Miami Can Lead the Way on Mental Health Treatment While Saving Taxpayers Millions

Implementation of the National Judicial Task Force to Examine State Courts' Response to Mental Illness Report and Recommendations

The Task Force made a number of important findings, with corresponding recommendations, supported by over 100 new resources for courts and our partner stakeholders. Going forward each Behavioral Health Alerts will revisit a Task Force recommendation and an accompanying resource.

Finding: Peers, Individuals with Lived Experience, and Families Too often the voices of families and individuals with lived experience are left out of implementation and improvement efforts, and our responses suffer as a result.

Recommendation: Courts should create opportunities to listen to and gather input from individuals with lived experience and their families in all efforts to improve court and community responses.

A choir of voices and perspectives is needed in every effort to improve court and community responses to individuals with serious mental illnesses.

Courts should examine Peers in Courts to learn about strategies for the use of peers in court settings and other SAMHSA resources available to support these efforts. Courts should encourage the integration of trained peers at all appropriate points in the treatment, case management, and justice processes including hiring trained peers in their programs, services, and operations to improve the responses for individuals with behavioral health needs. Courts should promote and support the certification and education of peers.

Miami can lead the way on mental health treatment while saving taxpayers millions For far too long, Miami-Dade County’s jail has been used as a defacto psychiatric institution. This misguided practice been going on for years — for decades, in fact — with the jail a warehouse for people with acute mental illness, many of whom are homeless. The Miami Center for Mental Health and Recovery, the brainchild of longtime mental health advocate and Miami-Dade Circuit Court Judge Steve Leifman, will be a one-stop center for primary care and psychiatric services. It aims to break the homelessness-to-jail cycle. After 14 years of work by Leifman and others, it’s set to open this fall. This is a worthy and important project. It will help solve one of the community’s most tenacious problems. And it will save taxpayers money. Leifman calls this a “once-in-a-lifetime opportunity.” This May, as we think about mental health, there is hope in Miami.

Governor Gordon Wants More Treatment, Not Jail, For Criminal Offenses In Wyoming Gov. Mark Gordon and top court officials say a pilot mental health program set to launch in Gillette in 2024 will keep people from sitting too long in county jails instead of having mental health issues addressed, which Sen. Cale Case, R-Lander, calls "an astounding waste of resources." A few members of the Legislature and other state officials went to Miami last month to learn about the “Miami model.” Studies have found the program helps reduce crime, homelessness and demand on mental health services in the Miami area, as well as precipitated the closure of a jail. “We understand in Wyoming it will be a stripped-down version of that,” [State Court Administrator] Butler said.

Supreme Court of Wisconsin: Summit looks to improve criminal justice system response to mental illness Is there a better way for Wisconsin’s criminal justice system to respond to people with mental illness? If so, what does such an approach look like? About 200 people, including criminal justice system partners, judges, law enforcement officials, policy makers and treatment service providers, gathered Friday in Madison to consider those questions, and to exchange ideas on the topic at the Chief Justice’s Summit on Mental Health. Chief Justice Ziegler encouraged attendees to take advantage of best practices, whether those ideas come from local or national examples. Ziegler is a member of the Conference of Chief Justices, which encourages states to undertake a collaborative, coordinated approach to improving the criminal justice system’s response to people with mental illness.

Research and Resources

Judges and Psychiatrists Leadership Initiative newsletter In addition to linking to JPLI related resources, this special issue is dedicated to the recipients of the 2023 Judge Goss Memorial Award, including National Judicial Task Force member Judge Matthew D’Emic!

Web Tool: Collaborative Comprehensive Case Plans Even though criminal justice and behavioral health professionals have the tools to identify high-risk and high-needs people in the criminal justice system, many programs still struggle to develop and implement comprehensive case plans that integrate critical behavioral health and criminogenic risk and needs information. This web-based tool from CSG can help professionals better understand which people and organizations need to be part of this case plan development and how programs can actively engage the participant in meaningful plans that improve their health outcomes and chances for reentry success.

Expansion of the Police Role in Responding to Mental Health Crises Over the Past Fifty Years: Driving Factors, Race Inequities and the Need to Rebalance Roles Substantial resources have been focused on improving law enforcement’s ability to safely provide response to people experiencing mental health crises in the community, diverting people with serious mental illnesses away from the criminal legal system, and providing mental health focused programming within the criminal legal system. Codified roles for police in the civil commitment process have further centered mental health crisis response as a police responsibility. Mental health professions have not only been complacent with this arrangement, they have been complicit. They have off-loaded patients considered to be undesirable—those who are poor and not white—to police and the criminal legal system. There is currently a window of opportunity to significantly reduce the footprint of police in mental health care. We conclude with a note on the importance of maintaining a race equity lens to ensure that previous inequities and injustices are not replicated.

"Judicial Frustration": A Local Judge's Bold Attempt to Solve the Homelessness Crisis from the Bench In May 2021, in the case of LA Alliance v. Los Angeles, Judge David O. Carter of the Central District of California granted a sweeping order enjoining the city and county of Los Angeles to offer shelter to all unhoused persons living in Skid Row. The 109-page order identified structural racism and government indifference as the unconstitutional causes of homelessness in the region, and condemned California’s housing-first approach to addressing the issue. Although the Ninth Circuit swiftly vacated the preliminary injunction on procedural grounds, Judge Carter’s order begs the question: would universal shelter offers actually ameliorate the homelessness crisis?

Making a Case for Gender-Responsive, Trauma-Informed Mental Health Courts: An Exploration of Participant Trauma Histories The present study aimed to describe the lifetime prevalence of traumatic events and posttraumatic stress disorder (PTSD) diagnosis among a sample of 163 participants within a Northeastern U.S. MHC. Overall, about 83% of MHC participants reported any lifetime trauma, with significantly higher rates among female participants (94.2%) as compared to male participants (78.4%). These findings underscore the need for a trauma-informed and gender responsive approach to MHCs. Suggestions for MHCs to consider are offered, including trauma screening tools into MHC assessment procedures, cultivating a more trauma-informed culture by adapting key principles, and incorporating trauma-specific programming and therapies into their offerings.

Between Punishment and Care: Autonomous Offenders Who Commit Crimes Under the Influence of Mental Disorder The aim of this paper is to present a solution to a problem that arises from the fact that people who commit crimes under the influence of serious mental disorders may still have a capacity to refuse treatment. Several ethicists have argued that the present legislation concerning involuntary treatment of people with mental disorder is discriminatory and should change to the effect that psychiatric patients can refuse care on the same grounds as patients in somatic care. However, people with mental disorders who have committed crimes and been exempted from criminal responsibility would then fall outside the scope of criminal justice as well as that of the psychiatric institutions if they were to refuse care. In this paper, I present and develop a solution to how society should deal with this group of people, called Advance criminal responsibility. The basic idea being that if a person with a potentially responsibility exempting psychiatric condition refuses care, that person is responsible for any future criminal acts which are due to the mental disorder.

TAC Research Weekly: Lack of consensus on definition of “SMI” within research There is no consistent definition of “SMI,” despite being widely used in scientific, clinical, and policy settings. Definitions of “SMI” varied substantially across scientific literature, according to the results. Below is a list of how frequently aspects of “SMI” were utilized:

  • 41% of studies used “SMI” to reference “severe mental illness,” while 37 % of studies referenced “serious mental illness.”
  • 85% of studies failed to fully define “SMI,” meaning there was not specific criteria listed as to what qualifies as “SMI” and examples of which diagnoses are included under the term.
  • 37% of studies mentioned specific mental health diagnoses that fall under the term “SMI.”
  • 9% of studies included functional impairment in the definition of “SMI.”
  • 5% of studies mentioned a duration of time symptoms must have been present (e.g., longer than a year).

To solve this problem, the researchers suggest the creation of professional working groups to clearly define and operationalize the term “SMI,” so that its usage is consistent across research, clinical practice, and policy.

TAC Research Weekly: April Research Roundup People with serious mental illness prefer nonpolice crisis response. Individuals with serious mental illness prefer a nonpolice response to a mental health crisis, according to new research published in “Psychiatric Services.” Family members and friends agreed, describing the need for a calm environment and empathy during a mental health crisis with their loved one. Of four potential options, individuals with serious mental illness and their families selected a crisis response from a law enforcement crisis intervention team as their least preferred response.

Facebook Live: Understanding Schizophrenia During the event, NIMH experts Robert Heinssen, Ph.D., ABPP, senior advisor for learning health care research and practice, and Sarah E. Morris, Ph.D., chief of the Adult Psychopathology and Psychosocial Interventions Research Branch, will lead a discussion on the signs and symptoms of schizophrenia, risk factors, treatments, as well as the latest NIMH-supported research on schizophrenia. A Facebook account is not required to watch, but it is to ask questions.

Mental Health Screening Dashboard Join us next Wednesday, May 3, at 12pm (CT) to explore the dashboard and mental health screen findings for Cook County. The webinar will webinar to discuss the MHA Screening Program and dashboard functionality, the Cook County findings and its real-world implications, and use of this data to inform clinicians.

Judges and Defense Attorneys:  Register Now for Practitioner Training Registration is now open for practitioner training for treatment court judges and defense attorneys from NADCP's National Drug Court Institute (NDCI)! These four-day, in-person trainings will be held in Oklahoma City and facilitated by national experts.

OJJDP Releases FY23 Family Treatment Court Program Solicitation Programs funded under Category 1 are expected to implement new family treatment courts to provide parental substance use disorder treatment services, including screening, assessment, case management, recovery support services, and program coordination to family treatment court participants. Award amount: $750,000 each; Award period: 36 months. Programs funded under Category 2 are expected to enhance and/or expand parental substance use disorder treatment services to their participants in existing family treatment courts. Award amount: $850,000 each; Award period: 36 months.

Alternative 9-1-1 Emergency Response Community of Practice Harvard University’s Kennedy School Government Performance Lab is offering technical assistance and applied research support to local or regional jurisdictions who are launching, improving, or expanding community responder programs as a fourth option to 9-1-1 calls for service (in addition to police, fire, or emergency medical services response). Jurisdictions selected through the 2023 application process will receive pro bono technical assistance and applied research support, which may include short-term coaching focused on reaching specific implementation, operational, or expansion milestones and longer-term intensive supports.

In the News

California Supreme Court rejects lawsuit challenging Newsom’s plan to treat mental illness The California Supreme Court this week declined to block the rollout of Gov. Gavin Newsom’s sweeping new plan to compel people with severe mental illness into treatment, meaning the controversial program remains on track to begin this fall in several counties. Earlier this year, a coalition of disability and civil rights groups asked the state’s high court to strike down as unconstitutional Newsom’s program known as CARE Court (for Community Assistance, Recovery and Empowerment), claiming that it violated due process and equal protection rights.

72 hours: Inside San Diego County’s mental health crisis For three days last year, reporters followed patients, police, clinicians, dispatchers and those struggling for help to create a minute-by-minute account of an overwhelmed system. Unsurprisingly, the largest provider of mental health care in the county isn’t a hospital system or a nonprofit or a crisis center. It’s jails. More than a third of people jailed last April were on psychotropic medication for a mental health disorder.

Report: Michigan 'problem-solving' courts lowered unemployment and recidivism rates for 2022 Among drug, sobriety, and veterans courts, unemployment rates dropped by over 80% across the board. Additionally, mental health, sobriety, and veterans court graduates were all found to be less likely to reoffend within three years of joining the program. "If a veteran has PTSD or someone suffers from addiction, incarcerating them may not be the best path forward,” said Justice Bolden. “Putting these individuals in different programs where they can be supported and avoid incarceration…is what we need." Bolden says "problem-solving" courts have shown to be a more effective solution than incarceration.


Judge on Michigan's Top Court Getting Mental-Health Care A Michigan Supreme Court justice announced Tuesday that he is getting mental-health treatment outside the state and will not hear a case next week. “I encourage everyone who struggles to seek the help they need,” Richard Bernstein said in a statement released by the court.

Survey finds deluge of mental health issues among state’s lawyers Mental health, burnout, and substance abuse issues pervade the state’s corps of attorneys, according to a survey released by the New Jersey State Bar Association. The figures, which show a prevalence of mental health problems that far exceeds what is seen in most other fields, come amid a historic shortage of Superior Court judges and an erosion of traditional work-life boundaries spurred by increasing digitization. Chief Justice Stuart Rabner will convene a Supreme Court committee on mental health in the legal field, according to Lawrence, who said the chief justice agreed to that recommendation “on the spot” shortly after hearing it.


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