Behavioral Health - Policy Brief on Mental Health

The Criminalization of Individuals with Mental Illnesses:
Issues and Solutions in Miami-Dade County

Community Voices Miami
Issue Brief

The Problem

Miami-Dade County has the highest percentage of people with mental illnesses of any urban area in the United States. Mental illness, which looks past race, age, religion, socioeconomic status and sexual orientation, affects 9% of our county’s population. This is approximately 210,000 individuals. Jail has by become, by default, the largest psychiatric institution in Florida, though it is ill equipped to provide the necessary and appropriate treatment that is vital to this population. The result is an approach that warehouses individuals with mental illness in “holding cells,” until they are released without treatment, causing them to recycle in and out of the criminal justice system for their entire adult lives.

Background

• There are between 800-1200 detainees with mental illnesses in the Miami-Dade County Jail.
• Approximately 500 detainees receive psychotropic medication per day, costing about $15 million dollars annually to manage this population in jail.
• Persons with mental illnesses stay in jail eight times longer than those individuals without mental illness, which costs the system seven times more.
• About 250 individuals are committed to state forensic facilities every year from our community.
• The annual cost per individual at a state forensic facility is approximately $112,000.

Existing Solutions: The Eleventh Judicial Circuit Criminal Mental Health Project’s Jail Diversion Program
The Eleventh Judicial Circuit Criminal Mental Health Project was created to integrate existing resources in order to divert people with mental illnesses to comprehensive, community-based treatment and services. The mission of the Jail Diversion Program is to make jail the last resort for people with severe mental illnesses. The goal of the program is to assist individuals with diversion from jail to treatment, rehabilitation and support services that are essential to their success with community living.

Currently, the Jail Diversion Program takes nonviolent people who have been charged with a misdemeanor and places them in more appropriate Crisis Stabilization Units (CSUs) in the community where linkage to treatment and services can be provided upon discharge. As a result,

• Recidivism among this population has been reduced from 70% to 16%.
• Miami-Dade County is saving more than $2.5 million annually.
• Police injuries have been reduced and many lives saved.

For those being released from jail, there is an identified gap in funding for establishing such linkages and sustaining the community-based services. The majorities of individuals served either do not receive benefits from the federal government, such as Social Security Disability or they are undocumented individuals and do not qualify because of their immigration status. Following stabilization in the CSU, many of these individuals cannot access necessary treatment and case management services in the community due to the lack of payment. As a result, they often decompensate and return to the criminal justice system.

Other Solutions

#1 Expand eligibility for benefits and simplify enrollment. Resources must be secured to close the gap in services so that housing, support and treatment services are available and likely to result in successful adaptation to community living. In order for jail diversion programs to be successful, adequate services and corresponding funding must exist in the community. Intensive case management or assertive community treatment is the most effective method of reducing harmful behaviors, recidivism and time spent incarcerated. Linkage to continuing care is essential for successful rehabilitation and recovery outcomes.

However, many either do not receive or qualify for benefits. The process of establishing or reinstating benefits is cumbersome and often takes six to nine months or longer to accomplish. Although limited public funding is allocated to provide mental health services for indigent populations, the reality is that the demand for these services in our community far outweighs the available resources to pay for such services. The result is that many individuals are denied access to services that are critical to ongoing psychiatric stabilization and recovery. Without adequate care at the time of community re-entry, individuals diverted from the criminal justice system are at increased risk for patterns of self-neglect, maladaptive behavior, and subsequent recidivism to jail.

Approximately 70% of the individuals served currently in Miami’s CMHP do not have active benefits at the time they are released.

#2 Individuals should receive needed support and treatment regardless of immigration status About 15 percent of the individuals served by the CMHP in Miami are undocumented immigrants who are not eligible to receive public entitlement benefits that can be utilized to access needed mental health services in our community. Many of these individuals face additional barriers to ongoing psychiatric stabilization and continuing care services upon re-entry into the community. Many of these individuals end up recycling through our criminal justice systems exacting significant costs to the community with minimal return on the this recurring investment.

The CMHP estimates that for $40 dollars per day, individuals in our community can be provided with the type of housing, support, and treatment services that are most likely to result in successful adaptation to community living and reduce the likelihood of subsequent recidivism to jail.

Summary:

Our system does not make sense. Programs like the Jail Diversion Program and the specific recommendations made here are a more effective and efficient alternative than institutionalization for individuals with severe mental illnesses that have been arrested for a misdemeanor or at risk of being arrested for a misdemeanor. It offers the concept of hope and recovery for individuals with severe mental illnesses that have often been misunderstood and discriminated against, giving these individuals the opportunity to achieve successful community integration.

FOR MORE INFORMATION, contact: Leda M. Perez, Director, Community Voices Miami, Collins Center for Public Policy, 305-377-4484, ext. 29

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