April 28, 2025 • 31 mins
Judge Steven Leifman shares his remarkable journey from witnessing horrific conditions in a state psychiatric hospital as a teenager to becoming a leading judicial advocate for mental health reform.
His work in Miami-Dade County has transformed how the criminal justice system handles people with mental illness, saving millions of dollars while giving thousands a path to recovery.
• Began his advocacy at 17 when investigating abuse at a state psychiatric hospital where he found an autistic young man being improperly treated as psychotic
• Discovered as a judge that our system has transferred responsibility for the mentally ill from inadequate state hospitals to equally inadequate jails
• Found that just 97 people with severe mental illness were arrested 2,200 times over five years, costing Miami taxpayers tens of millions
• Created a comprehensive diversion program that reduced Miami arrests from 118,000 to 53,000 annually and closed one jail, saving $168 million
• Building a first-of-its-kind mental health facility with crisis stabilization, housing, employment support, primary healthcare, and court services
• Working with Chief Justices nationwide to replicate Miami's successful model in communities across America
• Emphasizes that people with mental illness are more likely to be victims than perpetrators of crime
• Advocates for early trauma intervention since 92% of incarcerated women and 75% of men with mental illness have histories of severe trauma
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to why Not Me ?
The World Podcast, hosted byTony Mantor, broadcasting from
Music City, usa, nashville,tennessee.
Join us as our guests tell ustheir stories.
Some will make you laugh, somewill make you cry.
Their stories Some will makeyou laugh, some will make you
(00:30):
cry.
Real life people who willinspire and show that you are
not alone in this world.
Hopefully, you gain moreawareness, acceptance and a
better understanding for autismaround the world.
Hi, I'm Tony Mantor.
(00:52):
Welcome to why Not Me?
The World Humanity OverHandcuffs, the Silent Crisis
special event.
Joining us today is JudgeStephen Leifman.
He was first elected to the11th Judicial Circuit Court of
Florida in 1995.
In 2007, he served as a specialadvisor on criminal justice and
mental health for the SupremeCourt of Florida.
(01:12):
He has received several awards,including one from the Pope.
It is truly an honor to havehis honor with us today.
Thanks for coming on.
Sure, thanks for having me.
Oh, it's my pleasure.
You've been doing this for avery long time.
What led you to become anadvocate for people with mental
health and autism?
Speaker 2 (01:29):
Yeah, I have two stories and the first one starts
when I was 17 years old.
I was an intern for a statelegislator here in Miami and he
had received a letter from thethen editor of the Miami Herald
about a young man who was in ourlocal state psychiatric
hospital.
This is 48 years ago.
This is the height ofinstitutionalization and it's
(01:53):
the height of the abuses thatwent on at state hospitals.
So I guess, being the low guyin the totem pole, I got asked
to go to the state hospital toinvestigate.
The editor of the Miami Herald,who wrote the letter to the
legislator, raised concerns thatthere was abuse going on at
this facility and that thisyoung man was being abused as
(02:14):
well.
So I walked through the frontdoors of a state psychiatric
hospital 48 years ago and it wasa scene out of.
One Flew Over the Cuckoo's Nest.
Funny, in a way, I'm a21-year-old son.
I would never allow him to go.
I can't believe they sent a17-year-old kid.
Anyway, I found Jonathan, theyoung man I was looking for.
(02:37):
He was in all four-pointrestraints.
He was being injected withprobably Thorazine, which was
the only antipsychotic at thetime.
He was screaming and moaningand crying and it was a scene
out of a horror movie.
So I started to look at hisrecords.
This is well before HIPAA.
I started to talk to the staff,although, I will candidly tell
(03:01):
you, I had no idea what I waslooking at.
I was 17 and knew nothing.
But what I did find thatshocked me.
And when I spoke to the staff,it turns out that he was not
psychotic at all.
He was autistic.
Speaker 1 (03:13):
Wow, that's amazing.
Speaker 2 (03:15):
Here they were injecting him with antipsychotic
medications.
Speaker 1 (03:18):
What was the next step when this came to your
attention?
Speaker 2 (03:21):
While I was there, there was a group of advocates
touring the facility and theyfound out that there was a
representative from alegislator's office, albeit a
17-year-old, who had noknowledge and no power.
But they insisted I take a tourof the facility.
They brought me downstairs towhat looked like a dungeon.
It was like a jail cell and Ifound these seven men lying in
(03:45):
their own feces while a guardthey were naked and a guard
stood there with a hose andwashed them down like they were
animals and it was prettytraumatizing and pretty horrific
.
And while I did not have muchauthority to help them, I was
able, with the help of thesenator, to get the young man
out of the hospital and we gothim placed in a really wonderful
(04:07):
, amazing adult living facilityfor other young men with autism
and he was very well cared forafter that.
Speaker 1 (04:14):
That's really good that you could help him.
How did that affect you?
Speaker 2 (04:18):
It left a pretty indelible mark on me.
About 17 years later I gotappointed to the bench and,
ironically, that hospital that Ihad been at 17 years earlier
was closed.
The jail across the street fromme started to become the
psychiatric facility for ourcommunity.
So those same folks, or type offolks that had been in the
(04:40):
state hospital, they gotreleased to the streets without
services and many of them endedup in the criminal justice
system.
In 1955, there were about maybewe estimate 5,000 people with
serious mental illnesses instate hospitals.
There were about excuse me, injail.
There were about 550,000 atthat time in state hospitals.
Today there's less than 30,000civil psychiatric beds in this
(05:03):
country, and last year we hadabout 1.5 million people with
serious mental illnessesarrested and about 2 million
incidents.
And so we neverdeinstitutionalized.
What we really did is wetransferred responsibility from
these really terrible, crappy,horrible state hospitals to
these really terrible, crappyjails, and the problem is, in
(05:24):
some ways it's worse, becausenow you end up with a criminal
record and it's harder to gethousing and it's harder to get
employment.
Speaker 1 (05:31):
Did you have any single case that stands out in
your mind?
You now look back on it and itwas the beginning of your
journey of helping those withautism and mental health.
Speaker 2 (05:41):
When I got assigned to the criminal division, I
ended up having a case.
This is the second part of mystory.
I was getting ready to go onthe bench one morning and the
assistant public defender andthe assistant state attorney
came to see me and they saidthat there was a case that was
really mind-boggling on mydocket.
If I wouldn't mind, would Iplease speak to the defendant's
(06:02):
parents, who were in court Atthe time?
I was handling what we call ajail misdemeanor division.
These are people on verylow-level charges who are still
in custody.
There's kind of three types offolks in that division.
There are those with attachedfelonies who are not allowed out
of custody.
There are those that are toopoor and they cannot afford to
bond out of custody, but mostlyit's really people with serious
(06:22):
mental illnesses that don't knowhow to get out of custody.
The parents came in and theystarted telling me this story
about how their son wasbrilliant, how he had gone to
Harvard, how he had a late onsetof schizophrenia and he became
homeless and started cyclingthrough the criminal justice
system.
And as I started to go backinto the courtroom, they were
pretty distraught.
The mom was crying and the dadwas shaking and they literally
(06:44):
were begging me to get their sonhelp.
Of course, being a new judge,you think you have a lot more
wisdom and a lot more power thanyou do.
I made a rookie mistake and Ipromised them that I would get
their son help because I assumedthere was a system in place to
treat him.
Sadly there was not.
As I was going back into thecourtroom, the mom stopped me
and judges.
One more thing I need to tellyou about my son.
(07:04):
She said not only is hebrilliant, but he probably knows
more about the mental healthsystem than you do.
And I was surprised and Ilooked at her and I think she
thought the lawyers had told methe whole story.
They had not.
And I said, excuse me.
And she said my son is theformer head of psychiatry at
jackson memorial hospital.
That was our, or is our,largest public hospital in
Florida.
And she said he didn't show upto work one day and he was
(07:27):
having religious ideations.
So he cashed in his lifeinsurance policy, he flew to
Israel to be closer to God andwithin a few weeks he was
deported back because he wasrunning around naked in the
Orthodox sections of Jerusalemand they were afraid for his
safety.
So they sent him back to Miamiwhere he became homeless and
started cycling through oursystem.
(07:47):
What happened from there?
I called this case.
We had a great conversation.
He ended up having a full-blownpsychotic episode in court,
screaming at the top of hislungs that his real parents had
died in the Holocaust and thiscouple sitting in the back were
from the CIA and they'd come tokill him.
And after ordering a battery ofevaluations and adjudicating
him incompetent to proceed, itturned out in Florida that,
(08:10):
because it was only amisdemeanor, I literally had no
authority to get him help and Ihad to release him back to the
street.
Well, that was the beginning ofmy journey, and between those
two incidents I think I becamethe Forrest Gump of mental
health.
I just started going throughand trying to fix things the
best I could, given thewonderful moral authority I had.
To my great pleasant surprise,it has far exceeded all of our
(08:35):
expectations.
We've been able to do somemiracles because I have an
amazing staff and an amazingcommunity that has allowed me to
make these structural changesthat were so necessary.
Speaker 1 (08:46):
That's great that you have such supportive people
around you.
Now I understand you arestarting a crisis unit or a
facility along that line.
Speaker 2 (08:55):
I'm already working on that.
It's not a crisis unit, but Iappreciate you asking about it
because it's fascinating.
It is the first of its kind inthe United States, possibly in
the world.
It is the first of its kind inthe United States, possibly in
the world.
It is a one-stop shop for themost acutely ill that
continuously cycle between themost acute systems of care, such
as homelessness, jail andhospitalization, both primary
(09:18):
and psychiatric.
It's the old competencyrestoration facility.
It's 181,000 square feet andit's going to be a mental health
diversion facility for thatpopulation.
Just back up a little bit soyour listeners understand the
problem.
When community mental health wasdesigned in the United States,
the most acutely ill were stillin psychiatric hospitals.
(09:41):
Community mental health wasdesigned for people with
moderate mental illnesses, notacute, and so when we shut down
the hospitals and we went to thewar on crime and the war on
drugs and we went to sentencingguidelines and we massively cut
housing back in the 80s, thispopulation got thrown into
communities, into communitymental health systems that were
never designed for them, and soof course it didn't work and
(10:04):
they didn't behave the way thatwe wanted them to behave.
But instead of looking at how dowe build a better system for
them?
We instead started toincarcerate them and that's what
happened.
So we are building thisfacility in fact it's done to
account for that population thatnever got what they needed and
understand that there's asmaller subset of this
(10:25):
population that are so sick, butthey're using up all the
resources.
We did one study with one ofour universities in Florida that
looked at who the highest usersof criminal justice and mental
health services were.
We sent them the names of 3,300people who had come through our
system and they had access toall the arrests in Florida and
all of the civil commitments inFlorida, all the Medicaid and
(10:47):
Medicare records.
Speaker 1 (10:48):
That's very interesting.
When you got the numbers back,what did they tell you?
Speaker 2 (10:53):
They narrowed it down to basically 97 people,
primarily men, primarilydiagnosed with a severe
psychotic disorder, primarilyhomeless, primarily co-occurring
, who over a five-year periodthese 97 people were arrested
2,200 times.
They spent 27,000 days in theDade County Jail.
13,000 days at a psychiatricfacility cost taxpayers tens of
(11:16):
millions of dollars and we gotnothing for it.
And so this building is reallyfor that subpopulation.
In fact, we've had thisdiversion program going on for
24 years and I'll describe it alittle bit more in a minute.
But we get a list every day frommy county of who is eligible to
be diverted into the community.
Because of the lack of capacity, we can't get to them all.
(11:39):
Over the last five years wejust looked at the data because
we're trying to figure out who'sgoing to go into this building
first.
Over the last five years wejust looked at the data because
we're trying to figure out who'sgoing to go into this building
first.
We identified 16,000 people whoover five years they were
arrested 32,000 times.
They spent 1.2 million days inthe Dade County Jail.
That's 3,400 years, $414million in taxpayer dollars
(11:59):
wasted and we got nothing for it.
Speaker 1 (12:01):
Those are just totally amazing numbers.
What's this facility going tolook like when it's up and going
?
Speaker 2 (12:09):
So it's that type of population that this new
facility is for, and so thebuilding will have a receiving
facility, a crisis stabilizationunit, a short-term residential
facility, a deactivity programthat'll teach individuals
self-sufficiency how to managetheir illness, a culinary
supportive employment,vocational supportive employment
(12:31):
programs like computer labs.
It will have a primary healthclinic, a dental clinic, an eye
clinic and a podiatry clinic.
It'll have tattoo removal,because people do silly things
when they're psychotic andstunned.
It has a courtroom in thefacility so we can manage both
criminal and civil cases.
It has something called theliving room model so that for
people who are high users, heavyusers of these services, but
(12:54):
they're not meeting civilcommitment, they can stay there
voluntarily and we can engagethem into services.
And it has 208 beds of housing.
They're not going to be therepermanently, so we'll probably
be able to see quite a fewthousand a year, and there's a
limited number of these people.
They're just costing us themost because they go through
this deep end the most often.
(13:14):
If we can get our arms aroundthem, we can significantly
change their trajectory and wecan break the cycle of
incarceration, homelessness andhospitalization.
Speaker 1 (13:25):
That's great.
My next question actually wasthis looks like it's a facility
where you're helping people.
They're getting back on theirfeet Because of this.
It should help the legal systemthat they don't have to see
these people multiple times.
Speaker 2 (13:41):
Correct and that's the whole idea is to make sure
that we're using the criminalsystem for people that need to
be in jail.
70% of people in jail today inthe United States either have a
serious mental illness, asubstance use disorder or both.
I always joke that we needspecialty courts for the 30%
that don't, so that we can makesure we have a therapeutic
(14:05):
jurisprudence system for the 70%that do, so we can make sure
they get treatment and stopcycling in and out of the system
.
Speaker 1 (14:12):
Now, as a judge, you have certain things that you can
do.
Of course, you have certainlimitations that you have to
adhere to.
How do we get the empathy fromthe DA side working with the
defense lawyer so they can helpthese people rather than being
focused on the number ofconvictions that they're able to
(14:33):
get?
Speaker 2 (14:33):
Yeah, and that's a wonderful question and I'm
actually quite optimisticbecause it's changing.
And part of the reason it'schanging is I've been working
very closely over the lastseveral years with something
called the Conference of ChiefJustices and the Conference of
State Court Administrators Allthe chief justices of all the
state Supreme Courts in theUnited States and all their
court administrators and theyhave made mental illness their
(14:54):
primary issue for the last fouror five years.
They are having summits now.
We have tours to Miami quiteregularly.
They come here, they learnabout how to restructure their
community.
They're going back and startingto put together plans on how to
do what we've done, becausewe've been able to reduce the
(15:15):
arrests in Miami as a result ofour project from 118,000 a year
to 53,000.
Our jail audit went from 7,400to 4,400.
We closed one of our three mainjails at an actual savings, not
cost, shift of about $168million so far.
And one of the things that wehadn't anticipated our police
(15:36):
shootings have almost stoppedhere and while it's possible
that race certainly can play arole in a police shooting, it
turns out that the reality maybe that many of the police
shootings have as much to dowith PTSD among law enforcement
as anything.
They overreact because they getscared.
Speaker 1 (15:53):
I've been talking with several different people.
They actually go into precincts, work and train with the police
, so I'm hoping that's going tohelp out a lot as well.
Speaker 2 (16:03):
The woman that runs my training program for law
enforcement.
We call it CIT CrisisIntervention Team Policing.
She gets between 150 and 250calls a month from police
officers for their own personalmental health issues.
It's tragic, but last year moreofficers died from suicide than
in the line of duty.
We set up a program to help getthem treated when they're
(16:25):
having issues and it has helpedamazing and they've become
incredibly empathetic.
And then, as for theprosecutors, our own prosecutor
has become a huge advocatebecause she's learned that if
you want to really improvepublic safety, we have two
choices we can release thispopulation without treatment, or
we can release them withtreatment.
(16:45):
You know what happens when werelease them without.
We might as well do it theright way get people what they
need.
Recovery is real.
Many mental illnesses havebetter recovery rates than heart
disease and diabetes.
It's really just about makingsure there's access, competent
and quality care for thispopulation.
Speaker 1 (17:02):
This sounds like you have just such a great model to
go by.
You have the clinical side, youhave the prosecutors, the
defense, of course, the judgeson the bench.
How do you get this from beinga local to a state, to a
nationwide process where ithelps everyone across the
(17:24):
country?
Speaker 2 (17:26):
And that's one of the things that we're doing with
the Conference of Chief Justices.
So they started off by havingfour or five regional summits
around the United States whereall the chiefs came and then it
worked so well.
Most of them are havingstatewide regional conferences
and then it's breaking downspecific areas in their states.
Last year I probably put150,000 miles on in the air
(17:48):
helping states do it, because Iwant to focus my time to help
them set up similar programs intheir own states.
And it's exciting and it's alot of work, but we know that
it's doable.
Speaker 1 (18:00):
I think that you're correct.
It certainly is very doable.
The hard work you're putting inis just outstanding.
It must just give you innercomfort knowing you're working
on a project that, when finished, will change so many lives for
the better.
Speaker 2 (18:17):
I just feel very honored and blessed to have the
opportunity to do it.
My court has been incrediblysupportive of me doing this work
.
My previous chief justice inFlorida helped me start this by
assigning me to chair acommittee for the Supreme Court
on this issue and actually forthree years, pulling me off the
bench and assigning me to theSupreme Court to work on this
(18:38):
full-time, and it really gave mean opportunity to learn these
issues and figure out a way thatwe could do it better.
But I have to tell you it's notrocket science.
A few weeks ago, a month ago, Igot back from Italy and I was
part of a delegation that wasthere to study the Trieste
mental health system.
It was sponsored by the HiltonFoundation and they wanted to
(18:58):
see if it was a program thatcould be replicated or scaled in
the US.
And the reason they pickedTrieste is because the World
Health Organization hasdetermined that Trieste has the
best mental health system in theworld and after visiting it for
a week, I can unequivocallytell you it does.
They basically had no homeless.
They had few, if any, people injail with mental illnesses, few
(19:21):
, if any, people in their statepsychiatric system and few, if
any in their forensic system.
It was really remarkable andthey did it not through anything
that should shock anybody.
They intervened early.
If there was a break, thedoctor went to the house.
Intervened early.
(19:41):
If there was a break, thedoctor went to the house.
They wrap around services, theyget you housing.
They have a really great dayactivity program.
They don't define you by yourillness.
They put you on a long-terminjectable medication and they
make sure that you're incrediblywell case managed and you're
working during the day.
So you have a life and you havegoals and hopes.
Nothing that we all don't knowworks.
We're so quick to try toincarcerate before we treat that
(20:05):
.
It's absurd and it's expensive.
The United States spent almosta trillion with a T dollars last
year on costs related toincarceration.
Could you imagine what we coulddo with that kind of money for
mental health and autism?
Speaker 1 (20:18):
You've had a tremendous amount of success in
your area.
You're working on the newfacility, trying to work with
the legal system across thecountry.
What are some of the hurdlesthat has been presented to you
that you see that you've got toeither go around or jump over so
that you can make a difference,not just in Miami, but across
(20:38):
the country as well.
Speaker 2 (20:40):
It's a couple things.
The message is very important,but I'm finding equally
important is who delivers themessage, and I think one of the
great things that's going on inthe US right now is the level of
judges that have gotteninvolved.
Reality is that we're seen asSwitzerland.
We don't have an axe to grind.
We don't have an interest or afinancial interest by having
(21:03):
judges become involved in thisissue has really opened a lot of
doors.
It gets the right people to thetable.
I tell people.
The best part of my job is thatwhen I invite people to a
meeting, they come, and so weneed to use that moral authority
, get people to the table andexplain to them what we're doing
and why it works, and look ascynical as I could be on days, I
(21:23):
do believe when you get achance to meet people one-on-one
and you really get to talkabout these issues rationally,
instead of in the world we liveon, where everything is argued,
most people get this.
They don't want to see peoplewith mental illnesses in jail.
They have loved ones, they knowpeople, they want to make sure
that this population is caredfor, treated, housed, and they
know that if you do that, we'regoing to get better outcomes,
(21:45):
and they're pining for it.
They really want a system thatworks, as opposed to trying to
navigate one that doesn't.
Speaker 1 (21:51):
Now let's just take this in a slightly different
direction.
I see where you got a medalfrom the Pope.
Now that's pretty cool.
Speaker 2 (22:00):
Yeah, that was pretty amazing.
Talk about humbling, and notbad for a Jewish guy.
It came as quite a shock, quitea surprise.
It was one of the most humblingrecognitions I've ever received
.
The Archbishop, unbeknownst tome, was very familiar with my
work and he nominated me and thePope selected me and I received
this beautiful medal.
It was pretty stunning.
(22:22):
I think what I most appreciatedabout it was the level of
attention it has brought to thiscause, and I'm sure that's why
they do it, because this isn'tone of those sexy issues with
cute little kids.
People have a lot of stigmaabout this population.
They're afraid of thispopulation.
They think they're dangerous.
They're not.
For him to do that meant a lot,but it also meant a lot for the
(22:43):
cause and for the issue and forthat I am eternally grateful,
and I've ended up developing awonderful friendship with our
local archbishop here in Florida.
He actually had me give one ofthe keynote speeches recently to
all the new priests in Florida,which was great, so we could
talk to them about mental healthand what they can be doing when
people approach them, because Iused to be on the board of the
(23:05):
American Psychiatric AssociationFoundation and one of the
things that we learned is that,by a wide, far margin, more
people go to their clergy formental health than they do a
psychiatrist, and you want tomake sure that the clergy are
well informed and they are welleducated and that they don't try
to convince people it's thedevil or something like that.
The Catholic Church is prettysophisticated, but they really
(23:29):
appreciated learning about theseissues, so it's been a
wonderful experience.
Speaker 1 (23:33):
With everything that you've done, the medal you
received, the facility you'vebeen working on.
What's next?
What do you see coming in thenext three to five years that
can add to all youraccomplishments?
This new journey is justunderway.
You've got so many things to dowith getting the lawyers, the
judges, the police, gettingeveryone on the same page to
(23:56):
make a huge difference for allthese people that need help.
So what's coming in the nextthree to five years for you?
Speaker 2 (24:02):
I'm actually optimistic.
I'm.
I think many of us have beenworking and toiling in this
field for a good 20 years and alot of groundwork and
infrastructure has been laid.
And I think the country if wedon't kill ourselves politically
, I think the country is thismay be the last issue everyone
seems to agree on is poised totackle this issue.
(24:26):
I think people, whether you'recoming from the right because
you think it's ridiculous howmuch we're wasting in taxes, or
you come from the left and youthink it's horrible how we're
treating this population,everybody agrees it's not
working and it needs and can befixed.
Through this initiative with thechief justices, through this
other initiative I co-chairjudges and psychiatrists,
(24:47):
through the National Center ofState Courts and the Council of
State Government and theAmerican Psychiatric Association
Foundation, we've all partneredup and we're really working to
make the structural changes ineach community that are
necessary to fix it.
It's challenging because everycommunity is different.
There's not a switch that youcan flip in Minneapolis or San
(25:09):
Francisco or Mobile, alabama,right, they're all different.
You almost have to go communityby community to fix it and our
approach, and what I'm going tobe doing over the next three to
five years with this initiativeis to go into the states first,
get them to buy in, show themhow that they can save a lot of
money and save a lot of lives,and then work towards making
(25:32):
this structural change.
But it's going on.
There's examples all over thecountry right now that didn't
exist just five, 10 years ago.
I remember when I first startedon the lecture circuit for the
course, I'd spend the first 45minutes of my talk trying to
convince people there was aproblem.
Now all they want to know ishow do they fix it?
And so we've done a really goodjob, and the media has done a
(25:53):
decent job of educating peopleabout the problem.
Now we have to show people thatit's really fixable and that
these are the tools you need.
And this is what your systemshould look like.
And while each community isdifferent, we all have the same
essential elements that arenecessary to be able to get the
desired outcomes everybody wants.
It's just a matter of figuringout where you are on that and
(26:15):
what changes you need to get youto the next level.
Speaker 1 (26:18):
Yeah, in closing, what do you feel is important
that the listeners need to hearso they understand exactly what
you're trying to do across thecountry?
Speaker 2 (26:29):
Yeah, and thank you for that.
One I would say is people withmental illnesses are absolutely
no more dangerous than thegeneral population, and on
medication they're much lessdangerous than the general
population.
They are much, much more likely, by a wide margin, to be
victims of violent crimes thanperpetrators, and that recovery
(26:51):
rates for this population, formany of these illnesses, are
actually much better than heartdisease and diabetes.
That it's not a lost cause,that people can recover.
They can get their lives back.
What we need to do is createstructures in the community that
provide them access, providethem quality of care, provide
them an opportunity to recover.
We just don't do that In reallybad American fashion.
(27:14):
We punish them when it's nottheir fault, and we need to set
up a better system of care sothat people don't end up in the
criminal justice system that wasnever designed for people with
these illnesses.
If you do that, you get muchbetter outcomes, you improve
your public safety, you savetremendous tax dollars and you
give people an opportunity tohave a life of hope and recovery
(27:34):
, and I think that should be theultimate goal for every one of
us in our society.
Why else do what we do?
I would tell you, it's been thehonor of my life to be a judge
for almost 30 years.
It afforded me an opportunityto make change that I probably
never could have done as alegislator or someone in the
executive branch, and it'sbecause in many ways we're first
(27:56):
responders, like lawenforcement.
We're on the front line seeingthis population come in every
day and we don't have to standfor something that's not working
.
Our job is to do our best toadminister justice, and that
doesn't mean just punishingpeople.
It means figuring out whythey're in the system and what
can we do to keep them from evercoming back, triggering serious
(28:18):
mental illness.
We know today that we didn'tknow just 20 years ago that
about 92% of the women who arein jail and prisons in the
United States with seriousmental illnesses have horrific
histories of trauma, mostlysexual abuse, and that sexual
(28:39):
abuse occurs when they're quiteyoung five, six, seven years old
.
And about 75% of men who are injail and prison with serious
mental illnesses also havehorrific histories with trauma.
Sometimes it's sexual abuse.
More likely they've beenvictims of long-term domestic
violence or they've beenwitnesses to violent crimes,
like a soldier might see incombat.
(28:59):
We know today that trauma isnot an emotional response, but
physiological.
Without getting people treatedafter they've gone through this
kind of trauma, the chances are,by a huge percentage, that
they're going to end up with asubstance use disorder and or a
mental health disorder, and weneed to get ahead of that.
We need to be using tools toassess kids in elementary school
(29:22):
to see if they have historiesof trauma and, if they do, make
sure we're getting them treatedquickly, because if we had done
that here even in Miami weweren't aware of trauma when we
started we would have kept two,three generations from ever
coming into the criminal justicesystem at all and we got to get
smarter about it.
We have to do what Trieste isdoing and get ahead of this and
get people treated just like wewant to do with any other
(29:44):
illness.
We don't want to wait for yourskin cancer to metastasize and
get you so sick that you have togo to an intensive cancer
facility.
We want to get it at thebeginning because it's going to
be easier, cheaper and we'regoing to get much better
outcomes.
Mental illness is no different.
I would leave your listenerswith that.
We need to get ahead of thisand if we do, we'll get much
(30:06):
better outcomes.
We'll save a lot of money andwe will improve our public
safety, and people won't have tolive a life cycling in and out
of acute systems likehomelessness, jail, prison and
hospitalization.
Speaker 1 (30:18):
Absolutely.
I totally agree.
This has been a greatconversation, great information.
It's been a pleasure having youon.
I really appreciate you takingthe time.
Speaker 2 (30:29):
I appreciate you having me.
You have such a nice voice foryour podcast.
It's great, and your tone andyour questions are just perfect.
I'm honored to be here todayand thank you for inviting me.
Speaker 1 (30:42):
The pleasure is all mine.
Thanks again.
Thanks for taking the time outof your busy schedule to listen
to our show today.
We hope that you enjoyed it asmuch as we enjoyed bringing it
to you.
If you know anyone that wouldlike to tell us their story,
(31:05):
send them to TonyMantorcomContact then they can give us
their information so one daythey may be a guest on our show.
One more thing we ask telleveryone everywhere about why
Not Me, the world, theconversations we're having and
(31:25):
the inspiration our guests giveto everyone everywhere that you
are not alone in this world.
Welcome to why Not Me ?
The World Podcast, hosted byTony Mantor, broadcasting from
Music City, usa, nashville,tennessee.
Join us as our guests tell ustheir stories.
Some will make you laugh, somewill make you cry.
Their stories Some will makeyou laugh, some will make you
(00:30):
cry.
Real life people who willinspire and show that you are
not alone in this world.
Hopefully, you gain moreawareness, acceptance and a
better understanding for autismaround the world.
Hi, I'm Tony Mantor.
(00:52):
Welcome to why Not Me?
The World Humanity OverHandcuffs, the Silent Crisis
special event.
Joining us today is JudgeStephen Leifman.
He was first elected to the11th Judicial Circuit Court of
Florida in 1995.
In 2007, he served as a specialadvisor on criminal justice and
mental health for the SupremeCourt of Florida.
(01:12):
He has received several awards,including one from the Pope.
It is truly an honor to havehis honor with us today.
Thanks for coming on.
Sure, thanks for having me.
Oh, it's my pleasure.
You've been doing this for avery long time.
What led you to become anadvocate for people with mental
health and autism?
Speaker 2 (01:29):
Yeah, I have two stories and the first one starts
when I was 17 years old.
I was an intern for a statelegislator here in Miami and he
had received a letter from thethen editor of the Miami Herald
about a young man who was in ourlocal state psychiatric
hospital.
This is 48 years ago.
This is the height ofinstitutionalization and it's
(01:53):
the height of the abuses thatwent on at state hospitals.
So I guess, being the low guyin the totem pole, I got asked
to go to the state hospital toinvestigate.
The editor of the Miami Herald,who wrote the letter to the
legislator, raised concerns thatthere was abuse going on at
this facility and that thisyoung man was being abused as
(02:14):
well.
So I walked through the frontdoors of a state psychiatric
hospital 48 years ago and it wasa scene out of.
One Flew Over the Cuckoo's Nest.
Funny, in a way, I'm a21-year-old son.
I would never allow him to go.
I can't believe they sent a17-year-old kid.
Anyway, I found Jonathan, theyoung man I was looking for.
(02:37):
He was in all four-pointrestraints.
He was being injected withprobably Thorazine, which was
the only antipsychotic at thetime.
He was screaming and moaningand crying and it was a scene
out of a horror movie.
So I started to look at hisrecords.
This is well before HIPAA.
I started to talk to the staff,although, I will candidly tell
(03:01):
you, I had no idea what I waslooking at.
I was 17 and knew nothing.
But what I did find thatshocked me.
And when I spoke to the staff,it turns out that he was not
psychotic at all.
He was autistic.
Speaker 1 (03:13):
Wow, that's amazing.
Speaker 2 (03:15):
Here they were injecting him with antipsychotic
medications.
Speaker 1 (03:18):
What was the next step when this came to your
attention?
Speaker 2 (03:21):
While I was there, there was a group of advocates
touring the facility and theyfound out that there was a
representative from alegislator's office, albeit a
17-year-old, who had noknowledge and no power.
But they insisted I take a tourof the facility.
They brought me downstairs towhat looked like a dungeon.
It was like a jail cell and Ifound these seven men lying in
(03:45):
their own feces while a guardthey were naked and a guard
stood there with a hose andwashed them down like they were
animals and it was prettytraumatizing and pretty horrific
.
And while I did not have muchauthority to help them, I was
able, with the help of thesenator, to get the young man
out of the hospital and we gothim placed in a really wonderful
(04:07):
, amazing adult living facilityfor other young men with autism
and he was very well cared forafter that.
Speaker 1 (04:14):
That's really good that you could help him.
How did that affect you?
Speaker 2 (04:18):
It left a pretty indelible mark on me.
About 17 years later I gotappointed to the bench and,
ironically, that hospital that Ihad been at 17 years earlier
was closed.
The jail across the street fromme started to become the
psychiatric facility for ourcommunity.
So those same folks, or type offolks that had been in the
(04:40):
state hospital, they gotreleased to the streets without
services and many of them endedup in the criminal justice
system.
In 1955, there were about maybewe estimate 5,000 people with
serious mental illnesses instate hospitals.
There were about excuse me, injail.
There were about 550,000 atthat time in state hospitals.
Today there's less than 30,000civil psychiatric beds in this
(05:03):
country, and last year we hadabout 1.5 million people with
serious mental illnessesarrested and about 2 million
incidents.
And so we neverdeinstitutionalized.
What we really did is wetransferred responsibility from
these really terrible, crappy,horrible state hospitals to
these really terrible, crappyjails, and the problem is, in
(05:24):
some ways it's worse, becausenow you end up with a criminal
record and it's harder to gethousing and it's harder to get
employment.
Speaker 1 (05:31):
Did you have any single case that stands out in
your mind?
You now look back on it and itwas the beginning of your
journey of helping those withautism and mental health.
Speaker 2 (05:41):
When I got assigned to the criminal division, I
ended up having a case.
This is the second part of mystory.
I was getting ready to go onthe bench one morning and the
assistant public defender andthe assistant state attorney
came to see me and they saidthat there was a case that was
really mind-boggling on mydocket.
If I wouldn't mind, would Iplease speak to the defendant's
(06:02):
parents, who were in court Atthe time?
I was handling what we call ajail misdemeanor division.
These are people on verylow-level charges who are still
in custody.
There's kind of three types offolks in that division.
There are those with attachedfelonies who are not allowed out
of custody.
There are those that are toopoor and they cannot afford to
bond out of custody, but mostlyit's really people with serious
(06:22):
mental illnesses that don't knowhow to get out of custody.
The parents came in and theystarted telling me this story
about how their son wasbrilliant, how he had gone to
Harvard, how he had a late onsetof schizophrenia and he became
homeless and started cyclingthrough the criminal justice
system.
And as I started to go backinto the courtroom, they were
pretty distraught.
The mom was crying and the dadwas shaking and they literally
(06:44):
were begging me to get their sonhelp.
Of course, being a new judge,you think you have a lot more
wisdom and a lot more power thanyou do.
I made a rookie mistake and Ipromised them that I would get
their son help because I assumedthere was a system in place to
treat him.
Sadly there was not.
As I was going back into thecourtroom, the mom stopped me
and judges.
One more thing I need to tellyou about my son.
(07:04):
She said not only is hebrilliant, but he probably knows
more about the mental healthsystem than you do.
And I was surprised and Ilooked at her and I think she
thought the lawyers had told methe whole story.
They had not.
And I said, excuse me.
And she said my son is theformer head of psychiatry at
jackson memorial hospital.
That was our, or is our,largest public hospital in
Florida.
And she said he didn't show upto work one day and he was
(07:27):
having religious ideations.
So he cashed in his lifeinsurance policy, he flew to
Israel to be closer to God andwithin a few weeks he was
deported back because he wasrunning around naked in the
Orthodox sections of Jerusalemand they were afraid for his
safety.
So they sent him back to Miamiwhere he became homeless and
started cycling through oursystem.
(07:47):
What happened from there?
I called this case.
We had a great conversation.
He ended up having a full-blownpsychotic episode in court,
screaming at the top of hislungs that his real parents had
died in the Holocaust and thiscouple sitting in the back were
from the CIA and they'd come tokill him.
And after ordering a battery ofevaluations and adjudicating
him incompetent to proceed, itturned out in Florida that,
(08:10):
because it was only amisdemeanor, I literally had no
authority to get him help and Ihad to release him back to the
street.
Well, that was the beginning ofmy journey, and between those
two incidents I think I becamethe Forrest Gump of mental
health.
I just started going throughand trying to fix things the
best I could, given thewonderful moral authority I had.
To my great pleasant surprise,it has far exceeded all of our
(08:35):
expectations.
We've been able to do somemiracles because I have an
amazing staff and an amazingcommunity that has allowed me to
make these structural changesthat were so necessary.
Speaker 1 (08:46):
That's great that you have such supportive people
around you.
Now I understand you arestarting a crisis unit or a
facility along that line.
Speaker 2 (08:55):
I'm already working on that.
It's not a crisis unit, but Iappreciate you asking about it
because it's fascinating.
It is the first of its kind inthe United States, possibly in
the world.
It is the first of its kind inthe United States, possibly in
the world.
It is a one-stop shop for themost acutely ill that
continuously cycle between themost acute systems of care, such
as homelessness, jail andhospitalization, both primary
(09:18):
and psychiatric.
It's the old competencyrestoration facility.
It's 181,000 square feet andit's going to be a mental health
diversion facility for thatpopulation.
Just back up a little bit soyour listeners understand the
problem.
When community mental health wasdesigned in the United States,
the most acutely ill were stillin psychiatric hospitals.
(09:41):
Community mental health wasdesigned for people with
moderate mental illnesses, notacute, and so when we shut down
the hospitals and we went to thewar on crime and the war on
drugs and we went to sentencingguidelines and we massively cut
housing back in the 80s, thispopulation got thrown into
communities, into communitymental health systems that were
never designed for them, and soof course it didn't work and
(10:04):
they didn't behave the way thatwe wanted them to behave.
But instead of looking at how dowe build a better system for
them?
We instead started toincarcerate them and that's what
happened.
So we are building thisfacility in fact it's done to
account for that population thatnever got what they needed and
understand that there's asmaller subset of this
(10:25):
population that are so sick, butthey're using up all the
resources.
We did one study with one ofour universities in Florida that
looked at who the highest usersof criminal justice and mental
health services were.
We sent them the names of 3,300people who had come through our
system and they had access toall the arrests in Florida and
all of the civil commitments inFlorida, all the Medicaid and
(10:47):
Medicare records.
Speaker 1 (10:48):
That's very interesting.
When you got the numbers back,what did they tell you?
Speaker 2 (10:53):
They narrowed it down to basically 97 people,
primarily men, primarilydiagnosed with a severe
psychotic disorder, primarilyhomeless, primarily co-occurring
, who over a five-year periodthese 97 people were arrested
2,200 times.
They spent 27,000 days in theDade County Jail.
13,000 days at a psychiatricfacility cost taxpayers tens of
(11:16):
millions of dollars and we gotnothing for it.
And so this building is reallyfor that subpopulation.
In fact, we've had thisdiversion program going on for
24 years and I'll describe it alittle bit more in a minute.
But we get a list every day frommy county of who is eligible to
be diverted into the community.
Because of the lack of capacity, we can't get to them all.
(11:39):
Over the last five years wejust looked at the data because
we're trying to figure out who'sgoing to go into this building
first.
Over the last five years wejust looked at the data because
we're trying to figure out who'sgoing to go into this building
first.
We identified 16,000 people whoover five years they were
arrested 32,000 times.
They spent 1.2 million days inthe Dade County Jail.
That's 3,400 years, $414million in taxpayer dollars
(11:59):
wasted and we got nothing for it.
Speaker 1 (12:01):
Those are just totally amazing numbers.
What's this facility going tolook like when it's up and going
?
Speaker 2 (12:09):
So it's that type of population that this new
facility is for, and so thebuilding will have a receiving
facility, a crisis stabilizationunit, a short-term residential
facility, a deactivity programthat'll teach individuals
self-sufficiency how to managetheir illness, a culinary
supportive employment,vocational supportive employment
(12:31):
programs like computer labs.
It will have a primary healthclinic, a dental clinic, an eye
clinic and a podiatry clinic.
It'll have tattoo removal,because people do silly things
when they're psychotic andstunned.
It has a courtroom in thefacility so we can manage both
criminal and civil cases.
It has something called theliving room model so that for
people who are high users, heavyusers of these services, but
(12:54):
they're not meeting civilcommitment, they can stay there
voluntarily and we can engagethem into services.
And it has 208 beds of housing.
They're not going to be therepermanently, so we'll probably
be able to see quite a fewthousand a year, and there's a
limited number of these people.
They're just costing us themost because they go through
this deep end the most often.
(13:14):
If we can get our arms aroundthem, we can significantly
change their trajectory and wecan break the cycle of
incarceration, homelessness andhospitalization.
Speaker 1 (13:25):
That's great.
My next question actually wasthis looks like it's a facility
where you're helping people.
They're getting back on theirfeet Because of this.
It should help the legal systemthat they don't have to see
these people multiple times.
Speaker 2 (13:41):
Correct and that's the whole idea is to make sure
that we're using the criminalsystem for people that need to
be in jail.
70% of people in jail today inthe United States either have a
serious mental illness, asubstance use disorder or both.
I always joke that we needspecialty courts for the 30%
that don't, so that we can makesure we have a therapeutic
(14:05):
jurisprudence system for the 70%that do, so we can make sure
they get treatment and stopcycling in and out of the system
.
Speaker 1 (14:12):
Now, as a judge, you have certain things that you can
do.
Of course, you have certainlimitations that you have to
adhere to.
How do we get the empathy fromthe DA side working with the
defense lawyer so they can helpthese people rather than being
focused on the number ofconvictions that they're able to
(14:33):
get?
Speaker 2 (14:33):
Yeah, and that's a wonderful question and I'm
actually quite optimisticbecause it's changing.
And part of the reason it'schanging is I've been working
very closely over the lastseveral years with something
called the Conference of ChiefJustices and the Conference of
State Court Administrators Allthe chief justices of all the
state Supreme Courts in theUnited States and all their
court administrators and theyhave made mental illness their
(14:54):
primary issue for the last fouror five years.
They are having summits now.
We have tours to Miami quiteregularly.
They come here, they learnabout how to restructure their
community.
They're going back and startingto put together plans on how to
do what we've done, becausewe've been able to reduce the
(15:15):
arrests in Miami as a result ofour project from 118,000 a year
to 53,000.
Our jail audit went from 7,400to 4,400.
We closed one of our three mainjails at an actual savings, not
cost, shift of about $168million so far.
And one of the things that wehadn't anticipated our police
(15:36):
shootings have almost stoppedhere and while it's possible
that race certainly can play arole in a police shooting, it
turns out that the reality maybe that many of the police
shootings have as much to dowith PTSD among law enforcement
as anything.
They overreact because they getscared.
Speaker 1 (15:53):
I've been talking with several different people.
They actually go into precincts, work and train with the police
, so I'm hoping that's going tohelp out a lot as well.
Speaker 2 (16:03):
The woman that runs my training program for law
enforcement.
We call it CIT CrisisIntervention Team Policing.
She gets between 150 and 250calls a month from police
officers for their own personalmental health issues.
It's tragic, but last year moreofficers died from suicide than
in the line of duty.
We set up a program to help getthem treated when they're
(16:25):
having issues and it has helpedamazing and they've become
incredibly empathetic.
And then, as for theprosecutors, our own prosecutor
has become a huge advocatebecause she's learned that if
you want to really improvepublic safety, we have two
choices we can release thispopulation without treatment, or
we can release them withtreatment.
(16:45):
You know what happens when werelease them without.
We might as well do it theright way get people what they
need.
Recovery is real.
Many mental illnesses havebetter recovery rates than heart
disease and diabetes.
It's really just about makingsure there's access, competent
and quality care for thispopulation.
Speaker 1 (17:02):
This sounds like you have just such a great model to
go by.
You have the clinical side, youhave the prosecutors, the
defense, of course, the judgeson the bench.
How do you get this from beinga local to a state, to a
nationwide process where ithelps everyone across the
(17:24):
country?
Speaker 2 (17:26):
And that's one of the things that we're doing with
the Conference of Chief Justices.
So they started off by havingfour or five regional summits
around the United States whereall the chiefs came and then it
worked so well.
Most of them are havingstatewide regional conferences
and then it's breaking downspecific areas in their states.
Last year I probably put150,000 miles on in the air
(17:48):
helping states do it, because Iwant to focus my time to help
them set up similar programs intheir own states.
And it's exciting and it's alot of work, but we know that
it's doable.
Speaker 1 (18:00):
I think that you're correct.
It certainly is very doable.
The hard work you're putting inis just outstanding.
It must just give you innercomfort knowing you're working
on a project that, when finished, will change so many lives for
the better.
Speaker 2 (18:17):
I just feel very honored and blessed to have the
opportunity to do it.
My court has been incrediblysupportive of me doing this work
.
My previous chief justice inFlorida helped me start this by
assigning me to chair acommittee for the Supreme Court
on this issue and actually forthree years, pulling me off the
bench and assigning me to theSupreme Court to work on this
(18:38):
full-time, and it really gave mean opportunity to learn these
issues and figure out a way thatwe could do it better.
But I have to tell you it's notrocket science.
A few weeks ago, a month ago, Igot back from Italy and I was
part of a delegation that wasthere to study the Trieste
mental health system.
It was sponsored by the HiltonFoundation and they wanted to
(18:58):
see if it was a program thatcould be replicated or scaled in
the US.
And the reason they pickedTrieste is because the World
Health Organization hasdetermined that Trieste has the
best mental health system in theworld and after visiting it for
a week, I can unequivocallytell you it does.
They basically had no homeless.
They had few, if any, people injail with mental illnesses, few
(19:21):
, if any, people in their statepsychiatric system and few, if
any in their forensic system.
It was really remarkable andthey did it not through anything
that should shock anybody.
They intervened early.
If there was a break, thedoctor went to the house.
Intervened early.
(19:41):
If there was a break, thedoctor went to the house.
They wrap around services, theyget you housing.
They have a really great dayactivity program.
They don't define you by yourillness.
They put you on a long-terminjectable medication and they
make sure that you're incrediblywell case managed and you're
working during the day.
So you have a life and you havegoals and hopes.
Nothing that we all don't knowworks.
We're so quick to try toincarcerate before we treat that
(20:05):
.
It's absurd and it's expensive.
The United States spent almosta trillion with a T dollars last
year on costs related toincarceration.
Could you imagine what we coulddo with that kind of money for
mental health and autism?
Speaker 1 (20:18):
You've had a tremendous amount of success in
your area.
You're working on the newfacility, trying to work with
the legal system across thecountry.
What are some of the hurdlesthat has been presented to you
that you see that you've got toeither go around or jump over so
that you can make a difference,not just in Miami, but across
(20:38):
the country as well.
Speaker 2 (20:40):
It's a couple things.
The message is very important,but I'm finding equally
important is who delivers themessage, and I think one of the
great things that's going on inthe US right now is the level of
judges that have gotteninvolved.
Reality is that we're seen asSwitzerland.
We don't have an axe to grind.
We don't have an interest or afinancial interest by having
(21:03):
judges become involved in thisissue has really opened a lot of
doors.
It gets the right people to thetable.
I tell people.
The best part of my job is thatwhen I invite people to a
meeting, they come, and so weneed to use that moral authority
, get people to the table andexplain to them what we're doing
and why it works, and look ascynical as I could be on days, I
(21:23):
do believe when you get achance to meet people one-on-one
and you really get to talkabout these issues rationally,
instead of in the world we liveon, where everything is argued,
most people get this.
They don't want to see peoplewith mental illnesses in jail.
They have loved ones, they knowpeople, they want to make sure
that this population is caredfor, treated, housed, and they
know that if you do that, we'regoing to get better outcomes,
(21:45):
and they're pining for it.
They really want a system thatworks, as opposed to trying to
navigate one that doesn't.
Speaker 1 (21:51):
Now let's just take this in a slightly different
direction.
I see where you got a medalfrom the Pope.
Now that's pretty cool.
Speaker 2 (22:00):
Yeah, that was pretty amazing.
Talk about humbling, and notbad for a Jewish guy.
It came as quite a shock, quitea surprise.
It was one of the most humblingrecognitions I've ever received
.
The Archbishop, unbeknownst tome, was very familiar with my
work and he nominated me and thePope selected me and I received
this beautiful medal.
It was pretty stunning.
(22:22):
I think what I most appreciatedabout it was the level of
attention it has brought to thiscause, and I'm sure that's why
they do it, because this isn'tone of those sexy issues with
cute little kids.
People have a lot of stigmaabout this population.
They're afraid of thispopulation.
They think they're dangerous.
They're not.
For him to do that meant a lot,but it also meant a lot for the
(22:43):
cause and for the issue and forthat I am eternally grateful,
and I've ended up developing awonderful friendship with our
local archbishop here in Florida.
He actually had me give one ofthe keynote speeches recently to
all the new priests in Florida,which was great, so we could
talk to them about mental healthand what they can be doing when
people approach them, because Iused to be on the board of the
(23:05):
American Psychiatric AssociationFoundation and one of the
things that we learned is that,by a wide, far margin, more
people go to their clergy formental health than they do a
psychiatrist, and you want tomake sure that the clergy are
well informed and they are welleducated and that they don't try
to convince people it's thedevil or something like that.
The Catholic Church is prettysophisticated, but they really
(23:29):
appreciated learning about theseissues, so it's been a
wonderful experience.
Speaker 1 (23:33):
With everything that you've done, the medal you
received, the facility you'vebeen working on.
What's next?
What do you see coming in thenext three to five years that
can add to all youraccomplishments?
This new journey is justunderway.
You've got so many things to dowith getting the lawyers, the
judges, the police, gettingeveryone on the same page to
(23:56):
make a huge difference for allthese people that need help.
So what's coming in the nextthree to five years for you?
Speaker 2 (24:02):
I'm actually optimistic.
I'm.
I think many of us have beenworking and toiling in this
field for a good 20 years and alot of groundwork and
infrastructure has been laid.
And I think the country if wedon't kill ourselves politically
, I think the country is thismay be the last issue everyone
seems to agree on is poised totackle this issue.
(24:26):
I think people, whether you'recoming from the right because
you think it's ridiculous howmuch we're wasting in taxes, or
you come from the left and youthink it's horrible how we're
treating this population,everybody agrees it's not
working and it needs and can befixed.
Through this initiative with thechief justices, through this
other initiative I co-chairjudges and psychiatrists,
(24:47):
through the National Center ofState Courts and the Council of
State Government and theAmerican Psychiatric Association
Foundation, we've all partneredup and we're really working to
make the structural changes ineach community that are
necessary to fix it.
It's challenging because everycommunity is different.
There's not a switch that youcan flip in Minneapolis or San
(25:09):
Francisco or Mobile, alabama,right, they're all different.
You almost have to go communityby community to fix it and our
approach, and what I'm going tobe doing over the next three to
five years with this initiativeis to go into the states first,
get them to buy in, show themhow that they can save a lot of
money and save a lot of lives,and then work towards making
(25:32):
this structural change.
But it's going on.
There's examples all over thecountry right now that didn't
exist just five, 10 years ago.
I remember when I first startedon the lecture circuit for the
course, I'd spend the first 45minutes of my talk trying to
convince people there was aproblem.
Now all they want to know ishow do they fix it?
And so we've done a really goodjob, and the media has done a
(25:53):
decent job of educating peopleabout the problem.
Now we have to show people thatit's really fixable and that
these are the tools you need.
And this is what your systemshould look like.
And while each community isdifferent, we all have the same
essential elements that arenecessary to be able to get the
desired outcomes everybody wants.
It's just a matter of figuringout where you are on that and
(26:15):
what changes you need to get youto the next level.
Speaker 1 (26:18):
Yeah, in closing, what do you feel is important
that the listeners need to hearso they understand exactly what
you're trying to do across thecountry?
Speaker 2 (26:29):
Yeah, and thank you for that.
One I would say is people withmental illnesses are absolutely
no more dangerous than thegeneral population, and on
medication they're much lessdangerous than the general
population.
They are much, much more likely, by a wide margin, to be
victims of violent crimes thanperpetrators, and that recovery
(26:51):
rates for this population, formany of these illnesses, are
actually much better than heartdisease and diabetes.
That it's not a lost cause,that people can recover.
They can get their lives back.
What we need to do is createstructures in the community that
provide them access, providethem quality of care, provide
them an opportunity to recover.
We just don't do that In reallybad American fashion.
(27:14):
We punish them when it's nottheir fault, and we need to set
up a better system of care sothat people don't end up in the
criminal justice system that wasnever designed for people with
these illnesses.
If you do that, you get muchbetter outcomes, you improve
your public safety, you savetremendous tax dollars and you
give people an opportunity tohave a life of hope and recovery
(27:34):
, and I think that should be theultimate goal for every one of
us in our society.
Why else do what we do?
I would tell you, it's been thehonor of my life to be a judge
for almost 30 years.
It afforded me an opportunityto make change that I probably
never could have done as alegislator or someone in the
executive branch, and it'sbecause in many ways we're first
(27:56):
responders, like lawenforcement.
We're on the front line seeingthis population come in every
day and we don't have to standfor something that's not working
.
Our job is to do our best toadminister justice, and that
doesn't mean just punishingpeople.
It means figuring out whythey're in the system and what
can we do to keep them from evercoming back, triggering serious
(28:18):
mental illness.
We know today that we didn'tknow just 20 years ago that
about 92% of the women who arein jail and prisons in the
United States with seriousmental illnesses have horrific
histories of trauma, mostlysexual abuse, and that sexual
(28:39):
abuse occurs when they're quiteyoung five, six, seven years old
.
And about 75% of men who are injail and prison with serious
mental illnesses also havehorrific histories with trauma.
Sometimes it's sexual abuse.
More likely they've beenvictims of long-term domestic
violence or they've beenwitnesses to violent crimes,
like a soldier might see incombat.
(28:59):
We know today that trauma isnot an emotional response, but
physiological.
Without getting people treatedafter they've gone through this
kind of trauma, the chances are,by a huge percentage, that
they're going to end up with asubstance use disorder and or a
mental health disorder, and weneed to get ahead of that.
We need to be using tools toassess kids in elementary school
(29:22):
to see if they have historiesof trauma and, if they do, make
sure we're getting them treatedquickly, because if we had done
that here even in Miami weweren't aware of trauma when we
started we would have kept two,three generations from ever
coming into the criminal justicesystem at all and we got to get
smarter about it.
We have to do what Trieste isdoing and get ahead of this and
get people treated just like wewant to do with any other
(29:44):
illness.
We don't want to wait for yourskin cancer to metastasize and
get you so sick that you have togo to an intensive cancer
facility.
We want to get it at thebeginning because it's going to
be easier, cheaper and we'regoing to get much better
outcomes.
Mental illness is no different.
I would leave your listenerswith that.
We need to get ahead of thisand if we do, we'll get much
(30:06):
better outcomes.
We'll save a lot of money andwe will improve our public
safety, and people won't have tolive a life cycling in and out
of acute systems likehomelessness, jail, prison and
hospitalization.
Speaker 1 (30:18):
Absolutely.
I totally agree.
This has been a greatconversation, great information.
It's been a pleasure having youon.
I really appreciate you takingthe time.
Speaker 2 (30:29):
I appreciate you having me.
You have such a nice voice foryour podcast.
It's great, and your tone andyour questions are just perfect.
I'm honored to be here todayand thank you for inviting me.
Speaker 1 (30:42):
The pleasure is all mine.
Thanks again.
Thanks for taking the time outof your busy schedule to listen
to our show today.
We hope that you enjoyed it asmuch as we enjoyed bringing it
to you.
If you know anyone that wouldlike to tell us their story,
(31:05):
send them to TonyMantorcomContact then they can give us
their information so one daythey may be a guest on our show.
One more thing we ask telleveryone everywhere about why
Not Me, the world, theconversations we're having and
(31:25):
the inspiration our guests giveto everyone everywhere that you
are not alone in this world.
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