LA jail overcrowding: Is Miami a model for getting the mentally ill out of jails?

The L.A. County Board of Supervisors Tuesday will look at suggestions for reducing the county's notoriously high number of mentally ill jail inmates — and a lot of those ideas come from Florida.

Over the past 14 years, Miami-Dade County has developed a reputation amongst mental health experts as the gold standard for programs that keep the county jails from becoming de facto mental institutions. 

Now that L.A. County is debating building a $1.7 billion jail mostly dedicated to treating its mentally ill offender population — and faces federal intervention because of poor conditions for such offenders — Miami's programs have been receiving a lot of attention from L.A. officials.

• District Attorney Jackie Lacey, sent a team from her office to Miami-Dade to check out that county's programs.
• In a recent report, the ACLU of Southern California also highlighted Miami's success with keeping the mentally ill out of jail, success that allowed the county to close down one of its jails last year, saving the county about $12 million annually. 

"It really started not because we're better than or smarter than anyone else, but because our needs are worse than anyone else," said Steve Leifman, the associate administrative judge of the Miami-Dade criminal division and chair of Florida's task force on substance abuse and mental health issues in the courts.

Leifman said that while the national average for serious mental illness in the population is about 3 percent, in his county, it's 9.1 percent.

Meanwhile, Florida's public mental health spending ranks near the bottom in the nation. (He estimates public health dollars provide enough care for about 1 percent of the population.)

The county held a summit — similar to the one held by Lacey in L.A. in May — and commissioned a study from the University of Southern Florida to look at its large mentally ill jail population.

Leifman said the results were striking.

“What they found is that there were 90 people — primarily men, primarily diagnosed with schizophrenia — who over a five-year period were arrested almost 2,200 times, spent almost 27,000 days in the Dade County jail. Spent almost 13,000 days at a psychiatric facility or emergency room. And cost taxpayers about $13 million in hard dollars," he said.

To turn things around, the county has relied largely on federal aid, through Medicare, to fund treatment-based programs for its mentally ill misdemeanants and non-violent felons. It's also learned to leverage local resources well by collaborating with community partners, Leifman said.

The main programs fall into two categories: pre-arrest and after-arrest.

Pre-arrest program

Post-arrest programs

Fred Osher, Director of Health Systems and Services Policy at the Council of State Governments Justice Center, said nationwide now there are about 1,600 programs based on the CIT model — including the LAPD's program, which is also nationally recognized. About 500 mental health courts exist nationwide as well, including one in L.A. 

“What we see are points of light, and yet it’s really hard to find places like Miami that have strung all these things together," Osher said. "It really requires attention to all the intercepts in order to make that difference going forward.”

One of the key elements of Miami's program, Osher said, is that it's revolutionized the concept of mental health interventions in courts.

Most local courts — including L.A.'s mental health court — generally focus on defendants who are deemed "incompetent to stand trial," meaning they're incapable of participating in their own defense. 

"That results in long waits for their transfer to state facilities," Osher said. "And then, at state facilities, long periods of time providing them basic information about core processing, and then they’re often just let out for time served without anything good happening.”

California's state hospitals are budgeted for 1,807 such beds in 2014, at an average operational cost of $194,000-$265,000 per year.

L.A. County refers about 104 such patients to state hospitals per month, as of the most recent estimates from the state's Legislative Analyst's Office — and those numbers are up from a year ago.

Miami's court program focuses more on treating defendants for their eventual release — not their day in court — and therefore sees those defendants return to court less, Osher said.

"That may be something L.A. will look to replicate," Osher said.

That will largely depend on what county leaders agree is appropriate for Los Angeles over the coming months.

L.A. is the largest county in the country, which raises concerns of size and scale about any potential new program. Such programs also take time to develop and implement--Miami's has been going for over a decade--and a lot of commitment from all areas of the criminal justice and community mental health system. L.A. leaders have already expressed concerns that there aren't enough community resources to treat those who would be diverted from L.A.'s jails.

Leifman doesn't want L.A. to see his county's model as a social handout for offenders, but something that might work, in some form, in the court system here.

“This isn’t about creating a new social program and patting the person on the head and telling them to do good," he said. “If you want to fight crime, you have to figure out what’s causing it. Then you need to put systems in place so that you can get better outcomes.”