Dade was chosen as one of the four launch sites last year, in order to help in the planning and development of other similar initiatives for different communities, such as ‘Stepping up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails’, launched by the American Psychiatric Association Foundation.
Although almost all of US faces a high percentage of adults with serious mental illnesses in jails, Florida tends to stand out and is ranked 48th nationally in state funding for community mental health services.