70 Million

In Miami, Jailing Fewer, Treating More

Episode Summary

This episode is a special collaboration with Miami’s WLRN radio station, whose reporters Nadege Green and Daniel Rivero report on the county’s Criminal Mental Health Project which has been instrumental in diverting mentally ill people away from jail. They meet the judge to started the program and see how counselors, peer specialists, and officers are focusing on treatment and services rather than arrests.

Episode Notes

Like in much of the country, jails in Miami-Dade County double as de facto mental health facilities for people with mental health issues cycling through the criminal justice system. But Miami-Dade’s Criminal Mental Health Project has taken the lead in addressing the needs of this population. Now it is a national model for how to tackle the interplay between mental illness and criminal justice, while driving down recidivism and jailing rates in the process. This episode is a special collaboration with Miami’s WLRN radio station, whose reporters Nadege Green and Daniel Rivero meet the judge who started the program and see how counselors, peer specialists, and officers are focusing on treatment and services rather than arrests.

Episode Transcription

Mitzi: 70 million adults in the United States have a criminal record. I’m Mitzi Miller and this is 70 Million -- an open-source podcast about people, and communities, taking on the broken criminal justice system. This season, we'll chronicle how local jails compound the problem, and what residents are doing about it. 

Montage: “Here I am with the judges and attorneys and, you know, police officers...” 

“You can have the most beautiful resume and they’re still going to label you as a felon.”

“I wanted to be able to, to dig in, roll up my sleeves and figure out what could be done about this issue.”

“You’re not letting us be human, like, you’re not letting us just be regular girls.”

“For 20 years all I heard was shut up inmate. And now all of a sudden I have a voice.” 

Mitzi: In many places in the US, jail is the de facto landing spot for the mentally ill. According to the National Alliance on Mental Illness, at least 400,000 people in jails suffer from a severe mental disorder. Psychiatric beds in hospitals and treatment centers are few and far between, and the largest mental health facility in virtually every state is a correctional one.

Of all large urban areas, Miami-Dade County leads the country in the number of residents with a serious mental illness, about three times the national average. And on any given day, about a third of the local jail’s population is on psychiatric medication. 

The Miami-Dade Criminal Mental Health Project has spent years trying to reverse that trend, by seeking treatment for people who need it--not more jail time. Since the Project  started, the county has been able to close one local jail, saving millions of dollars a year. Miami-based reporters Nadege Green and Danny Rivero take us to their city to see the program in action. 

Leah: It was years and years of not knowing, you know, whether she was going to wind up dead. Whether I was going to come home one day and, you know, I hear that she was--something had happened to her, whether she overdosed. 

Rivero: Leah Reed was a child when her mom Julie first went to jail. 

Green: After that, she was in and out a lot.  

Leah: When you’re doing drugs you’re in shady places that things happen, and I was exposed to a lot of things that most normal people didn't see at that age, you know, like giant bags of drugs. She used to steal from my grandmother. She’d steal from me. She'd steal from my sister. It was, it was rough. 

Julie: I was running the streets like a maniac, a drug maniac, fiending for drugs. I was self-medicating. 

Green: This is Leah’s mom, Julie. 

Julie: I had been diagnosed with a mental illness when I was 13, my first hospitalization. I guess untreated trauma and untreated mental illness and untreated addiction caused me to do small crimes to support my drug habit. So that’s how I wound up in and out of the criminal justice system.

Green: The last time she was arrested -- 8 years ago --Julie was referred to the Criminal Mental Health Project. It’s a jail diversion program for people with serious mental health problems who commit misdemeanors and some non-violent felonies, like theft or drug use.

Rivero: Everyone who enters the project receives a court-ordered wellness treatment plan designed specifically for their needs.

Green: The plan is created by doctors and mental health professionals who partner with the project. And once the plan is in place, participants check in with the court at least once a month, sometimes more, to make sure they’re following it until they complete the project. Julie was referred to a residential drug treatment program.

Julie: I didn't say yes immediately because I never went to a residential program before. I was scared. I didn't know what to expect. But. I was more afraid of going back out on the streets and dying. So yeah, I said yes.

Rivero: Julie says she truly wanted to get clean. But it was harder to accept that she needed to take medicine regularly for her mental health. She has bipolar disorder and also struggles with depression and anxiety. 

Julie: You don't want to take the medication. You don't want to say, I'm mentally ill. 

Rivero: When Julie was in the residential treatment program, her daughter visited regularly.

Green: Leah was 18 by then, and she says she made sure her mom knew that she was rooting for her.

Leah: So I was like a front row seat to her recovery.

Green: Leah had an idea of what rehab was like. When she was 16, she started using cocaine. She was arrested, and thought she was going down the same road as her mom. 

Leah: I got arrested early and I was juvenile, it's not on my record. But I did go through a juvenile diversion program for, um--and I went to rehab for four months. You know, I also suffer from, you know, severe anxiety and depression. I just have to, every day I have to tell myself to keep going. You know, it's really hard, no matter, whether you're, you know, currently addicted or not. 

Rivero: Leah says she can relate to her mom’s struggles, and is inspired by her recovery.

Leah: Seeing her get better, she's, you know, the mom that I know. She’s--like, that's my mother. That's not, you know, the monster that just took over her. But, I mean, she's come so far and I'm so proud of her for everything that she's done. No, don't cry. 

Green: Julie wipes away tears. She says she tried many times before to get clean on her own, but she would get turned away from treatment because beds were full or she couldn’t figure out how to get into affordable programs. 

Julie: I wasn't able to get in because if you don't have a team of people backing you up, it's hard to get help. It is hard to to utilize the system and any idea of how anything works.

Rivero: Julie and Leah now both work for the project as peer specialists. They help new participants navigate and hopefully complete the program, like Julie did.

Julie: The peer that came to see me talked to me and he helped me understand that taking medication was OK. You know, that it's OK. 

Rivero: On the seventh floor of the Miami-Dade County criminal courthouse, Justin Volpe is on his way out of the office. He’s also a peer specialist for the Criminal Mental Health Project, as well as a graduate. Half of the eight peer specialists on the team are.

Green: Justin’s part mentor, part case manager. He regularly checks in with the people in the program and makes sure they’re sticking to their wellness treatment plan. Today, he’s going to find someone who seems to have fallen off the radar. We’re calling the man John, to protect his privacy.

Volpe: We’ve been looking for this guy for a little bit. He’s got medicine. We’re about to go find him. 

Green: John hasn’t been following his court-ordered treatment plan and if he doesn’t get back on track, the judge overseeing his case could kick him out of the program and he’ll be back to facing the criminal charges and jail time. 

Rivero: John has to see a therapist, he has to take his medication. But first, Justin has to find him. 

Justin gets into the battered white Prius the county loans out to the Project for moments like this one. He says I can tag along in the car, but for privacy reasons I can’t go into the some of the places he hopes to find John.

He drives to the Allapattah neighborhood, about five minutes away from the courthouse. He pulls up to an outpatient behavioral health clinic. This is where John was ordered to go for his psychiatric appointments.

Volpe: So the program that this guy goes to is right here. This is Dade Family Counseling, let’s go real slow and see if we see him. I see some other familiar faces. 

Rivero: Justin scans the faces of the people outside but doesn’t see John. So he goes inside to check. 

Volpe: I talked to the people inside the program. He hasn’t been coming to the program and they’ve been unable to get in contact with him. So we don’t know if he’s working or he went AWOL or what. So, he struggles financially, so we’re gonna see if we can find him so I can deliver his medications to him.

Green: The Criminal Mental Health project has an agreement with the pharmacy down the street, for its staff to be able to pick up and deliver medicine. So, Justin says he’s going to stop by the pharmacy to bring John all of his medication in one bundle -- last week’s as well as a new prescription they’ve been holding for him. 

Volpe: Cool, cool, cool, thank you. 

Rivero: He returns with several pill bottles. Next, we’re heading to John’s house. 

Green: Justin can’t call him though. John doesn’t have a phone. If he did, this could be a lot simpler -- call him, ask how he’s doing, tell him his medication is ready. But this is common among the project’s participants, Justin says. 

Volpe: Poverty sucks, man. You don’t have a phone, you’re running around trying to hustle up money. It’s tough out there. And the system -- the program is good but we’re trying to fix, you know, fragmented pieces of the system here and it’s a mess, you know? 

Green: Justin knows from personal experience. He says he prefers not to share the type of mental illness he suffers from. But he was in this same program eleven years ago, after he was arrested on a theft charge. 

Rivero: He spent time in the county jail, on the ninth floor. Back then it was known as the Forgotten Floor -- a psychiatric ward that was so notorious, the U.S. Department of Justice stepped in to investigate its unsafe and deadly conditions. It was eventually shuttered in 2015.

Volpe: Yeah, it was crazy, people were screaming around the clock, they were handing me fistfuls of pills, I didn’t know what they were. I didn’t know where I was, I didn’t know why I was in there. I know that I had a cellmate that was in there for years and he had been in there for attempted murder, he had stabbed his wife with a pair of scissors. 

Green: Justin was released from jail after a few weeks and got into the Criminal Mental Health Project. Six months later, he completed the program. He says it changed his life. 

Volpe: I stopped doing drugs, and I started taking my medicine and I started to feel better. It was like a miracle. 

Green: He remembers his graduation day.

Volpe: It was November 2007, it was a day before my 24th birthday.  

Green: Some of the Mental Health Project staff brought him into the office.

Volpe: They said, ‘How would you like to work with severely mentally ill people?’ And I said, ‘That doesn’t sound really good.’ Right? And she goes, ‘Nah, nah, you could be a county employee.’ And I said, ‘I’m paranoid, I’m delusional.’ Cindy’s like, ‘Ahh, you’ll fit right in.’ 

Rivero: While we’re riding around, Justin’s phone is constantly ringing. A neighbor wants a referral for their son who has a mental illness. A client in the program checks in and gives him an update. This happens all the time, he says. 

Volpe: It’s our job to try to keep communication open and just meet them where they’re at, you know. My job at least isn’t to get someone in trouble. 

Rivero: Justin slows the car down. We’re getting close to John’s house now. Mango trees and banana plants cast shadows in the front yards of the homes on this street.

Volpe: That’s North Miami, so First is right here, I think it’s down here. Yeah this is it. This is the street. I remember the trees. 

Rivero: He stops in front of a house with a chain link fence.

Justin hops back into the car after talking to John’s girlfriend. 

Volpe: So we delivered the meds. He wasn’t home, we just missed him, we just missed him. I’m gonna call the case manager now and tell him what’s up. 

Green: A few hours later, John called Justin and told him he got the meds. It’s a small thing, getting someone their medicine. But a series of small things all together can add up to keep someone out of jail and help them get their life in order.

Rivero: The Miami-Dade Criminal Mental Health Project started in 2000. It was created by County Judge Steven Leifman -- a fierce advocate for mentally ill people in the criminal justice system who’s become nationally-known for his reform work in Florida.

Leifman: Our community mental health system and our laws are antiquated. The system’s terribly fragmented and horribly under-resourced. 

Green: He says law enforcement, the courts, social service agencies, were simply not addressing the underlying needs that led people with mental illnesses into the criminal justice system in the first place. 

Leifman: These illnesses are rough. The medications can be rough and, and, you know, society has really beat them up and we want them in a safe place and the courts should be a safe place. We're not there to hurt them. We're there to give them another chance because we now recognize that their illness had a lot to do with them ending up in our system.

Rivero: Judge Leifman says before mentally ill people ended up in his courtroom, many of them also interacted with a number of community institutions. 

Green: Hospitals, public housing agencies and nonprofits-- none of these groups were really talking to each other. The system was broken.

Leifman: What was so galling about it was not only was it designed to fail but when we didn't provide people with the treatment and services that they need, we would then punish them by arresting them because they were out in the street floridly psychotic and we didn't know what else to do.

Rivero: He uses an anecdote of a training he went to, which showed how ineffective the system was. Officials and service providers were sent to a park, and they had to pretend they were just released from jail. 

Leifman: They took their purses and their wallets and their shoes and their ID and their money and they said, ‘Okay, you have a serious mental illness. Tomorrow morning you need to be in court at 9 o'clock. Ten thirty you need to see your probation officer. At 1:00 o'clock you have an appointment with a psychiatrist. At three o'clock you have an appointment to go pick up your medication and good luck.’

Green: So Judge Leifman teamed up with what he describes as traditional and non-traditional stakeholders to start putting this puzzle together. 

Leifman: It was the courts, the Department of Corrections, the providers, the Department of Children and Families, the police chief, the director. Everybody started to sign on on how we could change the process.

Rivero: They started seeing results within a few years. People with mental illnesses who completed the program weren’t cycling in and out of jail as often.

Leifman: The recidivism rate dropped pretty quick among the misdemeanor population when we started. It went from about 72 percent to 20 percent. 

Green: And the daily number of people in local jails also went down. Police officers were brought in and trained not to arrest people having psychotic episodes; instead they took them to mental health facilities that worked with the Project. 

Rivero: By 2014 the county was able to close down one of its jails. The daily population used to average above 7,000. Today it hovers around 4,000.

Green: The project, now in its 18th year, is considered a model for others around the country. Judge Leifman says he’s been traveling from coast to coast to teach about it.

Leifman: We went from nobody understanding or caring -- not necessarily caring but realizing what can be done -- to now everybody wanting it fixed overnight. So I'm running around a little too much and as fast as I can.

Rivero: Recently, Judge Leifman has been chairing a Florida Supreme Court Task Force on Mental Health. 

Green: He says the state is slowly working its way towards a statewide system modeled after the one he started in Miami-Dade.

Leifman: Because if you do it right, it actually saves money. It improves public safety. It spends tax dollars in a much more appropriate way. And it also gives people their lives back and gives them an opportunity to recover.

Rivero: Judge Leifman still remembers the exact moment he decided to take on mental health in Miami-Dade.

Green: He was in his court chambers in 2000 when a family approached him about their son. 

Leifman: They told me that their son was brilliant. He had gone to Harvard. He had a late onset of schizophrenia and he was now homeless and he was recycling through the criminal system and they just didn't know what to do anymore.

Rivero: Judge Leifman told them he would help -- even though he had received no training at that point on what to do with criminal defendants with severe mental illnesses. 

Leifman: You know, we deal in logic. And I knew that if you got arrested and had a heart attack we clearly had a health care system in place for you. So I assumed the same must be true for people with mental illnesses. 

Green: The couple’s son was a former psychiatrist. He’d been arrested for a very low-level offense and been in jail for weeks at that point.

Rivero: The family wanted to get their son into some type of court-ordered treatment program.

Leifman: I went into the court and I was determined to help these people and save the day. And I remember vividly calling his case. And he stood and we started to have this amazing conversation. He was coherent. He was thoughtful.

Green: Except when he looked at him, Judge Leifman could see the man was disheveled and appeared to be homeless. The former psychiatrist kept insisting, “there’s nothing wrong with me”.

Rivero: Judge Leifman says he then gently asked the man: “if nothing is wrong with you, why are you homeless, and constantly going in and out of jail?”

Leifman: All of sudden he got a look on his face that I will not forget until the day I die. And it was a look of complete and total terror. 

Green: The man covered his ears and started screaming. 

Leifman: And he started to point to the back of the courtroom where his parents were standing and he started yelling, ‘Your Honor, Your Honor, Your Honor.’ And everything he said was like in sixes. And he's like, ‘You have to have that couple moved, you have to have that couple moved.’ And I said to him, ‘Aren't those your parents?’ And he's like, ‘No, no, no, no, my real parents, real parents, died died in the Holocaust, Holocaust, Holocaust, and they're from the CIA, CIA, CIA and they came to kill me, kill me, kill me, kill me, kill me.’

Green: Judge Leifman ordered a psychological evaluation. The results showed the man met the criteria to be involuntarily hospitalized.

Rivero: But county court judges did not have that authority, so all Leifman could do was tell the man to see a psychiatrist upon release and check back in with the court once he had. 

Leifman: While I did not agree with the law, I have no choice but to follow the law and I had to release him back to the street. And of course he never showed up to the psychiatrist and he never came back to court.

Green: To this day he doesn't know what happened to the man.

Leifman: God forbid something terrible happened to him or he did something terrible to someone else. So I went back to my chambers and I got on the phone because I did not want to be in that position again and I started making calls.

Fields: I was very interested in what he was doing to prevent the jails from becoming psychiatric hospitals. 

Rivero: Maria Fields is the clinical director at a mental health clinic called Dade Family Counseling. It’s where Justin--the peer specialist--drove by looking for John, the man who wasn’t going to his court-ordered appointments.

Green: Dr. Fields says it’s not easy for someone to graduate the program. You have to do constant check-ins, go to appointments, stay on your medications.

Fields: So they actually don't get a free ticket. It's actually quite a bit more work to fulfill the obligations of this program. 

Rivero: And she knows stigma can be a barrier to getting into treatment.

Fields: There's no shame in being mentally ill and you know, just like if you had a patient that had diabetes, you certainly would never tell them to stop taking their insulin. 

Green: Mental health specialists working with the program create treatment plans that can last six months up to a year. And during that time they send the court regular status updates--if the person is coming to their appointments, taking their medication and about their overall progress.

Rivero: Dr. Fields says without these interventions...

Fields: You'd have people, you know, not having treatment, you'd have people re-offending, you'd have people, you know, in and out of the hospitals. If we can keep people on their medication, keep them in treatment, it's less costly to taxpayers. 

Rivero: But what if you can't keep people in treatment, or on their meds? 

Green: And what happens if you can't even get them started in the first place?

Geurda Jean is sitting outside of the Little Haiti Caribbean Marketplace on a fold-out chair. Steps away from her, vendors are selling fried pork, leather masks made in Haiti, and healing crystals. She’s wearing large dark sunglasses and in Haitian-Creole, she calls out to the people she knows walking by.

Rivero: Guerda normally spends her days hanging out here or nearby--talking, and sometimes arguing and getting into fights. A few months ago, Geurda was arrested and sent to jail for one of those fights. She qualified for the Criminal Mental Health Project, but she’s having a hard time at it. 

Green: At Guerda’s last hearing at the Criminal Mental Health court, Judge Joseph Mansfield was not happy. This was her first check-in since agreeing to take part in the program. 

Rivero: And she had yet to make her first appointment with a psychiatrist, so she didn’t have the medical consultation that could guide her treatment plan. The judge gave her one more chance to make that appointment or else she’d go back to regular criminal court and the possibility of more jail time. 

Green: After her hearing, Geurda isn’t moved by what just happened in court. She says in Haitian-Creole, the judge and the psychiatrists in jail got it wrong. 

Guerda: Yo di’m mwen pa gen anyen. tet mwen pi dret pas yo wi. Li met fe mwen pyschic ki mele’m.

Green: She says there’s nothing wrong with her--that her head is better than theirs. 

Rivero: Emanuel Tafari sells Caribbean vegan food out of the Marketplace, just steps away from where Geurda is sitting. He says Geurda was banned by the management from coming inside because she usually causes some kind of disruption.

Tafari: We were informed as the vendors that if we ever see this woman on the premises that we call the police. Seems like whenever there’s something going on, you know, there’s an outburst and someone is running off with something, she’s always in the middle of it.

Rivero: But he admits, the mostly Haitian vendors still let her hang around and sometimes pay her a few dollars to help them set up.

Tafari: Because we’re part of the community. Every family might have somebody in the family who is not doing as well as others, whether it be mentally, whatever capacity--you’re going to have a little bit of tolerance for and a little understanding.

Leifman: Someone like this woman may need more structure. 

Green: Judge Steven Leifman again. 

Leifman: She probably has other issues going on as well. Cultural issues, language issues.

Green: Judge Leifman says there’s a lot of things going right with the program. But other things could clearly be better.

Leifman: There was no such thing as a treatment resistant person, there's only treatment resistant programs. And so, you have to keep reinventing yourself and what works.

Rivero: Still, eighty percent of the people who go through the Criminal Mental Health Project complete it and graduate.

Green: But Judge Leifman says even with a high success rate, he is still very concerned about those who don’t make it. 

Rivero: Like many other parts of the country, housing has become unaffordable for a lot of people here. Miami-Dade County consistently ranks as one of the nation’s most expensive rental markets.

Green: And if you’re already poor, struggling with a mental illness, and cycling in and out of jail, not having a place to live exacerbates all of that.

The Criminal Mental Health Project commissioned a study to take a look at all of the people who go into the program, don’t complete it, get arrested again and get referred back, again and again.

Leifman: On this one piece of paper were the names of 97 people, primarily men, primarily diagnosed with a schizoaffective, schizophrenia disorder, primarily homeless. 

Rivero: Over a five year period the cost to arrest these 97 people and the emergency medical cost to stabilize them short-term was over $12 million dollars. 

Leifman: They were arrested 2,200 times. They spent 27,000 days in the Dade County Jail, 13,000 days at a psychiatric facility or emergency room, and cost taxpayers 13.7 million dollars. And we got absolutely nothing for it.

Green: That’s why Judge Leifman says the Criminal Mental Health Project’s next step is a big deal. They’re creating what he calls a “one-stop-shop” in a seven-story building near Miami’s Wynwood neighborhood. The building is an abandoned psychiatric treatment facility. 

Rivero: And it’s being transformed into a state-of-the-art mental health and jail diversion center. It will house mental health and other medical care providers, a courthouse, and the homeless people in the program who were cycling in and out will also get to live there for up to a year. 

Leifman: The idea is to take this really acutely ill population and instead of just kicking them to the curb once we’ve adjudicated their case, we can gently and slowly reintegrate them back into the community in recovery, with all the supports and case management systems that they need for recovery. 

Green: Miami-Dade County and Jackson Memorial Hospital, the county’s largest provider for psychiatric care, are paying for the costs to get the building up and running. 

Leifman: This building is keeping me really going now because that's the light at the end of the tunnel. We see the successes and, you know, we still have failures but we try not to give up on people and we need more resources and we need to get the building open to really make the final push on, you know, serving this entire community. 

Rivero: Construction on the new facility will begin any day now and it should be open within two years. 

Green: In Miami, I’m Nadege Green. 

Rivero: And I’m Danny Rivero, for 70 Million. 

Mitzi: Thanks for listening. Now we want to hear from you. Email us at hello@70millionpod.com or call us at 202-670-4912. If you’re ready to share, we want to hear your story. For more information, visit 70millionpod.com. We invite you to use our materials anywhere they might be useful. You may rebroadcast parts of or entire episodes without permission. Just please drop us a line so we can keep track.

70 Million is made possible by a grant from the Safety and Justice Challenge at the John D. and Catherine T. MacArthur Foundation. 

The podcast is a production of Lantigua Williams & Co. It’s edited by Jen Chien and mixed by Luis Gil. Our associate producer is Oluwakemi Aladesuyi. Our marketing specialist is Kate Krosschell. Our resource guide writer is Amy Alexander. Juleyka Lantigua-Williams is the creator and executive producer. I'm Mitzi Miller.



Green, Nadege and Daniel Rivero. “In Miami, Jailing Fewer, Treating More.” 70 Million Podcast, Lantigua Williams & Co., October 15, 2018. www.70millionpod.com