The Definition of Insanity

♪♪ [Leifman] When I became a judge, I had no idea I was becoming the gate keeper to the largest psychiatric facility in the state of Florida, the Miami Dade County Jail.

(dramatic music) [Leifman] This was not just a local problem but it is a national one, as well.

- [Newscaster] LA County estimates 27% of it's homeless population suffers from serious mental illness.

[Newscaster] Neighbors say the man shot by police has struggled with mental illness.

[Leifman] They look at these folks as criminals and that the best way to handle it was to get them off the street, and just lock them up.

[Man]:Our jails have become the largest public psychiatric institutions in the country.

[Woman] They don't have the mental health staff and resources to provide treatment.

[Leifman] We were spending $80 million a year, to warehouse people in conditions that you wouldn't let your dog stay in.

[Leifman] It's foolhardy what we do now, it's dangerous what we do now and it's cruel because we're not affording people the opportunity for recovery.

- [Steadman] We know how to fix it.

It's a question of political will and it's a question of leadership.

[Leifman] This is not a criminal justice problem, this is a community problem that requires a community solution.

(dramatic music) (bright upbeat music) [Leifman] We want people to be part of their own change.

We want to be able to give them the tools that they need so that they get the insight but they also learn that there is a better way to live, there is a better way to deal with their illness and you need to stay away from committing offenses.

- [Narrator] In January 2000, Miami-Dade County court judge, Steven Leifman made one of the biggest mistakes of his career, he promised the parents of a man who had once been a practicing Harvard educated psychiatrist but was now homeless and appearing in his court for a minor offense that he would get him help.

- [Leifman] The case was a window to how horrifying the existing system was and the case involved somebody that had severe psychosis but the court had absolutely no authority to get him into the system.

And so my only option was to release him back to the street on a conditional release and tell him to go see a doctor.

Not only was I unable to fulfill the promise I made to his parents.

But I put him at risk, I put the community at risk, I probably put my job at risk but I followed the law.

- [Narrator] 20 years later Miami-Dade faces a crisis, nearly 10% of its adult population suffers from serious mental illness, but Judge Leifman presides over a system of care for people with mental illness, that he hopes could be a model, for the rest of the country.

- [Bailiff] All rise.

[Leifman] Thank you gentlemen.

Do you swear firm testimony you're about to give is the truth, the whole truth and nothing but the truth, thank you very much.

We started very slowly just with non-violent misdemeanor cases.

I know you don't look for trouble, these are really minor offenses.

You don't hurt anybody and I really appreciate that, you're a nice man.

- [Man] Yes, sir, okay your honor.

- I just don't like you having to be out on the street and getting sick out here.

Are you hearing voices today?

- [Man] Little voices.

- [Leifman] Little voices.

- [Man] Little voices.

- [Leifman] Okay.

And we had to prove that this would actually work and in a very short period of time it did.

[Espinosa-Clark] Judge, Mr. Alvarez is receptive to JDP services.

The recommendation at this time is a residential treatment facility, he expresses the need for that service.

He has been taken to central intake and has been placed on the wait list.

[Leifman] Great, hang in there with us, it's a lot better outcome once I can get you going, okay?

- [Man] I'm tired of the cycle.

- [Leifman] I know, I'm glad you see that.

We're going to work with you and get you everything you need.

All right good luck.

So what we've been able to do is a program that we've set up to actually help individuals navigate these complex systems so that they can get the treatments that they need, get the assistance they need so that they can actually recover.

- [Narrator] The program Leifman pioneered is officially titled the 11th Judicial Circuit Criminal Mental Health Project.

But to the team of people who chart it's course on a daily basis, it's known as JDP, short for the Jail Diversion Project.

[Schwartz] Okay, I wanted to talk about how many people we are enrolling in the project.

There have been 80 people enrolled and seven people are pending.

So, I'm going to assume that we're doing really pretty well towards our goal of 100.

So I think we're on target.

[Aristizabal] Morning Judge, Alejandro Aristizabal with the jail diversion program.

On Mr. Dolan's case the state approved his participation in diversion, we did screen and assess him, he meets criteria.

We would like to request, your honor, transfer the case to our mental health court.

- [Schwartz] Jail diversion, helps people that are identified with serious mental illness, when they're in jail to be released to the community with the treatments and services that are necessary to help them move towards recovery.

That's what we do.

- [Aristizabal] Jail diversion is not your regular route through the system.

Thank you Judge.

What the state attorney's office will do is come up with a diversion offer.

- Trevor - How you doing man?

- Good man.

I'm going to be working with you for the next year.

- [Dolan] Okay good.

- [Aristizabal] If you're gonna put in your half and work with us, this is gonna happen within two weeks, alright?

- It's good to meet you in person right.

- All right, take care.

- If you participate in Jail diversion, and you are successful throughout these 12 months, we are going to dismiss your charges, and that's huge.

- [Aristizabal] We're on our way to see Trevor.

- He spent about six months in jail, before he was approved for diversion, and this will be our first encounter with him, outside of the courthouse.

He's about the same age Justin was when we worked on getting Justin out of jail, and into treatment.

- [Volpe] I was in jail for a month and a half.

It was unpleasant.

- It was not the Holiday Inn - [Aristizabal] My job was to go out, and talk to Justin, and try to get him to agree to work with us, and Justin wasn't easy to work with.

- [Volpe] I was very sick.

I was very sick.

I told him, what'd I tell him, Al-Qaeda was on Miami Beach.

Do you remember that one?

- [Dolan] Hey!

- [Aristizabal] What's up, man?

- [Dolan] How you doing?

- [Aristizabal] What's going on?

- We really like seeing people outside of the courthouse.

- [Dolan] Yeah - [Aristizabal] We don't want to just have a two-minute conversation, - [Narator] In the Miami community mental health model.

There's no universal pathway to recovery.

For clients like 22-year old, Trevor Dolan, a jail inreach screening by JDP specialists, determines not only a diagnosis, but the resources he'll need going forward.

For Trevor, that means his first 60 days, will be spent at Better Way.

[Aristizabal] Have you ever been in a residential treatment before?

- [Dolan] No, I have not.

- So this is your first time?

- This is my first time [Dolan] This is my first time to ever geting any type of treatment.

- I'm glad to hear that.

- I did high school on my own - [Aristizabal] That's what we're about, trying to show you that, you're going to learn stuff here, that you have to take out into the real world.

You're seeing the doctor too, psychiatry?

- [Dolan] Yes, I've seen her once, so far.

- And the medications that she prescribed, how do you think they're working for you?

- I haven't taken them.

I haven't gotten them yet.

- You haven't gotten them yet?

- No, she just prescribed them to me.

- Abilify - We need to get that prescription - I need to work on that, And you want to pursue work, right?

- Yes.

I want to start working right now.

- [Volpe] You're not gonna be out working late, you know that right.

- No - Yeah.

You know, I'm in recovery myself.

I mean, I've been here 10 years now.

- Wow - Yeah, man.

Got wife, family, house.

I mean things get better.

- Is there anyhting you need?

- What do you mean?

I don't know.

I see you dressed nice.

Nice shoes, watch.

Do you need anything?

- No, I'm good.

I'm good.

- You good?

- I got everything I need.

- It's great to see you again.

- Yeah, you too Alejandro.

- Congrats - You got an awesome 30 days in already.

- I do.

- I can't wait till you got 12 months in.

[Aristizabal] Mental health doesn't fit to the criminal justice system.

It's not written in protocols.

There are no standard operating procedures for what we do.

So we often think of ourselves, as the glue that holds it all together, the translators, the interpreters, Mornings are rush, rush, rush.

So it takes a lot of coordination.

Trevor's new.

He is in residential treatment.

He's on an ankle monitor.

We actually saw him yesterday, we had some issues.

He was not being given his psychotropic medication.

- [Sayfie] I'm sorry, he's residential?

- [Aristizabal] Residential.

- He's there all the time, and there, they have not explained to him, no one's supervising his medication?

- Not until tonight.

- I'm not feeling good about that.

- [Sayfie] The mental health diversion court, It's a very different role for judges, not all judges, I think take to it.

You're really traveling outside the boundaries, of where you normally travel, as a judge in a regular courtroom.

You are in there, you're in the trenches, you're much more involved, and invested, I would say, in the specific cases in the clients.

- So Trevor, gets a null-pross though if the restitution is paid on all the cases?

- [Attorney] Yes judge - [Sayfie] Oh good.

- You definitely have to believe in rehabilitation, you have to believe, in redemption.

I think that that's really a cornerstone of being a judge in the diversion program is to make sure that they know, that we're there for them and that we believe in them.

- All right, so Mr Dolan if all goes, well here, in this program, your cases are gonna be dismissed, - [Dolan] Yes, ma'am.

- [Sayfie] So this court is unlike the court you started out, in that court and you're being prosecuted, and - Correct.

- Ultimately, it was about whether you're going to go to trial, or take a plea.

We're all basically on the same team here.

We all want to see you succeed.

Alright, so the state, your attorney, the court, we all want to see your case get dismissed.

- Thank your honor, thank you.

- [Leifman] I think if you're not someone that's really in this field, they think if they just give the person medication, a pill, or a shot, they're gonna be fine, that their lives are going to turn around, and they're going to be healthy and have happy lives.

Well, if you're homeless, if you have a drug addiction, if you have a lot of trauma history.

All the medication is going to do is reduce your symptoms.

It's not going to help you thrive, survive, be hopeful, and happy, and so we've learned that we have to address all those other social issues on top of their psychiatric treatment to make this work.

- [Narrator] But recovery is never going to be easy, especially given the complex system of care that currently exists.

- [Volpe] You going down?

- [Narrator] It's difficult for anyone to navigate, much less someone with a mental illness, who's just been released from jail.

- [Volpe] I'm a certified recovery peer specialist by the State of Florida, which means I have a little piece of paper I pay $75 for every year to do my job.

I get people out of jail every week.

I get them where they're going in the community, get them to their housing, and in Camillus House shelter, ALF, three quarter way house.

I bring their medication, and then I get them linked to treatment, and I follow up with them in treatment.

Hey Yuri, what's up brother?

You remember me?

- [Yuri] Yeah, yeah from the program.

- So this is what's going to happen.

Are you hungry?

- Yeah, I'm hungry - Then we gonna get something to eat, but first of all, I got T-shirt, jeans, to get the booze off.

You know, you go like this.

- Yeah, they told me about that.

- Might be a little bit big, but that's all I got right now.

-It's better than nothing - [Schwartz] When I first started in 2003, we would set up treatments and services for people that appeared to be the right thing to do.

- [Volpe] How about these to sleep in?

Something to chill.

- [Yuri] I like those - [Schwartz] And we would help people to get to wherever they were going to be living, with treatments available, and they would run away in the first five minutes.

- [Volpe] They used to get people out of jail, and tell them you have court next month, you have to be at this address on Monday to get your medicine, and they would send them in a taxi by themselves, and they would never see them again.

It was that simple.

You know, what would you do if you got out of jail and somebody give you a free taxi ride?

You'd say, "I'm gonna do what I want to do, which is not this."

- [Schwartz] So we had to come back to the table, and say, "Okay, what are we missing here?"

- [Volpe] How is the food?

- [Yuri] It's good.

- Yeah.

You owe me $7.50.

- [Schwartz] And at the same time, on the federal level, peer specialists were being looked at as a good alternative to engaging people in the process, in their own process of recovery.

- [Volpe] We got about 30 beds from jail diversion.

We got guys on the sixth floor, and sometimes on the seventh floor.

I do a couple groups with the guys.

We get coffee, we get food, we go to AA, NA meetings, I take them to doctor's appointments.

Just little things to help make it easier, you know, to know that they got an extra supporter in the community.

Sign in.

Aright guys, we're going over the basics today.

What does education means to you?

- [Man1] Is it being edudcated on - [Man2] On our sickness.

- [Volpe] Why don't you just say health.

Because you know, this is the same category as heart disease, or diabetes or something.

Just because people say you have a mental illness doesn't make you weak or anything, you know.

- [Man1] Sometimes I feel like that though.

- [Volpe] Yeah, but you're a lot stronger than a lot of people out there, because you're dealing with stuff that a lot of normal people don't deal with.

So you got to think of it as strength based.

You know, so many people put us down so many times over the years - [Man1] I been dealing with that a lot - [Volpe] Yeah, but now we're gonna give you the tools.

Let's do a little skit right now.

- [Kelvin] Can I do it with you?

- Let me do it with you.

Come on.

Please!

Come on, let me do it with you.

(all arguing) - [Kelvin] Let me tell you like he doing.

[Thompson] Come on Kelvin, no come on, come on.

[Volpe] You gonna be serious?

Ok, we're gonna do something else, I'm gonna do something else All right, you're my friend I'm a bad influence, okay?

Wait, wait - I'mma set the scene.

I'mma set the scene.

You're gonna stand up for yourself.

- [Kelvin] Okay.

- [Volpe] We're gonna be about one minute, and then we're gonna sit down.

- Okay.

- Okay.

So I got these dumb kids we're gonna go hustle 'em, so I need you to come with me to come talk to them, so we can get money off them.

- You gonna come?

I'll give you half.

- [Kelvin] No, Justin no.

- Why not?

- Why not?

I thought you were my friend.

- You just got out of jail.

Me too man.

(all laughing) - That's what these sneakers are for man.

You can run.

(all laughing) - [Narrator] The Miami model, based on Comprehensive Community Care, is unique in the United States, but it is not a new idea.

- [Kennedy] Hearings begin in the senate this week on our bills to combat mental illness, and mental retardation.

Almost every American family at some stage will experience, or has experienced a case of mental affliction, and we have to offer something more than crowded custodial care in our state institutions.

[Leifman] The hospitals were horrific, and there was a lot of torture, and human experimentation going on, and we started to become more aware of these horrors, and people started to put a stop to it.

- [Kennedy] Our task is to prevent these conditions, our next, to tream them more effectively and sympathetically in the patient's own community.

- [Leifman] President Kennedy, his last public signing was to create this national community mental health system, but not $1 got appropriated because of the escalation of the Vietnam War and his assassination.

It just kind of got forgotten.

- [Rundle] The goal was to deinstitutionalize.

So there was supposed to be community centers, health centers, where families could go, where they could go, and they could get their medication, they could do their treatment, and government lawmakers just didn't give the money, the resources that was needed to do it.

- [Leifman] And so we close all hospitals.

We significantly cut back on federal housing.

They go to sentencing guidelines to get tough on crime.

They go to the war on drugs.

You had a tripling of the number of people getting arrested since the '80s, and these folks just get swept up into it.

And so we never deinstitutionalize, we transfer the responsibilities from the really crappy, horrible, dangerous state hospital to the really crappy, dangerous, horrible jail.

- [Volpe] Eleven years ago, I was in the ninth floor, in the Dade County Jail.

I'm laying in a pile of feces, vomit and urine.

I'm sick, I'm hearing voices, I'm seeing things, people are lining up like sardines on the floor.

Bah, bah, bah, and this guy comes with this white powder out of his socks.

He's got real high socks, like Dr. J used to wear, you know, and he starts sprinkling this white powder, and on the same disgusting floor, people are doing lines of it off the floor.

When I was arrested, I had medication with me, and I told him I need to go to the hospital, I take pills, and they're like, "Oh, we'll put you on the psych floor."

I'm like, thank goodness some some people(laughs) that understand me, but I get up there it's way worse, man.

There's people screaming around the clock and the abuse from the corrections officer, he beat a guy unconscious in the cell next to me.

I just heard this guy screaming at three o'clock in the morning, you know, please God no, please God stop.

I'm sorry, I'm sorry, And just his, his flesh just hitting the concrete until he just went, hit one last time and he went silent.

I didn't sleep for three weeks.

I was on the ninth floor.

It just made my mental health worse, and you know my bond was only like $500.

I had some money in my account, but I didn't know how to pay it.

The people that stay in jail, are the seriously mentally ill, because they don't know how to navigate the system.

You're either too poor, too ill, or too sick to get out.

- [Leifman] What happens is you then have systems that are developed to process people and cases for crimes, not a system developed to assess, and move people into treatment.

So guess what happens?

You end up spending your entire adult life, recycling through this criminal justice system.

I tell people, it was the definition of insanity, where we kept doing the same thing again and again, and expecting a different outcome.

[Volpe] You have kids?

- [Gonzalez] Yeah - Yeah?

- Three.

- [Volpe] You have three kids?

- Yeah, two and one on the way, you know.

(mumbles) - You're a busy man - Yeah.

- [Recoba] I'm gonna go inside.

to see what's going on, - [Gonzalez] All right.

Sounds good.

- [Narrator] When JDP was started, Charlie Gonzales would not have been eligible.

Only misdemeanor cases were allowed, but now third, and sometimes second degree felonies can be considered.

Charged with crimes that in criminal court could spell prison, today marks Charlie's halfway point in jail diversion.

- [Sayfie] Mr. Gonzalez, how are you.

- [Gonzalez] Pretty good and yourself, your honor?

- [Leifman] In the criminal justice system, there's really just three parties.

There's the defense attorneys, often represented by the public defender's office.

There's the State Attorney's Office in Florida, outside of Florida, sometimes they're known as district attorneys, and then there's the judge, and theoretically, the system works best, when both sides fight equally hard, and justice is supposed to fall through the middle, and so doing a collaboration in the criminal justice system is not a natural act, and so it has to be created.

- [Rundle] A community has to agree together that they're going to solve whatever particular problem exists in their community.

Listen, we all come to the table, and we can put you know, turfs to one side and say, we're going to build something really meaningful here.

- [Aristizabal] He's been attending all his appointments at Camillus outpatient.

He just went on Monday and saw the doctor, and, adhering with all recommendations, really.

And, I think he has had some big news in the last couple of days.

It looks like he's going to be expecting his third boy.

- [Martinez] So, pretty much everyone is on board with, we are not going to criminalize mental illness and that is a big shift.

That's a big cultural shift in the community, where people are actually seeing, the mentally ill as being part of this community, not being those people.

- [Aristizabal] Today we're here with private counsel, and the State to possibly motion for release from the GPS ankle monitor.

-[Recoba] Immediately, after Alejandro took Charlie's case, he was evaluated, and he started receiving treatment.

He called me two weeks after he had been admitted, and we're having a conversation at night and he's telling me how much he loves, you know, his job, and how his life is going great, and this is the first positive conversation we have with him, and like 10 minutes into it, I go, listen man "are you taking any meds?"

And he goes, "Yeah Nick.

And it feels great."

- [Sayfie] Okay, I know you've been doing consistently very well, since the beginning, and you want me to take you off the monitor?

- [Gonzalez] Yes, ma'am.

- Yes.

- If possible.

- All right.

State is in agreement?

- [Attorney] Yes.

Judge.

- [Sayfie] Okay, so at this time I'm going to order him off the GPS.

Alright, so we're at the six month mark right now, and keep working, save your money, - [Gonzalez] Thank you Your honor, - Because your kids are going to spend it all - Yeah, I already spend it all on them - They're gonna spend it even more.

- Thank you.

- All right.

- [Recoba] He was looking at five years minimum.

So we could have gone to trial, and the judge could have gone anywhere from five years to prison to life.

He was not a real threat to society, but he could have very well, become a threat to society.

This is all they needed to do.

They just need to diagnose him, and and they need to give him the right medication in the right amount, and this kid turn into a new leaf, and he has a total different life since he entered into the JDP program.

- [Gonzalez] Oh man, my ankle feels a little lighter.

- [Aristizabal] What we do is challenging.

We work with human tragedy all day, and when you have a success, you have to take it and run with it and really enjoy it.

(music) [Volpe] Oh wait, check this Out.

This is from Jersey.

I've had this thing, since I was probably 12 years old, I'm not gonna say how it got here.

I special ordered it.

This is it, man.

I got a couple of cert appreciations from the court.

I got an award one year, then in the Washington Post later that year they did a whole story on me and then how things need to change and need to change the system.

Like, you shouldn't have to go to jail, to be to get treatment, doesn't really make sense.

This is like the chill part, you know, you get home, you say a prayer, you meditate here, you know, give thanks, it helps keep you focused on what you're doing, you know, because you have to first take care of yourself to be able to give back, and that's why this work is important, because you know, you get to give back, and help other people.

(soft music) [Leifman] Recovery rates for people with mental illnesses, are better than heart disease and diabetes.

The earlier you catch it like any illness, the better services you get someone the better recovery rates you're gonna get.

They're just people and they want to do everything that everybody else wants to do.

They want to be happy, they want to be hopeful, they want to have dreams, and they can't get there without all these supports in place.

And so, part of it was identifying competent systems of care in the community, because some of it didn't even exist for people to get the services they needed to recover.

- [Narrator] The Dade Family Counseling center opened its doors in 2003, shortly after JDP was launched.

It serves as a hub for JDP clients whose needs range from the administration of psychotropic drugs, to guidance on how to organize your day.

- [Thompson] So you get up in the morning, you take your medicine or you shower, or whatever you do, you eat your breakfast and then you come to Dade Family.

So you start getting that, because what that does, that makes your day do what?

- [Man1] Better - It makes your day better... - [Thompson] I was an instructor also in the military, and a military instructor is a person that can teach anything.

When you develop that you also have to develop a way of helping people, and that's why I like teaching classes, because I'm looking for that one person.

That's all I'm looking for, that one person that gets it, and when that one person gets it, it's gonna spread around.

- [Medina] He's ready to take over - [Thompson] Come on Stephon -[Nory] Ball is in your court [Thompson] I got a move my stuff out of your way.

- [Narrator] Even as he nears completion of JDP, Stephon Berry comes to Dade Family regularly for group and individual therapy as well as medication.

It's a regimen he hopes can help him maintain work and find stability long after court supervision ends.

- [Berry] I want to talk job related.

Cuz, when I'm at work, I have to know good product knowledge at work.

I know I have to know that, but I have mental illness that's going on within me, and I know for a fact that when it's time for me to go to work, I have to make these sales, I gotta make sure my area's clean and I recover everything.

All that stuff is based on organizational skills.

And I'm really happy that I shared that to you all (all clapping) - [Medina] Stephon actually, was one of the ones that was very interested in the help.

He's had a lot of goods and bads.

He's gotten work, he's been fired, then he's been laid off.

We're going to keep helping him with that structure, and organization that he needs in order to avoid decompensation, because that's what we are most concerned about Stephon, his symptoms.

- [Berry] I try my best every day.

That's all I can do.

[Aristizabal] Trevor, he successfully completed 60 days out of Better Way.

He's now living independently with a maintenance manager.

He's engaging in work.

He's trying to see if he's going to do deliveries with a wine company.

Not sure that's the best, but it is a job (all laughing) It is employment, and it is legit.

- [Schwartz] Also, what about those programs at Miami Dade Community College for him?

He fits into that category.

- [Aristizabal] He does.

He's not expressing educational goals yet.

I think that he wants to get solid in the community, but we should bring that up.

- [Schwartz] As you all have heard me say, hope is the cornerstone of recovery, and it really would be helpful for a young guy like him, to not only get through his court plea, but to think about what's next for him?

What's my long range plan?

And that's what we can help him with.

[Dolan] My new job, I started yesterday, did eight hours.

- Put it behind schedule Rich.

- I guess I did a good job, because they asked me to come back here today.

I just want to show the JDP people that they chose a great person for this.

You kind of have like that, Angel, like looking over your shoulder, so if you do have a thought of doing bad, or doing something that's not really with the curriculum, you have these people to think about, you know, how would that make me look?

How would that make them look?

You know, I never really had that before, it was all about me, and I just want to impress everybody.

(soft music) [Berry] I always had a normal life, and then I had this whole schizophrenia thing, It really drowned my mind, like everything was crazy, like, I didn't know what was going on at the time.

It was real, it was real psychological warfare.

As I'm moving forward right now, my program is my only way to conclusions in everything that my thinking processes needs for the program.

I think my thought processes is always messed up.

but when the program started coming through, and the teachers start helping, that's how my mind getting better.

Like I know for a fact my mind's getting better, like every day.

- [Rundle] The criminal justice system really should be more preserved if you like for those that are really dangerous, people who are danger to others.

If they're coming into the system, and we know eventually, the criminal justice system is not the appropriate place for them.

What you want to do is intervene, you want to fix the problem, so that they're constructive, they're contributing members of our community.

(music) [Gonzalez] These walls over here, yeah these were walls we built right here.

Every time you see one of these walls, remember me.

- [Recoba] Charlie, he's a good worker.

His employers really like him, and he really loves his job.

I see him making money, I see him as a good leader.

So, we can only hope that the instruments and the tools to cope maturely, that he received through JDP, will carry him through.

- [Narrator] The tools and instruments of any recovery begin with whatever resources a community has to offer.

But, the challenge lies in connecting those resources, and figuring out what's missing.

For Miami, that process started in 2000.

At a meeting with researchers from the Policy Research Associates in upstate New York.

[Steadman] We were trying to think through a mechanism that we could effectively go into a community, and work with them and do strategic planning, and help them along.

So we had come up with this model, which we call sequential intercept.

Steve Leifman came over and said, will you guys come down here and do one of the mappings for us?

- [Lee] Basically, these are the different intercepts of the criminal justice system.

So right here, you have initial detention and arraignment.

Here you have jail, so this is the jails and the prison.

This is the reentry process, from to get back into the community, and then this is back in the community, so this is probation and parole.

And what we do is we map the different communities, and we figure out where their gaps and resources are.

- [Narrator] When Judge Leifman and his team mapped out the intersections between people with mental illness, and the criminal justice system in Miami.

It revealed huge gaps.

Not only for people who had been arrested, but also for those who hadn't yet entered the system.

- [Leifman] And so we realized that we needed a pre-arrest diversion program to try to limit the flow into the system, and that meant we needed to train more police officers so that they would make less arrest of people with serious mental illnesses.

-[Kocar] Hey guys, how are you?

- [Man1] How you doing sir?

-[Kocar] How's everything going?

What do you suffer from?

- [Man1] Schizophrenia - [Kocar] So you've been to crisis before, right?

And you suffer you suffer from schizophrenia?

- [Man1] Yeah.

- Okay, we'll do the best we can to help you guys out.

- [Man2] What's your name; I wanna pray for you.

- I'm Officer Kocar.

- [Man2] Thank you Father for this brave man, officer Kocar, who did shoot his gun in the line of duty and survived, and killed two people, right?

- [Kocar] No, but thank you though.

- You didn't kill anybody yet?

-No.

- [Man2] You're gonna kill two people before you get over.

And you won't get over it, but you have to save your life, and you're gonna survive.

- [Kocar] Thank you so much.

Thank you.

Have a good night.

Hello.

How are you?

[Kocar] When I first got on the street, and saw someone approached me aggressively, or fast, or their speech pattern was off.

It definitely, you know, made me nervous and scared.

It goes from being a calm situation, to, you know, a situation where now he's combative.

I'm combative, and then next thing you know, someone might get hurt.

So those are things that the training has taught me as an officer.

[Leifman] Crisis Intervention Team policing, is this wonderful 40 hour training program, developed in Memphis, Tennessee that teaches the police how to identify someone who's in crisis, how to deescalate a situation, and where to take the individual as opposed to arresting them.

[Kaba] CIT is first and foremost, officer safety.

So what do you think emotions can do to you, when you're out there on the street talking to someone?

-[Audience] They can get you hurt.

-[Kaba] They can get you hurt.

- It's really no fault of law enforcement, that they didn't have the tools, or resources, or the knowledge to divert to treatment.

Someone's loitering and they're not responding to the officers directions.

You are non-compliant.

You are uncooperative, and I'm arresting you.

You know, let's go buddy.

You're going to jail.

- Can I have a volunteer come up?

Thank you.

Thank you.

- [Diaz] Morning, how are you, I'm Officer Diaz - [Kaba] I am so happy that you're here.

- Me too.

- Will you join me in singing the national anthem?

- Where?

- Right here?

- Right now?

- Okay, no, no, no please, please take a step back!

- Just take a step back!

- Okay, not a problem.

- Okay, what made you make a step back?

-[Kaba] Well, what CIT teaches the officer is to see more than just, you know, the obvious potential crime.

- If I just asked you to take a step back, it did not compromise your your officer safety?

-No -And you were able to just take a step back -[Diaz] You gotta compromise with some of these people, man.

- Exactly!

- it can't always be you, you, you.

You can escalate it sometimes.

- Exactly.

Beautiful.

[Kaba] Thank you, thank you!

- [Diaz] The first day I was here, I learned more in those eight hours than I did in nine years with the highway patrol.

Not taking anything away from the patrol, the patrol's great.

It's just that us as law enforcement officers, we're made to wear so many hats, and now in today's society, they also wanted to wear a white lab coat, you know, to try to diagnose these people, we can't do, we're not medical professionals, but here teaches a little bit more to recognize some of these things that people are going through.

- [Kaba] The whole purpose of CIT, is let's decriminalize the mentally Ill.

Lets properly assess.

Let's get the person to the right place, and divert them to treatment when it's appropriate.

[Ulmer] How long ago was it that you stopped taking your medication?

A year?

Let me go ahead and speak to the mom, okay - [Woman] Help me.

Something is wrong with her she needs help.

- [Ulmer] Okay, but remember she also needs to be on the medication.

She hasn't been taking it for over a year.

She's 16 years old mom.

You need to get that medication for her.

Okay?

-Yeah -Okay - [Leifman] When we started the project, there were approximately 118,000 arrests per year in Dade County overall.

Now it's down to about 56,000.

And so police injuries have almost stopped entirely, injuries to people with mental illnesses have stopped, and police shootings went from almost two a month for people with serious mental illnesses in our community to maybe five, or six in the last eight to 10 years.

- [Ulmer] What are you feeling right now?

- Cold?

- Just relax, okay, you're good - [Narrator] Judge Leifmann and his team, have spent nearly two decades implementing the Jail Diversion Project, but on any given day in the US, there are still 400,000 people with serious mental illnesses behind bars.

Costing taxpayers more than $12 billion a year.

Given this national crisis, Miami has become a model for other communities.

[Aristizabal] One of the things you really have to let them know is... - [Leifman] This week we had a group of judges, the elected prosecutor, and providers from Cleveland come in, they're really working hard to try to replicate this.

- [Woman] What's the most difficult part about your job?

- [Volpe] Putting out fires.

Say I have like ten good clients, and I would just love to hang out with them all day, and eat empanadas and cannolis, right.

You're doing great, we're doing great.

Let's pat each other on the back, you know, But it's more like, this guy's out of meds, this guy needs to be hospitalized, this guy took off go find him.

Even though you'd rather just see people do well all the time, we can't close a blind eye to, you know, what's really happening.

- [Reed] Hey, - [Tommy] Hi - [Reed] How are you?

[Volpe] What happened?

- No.

You should have told me, you should have told the guy.

Let me see if I got some food.

- [Leifman] We've made a lot of progress, but we still have not figured out yet how to deal with the most severely ill that keep recycling.

- [Volpe] You want a piece of cake?

- [Tommy] Yeah.

- [Volpe] This is a good cake, man - [Leifman] 97 people.

Over a five year period, spent 27,000 days in the Miami Dade County Jail, and conservatively cost taxpayers 13.7 million, and we got absolutely nothing for it.

Nothing.

It's taken us a long time to figure out what most of this population that is that sick need, is to have all the essential elements of recovery in one place.

- [Narrator] Ironically, the site Judge Leifman has in mind for a first of its kind jail diversion center is a former state mental health facility.

[Leifman] We're going to remove the feel of it being a jail, or an institution.

For people with mental illnesses we're gonna take you from some horrible facility that's under-resourced and under-staffed.

It's going to look like crap.

We're going to throw you on a bed and medicate you against your will.

Who wants to go get treated?

And so this facility, people are gonna be happy to be here, they're gonna understand it's really to help them get into recovery and not to punish them, torture them, but make them want to get better.

- [Narrator] In the absence of a one stop shop, a patchwork system of care is a reality the JDP team must face on a daily basis.

- [Aristizabal] Don't forget to bring your prescription for Abilify.

- We do I talk to you about that?

So, my counselor doesn't have it so I have to get a whole new prescription.

- I thought you had it - No, my counselor has it.

- I'm gonna have to keep a closer eye on you, man.

I'm gonna have to sign a staff to really be on this, because I'm just not getting really good information.

So I'm going to give you a shorter reset date I'm gonna have you come back in two weeks, and we're going to work between you, Walter, or Justin and me.

We're going to try to make sure you're aware of all your appointments.

- Okay.

- All right.

Okay.

I'll see it a little while.

- Okay.

All right.

- [Aristizabal] Nobody is quarterbacking the team in the community.

Nobody can tell you, the therapist, the case manager, the director, the coutt liaison, nobody in these agencies can tell you what's going on with the client.

I'm frustrated.

Sorry about that, but... (music) [Aristizabal] Recording our drug test results, we're already getting started on that.

Check this out.

What does it say?

- And that's positive also?

[Bailiff] All rise.

- [Simon] Good afternoon everyone.

- [Courtroom] Good afternoon.

- [Simon] Please be seated.

[Aristizabal] On page 64, Trevor Dolan.

- [Aristizabal] Trevor.

What's going on.

- [Dolan] Hey.

- [Aristizabal] So, Trevor also came back positive for alcohol.

There several matters right now that I need to manage better with Trevor.

So we're going to be a little more involved and have him talk to us more frequently.

- [Simon] So, you taken on a lot: school, work, but when you take on a lot there's also the potential that you're not able to satisfy, and comply with everything.

So we want you to be careful, and now you come in with a positive for alcohol.

So that's concerning.

So let me hear from you a little bit about what you think about all this.

- [Dolan] Well I can understand the challenges it would be, taking all this stuff in, but I did get offered by the guy I'm staying with to quit my job.

So I can easily substitute it with meetings, or everything that I need to do.

Me working at the winery.

I don't really see it as a temptation.

I don't drink on the job.

I, you know, I had a drink when I came home yesterday.

- [Simon] Yeah, that's not good.

It's jeopardizing your sobriety, and it's jeopardizing your status here in this program, and that's important, because, Trevor, if you were to go back to division, what's he facing?

- [Attorney] Judge he just he has over, one-two-three-four felony cases.

So we made an exception to allow you proceed in this program.

I have approximately 45 years state prison.

- [Simon] You understand that Trevor?

The next time you think about having that drink, or you think about not doing something that you're supposed to be doing, you have 45 years, where you're facing, if you went back to the regular division.

That's a long time in prison to jeopardize for, for alcohol.

[Simon] Okay.

[Dolan] Correct.

[Simon] Nobody wants that.

Okay?

- [Dolan] Thank you your honor.

[Narrator] The Jail Diversion Project processes nearly 600 felony and misdemeanor cases a year.

The recidivism rate for those that finish the program is less than 25%, but not everyone finishes.

- [Aristizabal] See how you can look picture perfect and then all of a sudden within a minute, everything could just collapse.

- Hey, Joe, how are you?

- I just got out of court, and Trevor tested positive for alcohol.

- [Narrator] Clients can slip, participation declines, or symptoms return to complicate their path to recovery.

- [Volpe] Go take care of this, all right.

- [Dolan] I need to reevaluate my life right now - [Volpe] Seriously, seriously - [Dolan] I need to really think.

It's not worth it.

[Sayfie] On one hand, I think there's a lot of potential when you see somebody young like Trevor Dolan, - [Volpe] Call me, all right?

- [Dolan] All right Justin [Sayfie] But he needs to wrap his brain around the fact that he's gonna have to contend with his issues for the rest of his life.

Young kids can be very scary, just because they're usually the toughest cases.

(sad music) [Aristizabal] Charlie was supposed to successfully complete 12 months of court supervision, today.

We were all going to be clapping.

We were all going to be happy about him completing this portion in his life, where the court oversees his treatment, and we learned some really difficult news.

Unfortunately Charlie was arrested on a new felony.

The team and I have been, you know, thinking about this, you're always trying to second guess, what could we have done?

What could he have done?

What could his family have done?

But you have to be resilient, you have to be tolerant, and understand that he came into the criminal justice system, and the mental health care system for a reason.

He needs help.

Our doors are open to Charlie.

If the State Attorney's Office allows us to work with Charlie, we definitely want to take them up on that.

[Dolan] I've come so far, and it takes some time for me to actually sit down and reflect.

You know, some people tell me to forget that past, let that stuff go, and I can't do that.

I never will.

I'll always remember what it took for me to get to where I'm at, and I'll always remember what people helped me, and aI'll always remember every little detail.

I will.

Good morning.

Good morning.

My last semester I got straight A's.

So this semester I'm trying to do the same thing.

- [Professor] Okay, so last class what did we talk about?

Social comparison theory Okay, and what did it say?

- [Dolan] It said by watching people, it can influence you.

- [Professor] Yes.

What else?

- [Dolan] Monkey see, Monkey do.

- [Professor]Monkey see, Monkey do.

Right?

- [Dolan] So by the time, February comes around, I'm a free man.

And I'll be a free man.

[Thompson] We was talking about stereotyping, stigmas, and how people make you feel concerning your mental illness.

Whoever been discriminated by?

I've been discriminated by.

- (group) I have.

- [Woman] So because we have a mental, disable (stumbles) -[Thompson] Well, mental illness -[Woman] in our mind, that makes us dumb?

- [Berry] That makes us look like - [Thompson] That's what the stigma is.

That's what they try to stigmatize you as.

But, what is in your recovery toolbox to help you deal with what you have?

- [Berry] You go by not discriminating against others, by not saying anything about it, by being humble about how another person should feel.

[Berry] When I graduated, I felt better.

I've been looking for my jobs, looking for jobs lately, I always take my daily routines here to keep myself nourished.

I come here, I get on a computer, I make sure I keep my keep myself conquering who I am.

I make sure I love what I do.

I love what I make in life.

My light bulb still stay up there.

(laughing) I keep my lightbulb up.

- [Narrator] With the Jail Diversion Project in its 19th year, Judge Leifman has decided, now is the time to try and expand JDP across the state.

[Leifman] I'm not aware of any legislation like this in the United States.

And so I'm hopeful if we get it done, this will not only be great for Florida, but it also be great for the country as a model.

The other priority is the building.

There's still a few minor details that we're working out with the county and city, but they're very, very close to getting those resolved.

So it is possible within the next five weeks, we'll actually have a shovel in the ground.

We're really hopeful on that.

(music) [Book] I'm very, very pleased and honored to have Judge Leifman with us today, to talk a little bit about mental health in our state.

[Leifman] Thank you.

Madam Chairman, members of the committee, thank you very much for the opportunity to be here to discuss these very important issues.

My name is Steve Leifman.

The statistics are stunning.

We now have the largest trained squad of CIT officers in the United States.

We have over 6500 officers trained.

The recidivism rate of our misdemeanor program, dropped from 72% to 20%, because of a warm handoff, and making sure people were getting treated.

- [Medina] Beunos Dias!

Good morning.

Come on in.

Hey, Stephon.

- [Berry] It's a nice Tuesday, and I'm happy I'm here today.

[Leifman] The program worked so well The State Attorney allowed us to expand it to our felony non-violent cases.

That program has seen recidivism drop to about 25%, and has saved the county so far 31,000 jail bed days, 84 years of jail bed days.

- [Aristizabal] This could be your next to final report.

Can you imagine that?

- [Dolan] No.

- I can't either.

- I remember, I still remember standing on that bench man.

- I still remember you in orange - Nearly in tears.

- [Aristizabal] Judge, we're really excited about Trevor's future.

All his randomized drug tests are coming back negative.

He actually just found work.

- [Wolfson] What kind of work?

- [Dolan] I'm a busboy, at a nice restaurant.

- Good.

- Yeah, the managers come up to me, they even gave me $25.

And they said this is for being most helpful.

- [Wolfson] I'll be happy to be here and give you a round of applause on your big day.

Okay.

Thanks, Trevor.

[Leifman] It has been so successful, that Dade County actually closed one of its three main jails, six years ago, at an actual cost savings of 12 million a year.

It's been closed for six years.

That's $72 million in real savings.

- [Frampton] Your honor, we would ask you to reset this case in division 55, the JDP program.

- [Gerstin] Good morning, your honor, Erica Gerstin assistant public defender.

I'll be representing Mr. Gonzales in mental health diversion.

- [Milian] You know, Mr. Gonzales and I go way back.

We've been through a lot of cases, a lot of violations, a lot of jail time, and we only want you to succeed.

-[Gonzalez] Yes I understand your honor, you've always been a fair judge to me.

- [Milian] Well, the state has also been very fair, because in a lot of jurisdictions they would have given you a severe amount of incarceration, instead I will grant the request to transfer the case over to Division 55.

- [Gonzalez] Thank you your honor, I really appreciate you.

- [Milian] Thank you.

[Leifman] So, what did my county do?

They were smart, they're committed, and they deserve all the credit.

Our mayor and our Commissioner, they've reinvested a lot of that money to building the first of its kind, one stop shop for the most acutely ill, that keep recycling through the community.

[Leifman] We know treatment works.

People with mental illnesses have better recovery rates than people with diabetes and heart disease.

The key is helping them access appropriate and good services.

- [Volpe] Trevor.

What's your plan looking like this morning?

- [Dolan] I have a appointment with my primary doctor at three o'clock.

- Okay.

Did they talk to your lawyer?

- Oh, he told me to call him today too.

- Call him.

- Right now?

- Call him.

[Leifman] I'm confident that if this bill becomes law, we will begin to decriminalize mental illness, we can apply a population health model to these individuals with these illnesses, rather than a criminal justice model.

- [Aristizabal] On page 28 and 29 Charlie Gonzalez.

- [Sayfie] Alright, so as much as the whole year obviously has been a bad year and a sad year, I want you to think of today as being a positive day.

- [Gonzalez] Yes, ma'am.

I have.

A very positive day.

- Each and every one of us is imperfect.

-[Medina] There's always that one person or that group of people or that place that really helps you understand and feels that welcome that somebody cares about you.

- [Berry] Marlys, you've been a big help ever since I benn got out of jail, and I thank you for that.

- [Medina] Thank you Stephon.

[Leifman] We will reduce homelessness, we will improve our public safety, we will save taxpayers money and equally important, we will allow people with mental illnesses to have lives and recovery with hope and opportunity.

Thank you very much for your time and consideration.

(music) [Aristizabal] Judge, if we could call please on page 26 and 34, Trevor Dolan.

[Wolfson] All right.

Hi Trevor.

- [Dolan] Hello your honor how are you?

Happy Valentine's Day.

[Simon] Happy Valentines Day.

Good afternoon, everyone.

- [Aristizabal] Judge it's a pleasure to report that Trevor's been engaged in treatment and mental health and substance abuse disorder services for 12 months now.

He's active in recovery.

He's been testing negative for all illicit drugs for over eight months now.

He's engaged in all treatment services, but in addition to that, he's maintaining full time employment.

He's going to school.

We're really, really happy with the progress he's made throughout the 12 months, I think his lawyer has seen amazing progress, his family.

We're really happy to advocate today, or to inform the court that he's done excellent in these last 12 months.

And today should be his final report.

- [Wolfson] Excellent, let me hear from the State.

- [Attorney] Your Honor, Mr. Dolan has definitely earned the State's announcement today as to F 17 one-four-seven-seven-five, and F 17 one-four-three-six-eight.

The State announce a null-pross (clapping) [Wolfson] Trevor, we just have a small certificate here, but we're so so proud of you.

Can I give you a hug?

- [Dolan] Yeah, I would like one.

- [Wolfson] That's awesome.

You did a great job.

You are a star.

You really are.

-Thank you.

- Congratulations.

Good luck - Thank you.

Thank you.

- [Aristizabal] This is awesome.

Keep it up.

I'll see you next week.

- [Dolan] Alright, next week here?

- [Aristizabal] Oh yeah, I'm gonna be on, you know, I'll call you, stop in the restaurant, or Better Way, somewhere.

We'll catch up with you.

- Okay.

[Dolan] I didn't think it'd be this strenuous, you know, with the appointments they put on me, and then my first mistake didn't help me either, when I got tested positive for alcohol, but at the end of the day, people are trying to help you.

Justin, Alejandro , they're really just trying to like, be somebody that maybe you never had in your past, or maybe you never had, period.

- [Volpe] Not everybody who graduates gets a a cupcake, we just happen to have cupcakes.

It's not like a thing we have planned.

(whispers) We planned it.

(laughing) [Volpe] Congrats Trevor [Dolan] It's good [Dolan] Miami Dade County Mental Health Court in the Circuit Court of the State of Florida 11th Judicial Circuit Certificate of Completion Awarded to Trevor Dolan.

That's me.

(music) - [Schwartz] In the next two months, we have many visitors coming.

Our first set of visitors are coming from New Jersey, we have visitors coming from Michigan.

We have visitors coming from somewhere else, I can't even remember.

So we should be proud, and you know what?

We know what our challenges are, but that's only working towards systems improvement, right?

We just want to get better and better.