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Jail Wrong Place For Mentally Ill

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The Tampa Tribune

Published: March 29, 2009

Jails are the wrong place to warehouse the mentally ill. Yet for years Florida has taken this approach toward those who are sick and turn to crime: Lock 'em up and don't worry about the treatment they need.

And when treatment is offered by, say, putting them in a forensic hospital to return them to competency so they can stand trial, they've often been in jail long enough to have served their time. They are returned to society with little help and often cycle right back into the criminal justice system.

What Florida faces is a disease problem, not just a criminal justice problem, and because the state hasn't handled it responsibly, it has cost us, both socially and fiscally.

Without proper medications, some of these people hurt themselves or turn on others. Some who may have a chance of getting better and becoming productive citizens simply don't.

And it also costs us in dollars. Florida spends $250 million a year to pay for 1,700 forensic hospital beds, where people charged with a felony are sent to recover until they are competent. It is one of the costliest systems in the country. Yet Florida spends less on mental health programs outside the mental health system than almost any other state.

It is, as Department of Children and Families Secretary George Sheldon said, "the definition of insanity." It must be changed.

That can happen this legislative session if lawmakers have the political will to pass legislation that would redesign the mental health system by reforming the way the mentally ill are committed for treatment. Passage is DCF's primary legislative goal, but more importantly, it's a social and fiscal imperative.

According to DCF and a Supreme Court task force established by former Chief Justice Fred Lewis, the state could save billions by keeping the mentally ill out of prison or forensic hospital beds. So the legislation would target those who have committed petty offenses because of their psychiatric condition and who could safely be diverted from the criminal justice system, as well as the 6,000 or so who are released each year with serious mental illness.

Miami-Dade Judge Steven Leifman, who has spent the last two years focusing on this problem, quotes a Supreme Court study that found on a daily basis some 70,000 Floridians with mental illness are in prison or jail. And of the 600,000 individuals with mental illnesses in Florida, about 125,000 requiring immediate treatment are booked into county jails. Of those, 50,000 are likely to cycle back once they are released.

At that rate, the state will have to build a prison a year in the next decade just to keep up, and it will cost upward of $3 billion. And that doesn't include the cost of the forensic hospitals, which by the end of this year, will be at risk of running out of beds to treat those who need it.

The state would in effect be back in the position it was in three years ago, when a Pinellas judge held the DCF secretary at the time in contempt for failing to follow the legal requirement to provide timely treatment for mentally ill inmates.

Then the Legislature responded by freeing up emergency money and promising to spend $48 million annually to make up the difference, and that's not something taxpayers need in this austere budget year.

Fortunately, the legislation initially calls for pilot programs in the Tampa Bay area, South Florida and Pensacola and with no additional state funding. Backers hope to use some of the money used to pay forensic bed rates for community treatment initiatives. While it costs from $130,000 to $140,000 per bed to treat inmates, it would cost $18,000 or less to treat them in the community, Leifman said.

But the federal government would pick up most of the tab through Medicaid as long as those receiving treatment stay out of the criminal justice system.

For Floridians worried these programs would be get-out-of-jail-free cards, that is just not the case. Dangerous criminals will not be diverted, and those who have committed violent crimes will serve their time.

The legislation has support in the House and passed out of the Criminal and Civil Justice Policy Council last week. A similar Senate bill has bipartisan sponsorship but has not been heard.

All Floridians must realize the criminal justice system was not designed to treat the mentally ill. It is unproductive and cruel to warehouse in jail those with psychiatric diseases, as societies did 200 years ago. Florida must - and will, with passage of this legislation - do better.

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