Judge Liefman: Breaking the Cycle of Autism and Mental Illness in Criminal Justice

Welcome to Why Not Me the World? Podcast hosted by
Tony Mantor, broadcasting from Music City, USA, Nashville, Tennessee. Join
us as our guests tell us their stories. Some will
make you laugh, some will make you cry. Real life
people who will inspire and show that you are not
alone in this world. Hopefully you gain more awareness, acceptance,
and a better understanding for autism around the world. Hi,
I'm Tony Mantor. Welcome to Why Not Me the World?
Humanity over Handcuffs the Silent Crisis special event. Joining us
today is Stephen Leifman. He was first elected to the
eleventh Judicial Circuit Court of Florida in nineteen ninety five.
In two thousand and seven, he served as a special
Advisor on criminal justice and mental Health for the Supreme
Court of Florida. He has received several awards, including one
from the Pope. It is truly an honor to have
his honor with us today. Thanks for coming on.
Sure, thanks for having me.
Oh, it's my pleasure. You've been doing this for a
very long time. What led you to become an advocate
for people with mental health and autism?
Yeah? I have two stories, and the first one starts
when I was seventeen years old, I was an intern
for a state legislator here in Miami, and he had
received a letter from the then editor of the Miami
Herald about a young man who was in our local
state psychiatric hospital.
This is forty eight years ago. This is the height.
Of institutionalization, and it's the height of the abuses that
went on in state hospital at state hospitals. So I guess,
being the low guy in the totem pole, I got
asked to go to the state hospital to investigate. The
editor of the Miami Herald, who wrote the letter to
the legislator, raised concerns that there was abuse going on
at this facility and that this young man was being
abused as well. So I walked through the front doors
of a state psychiatric hospital forty eight years ago, and
it was a scene out of one flew over the
Cuckoo's Nest.
Funny in a way. I have a twenty one year
old son.
I would never allow him to go. I can't believe
they sent a seventeen year old kid.
Anyway.
I found Jonathan, the young man I was looking for.
He was in all four point restraints.
He was being injected with probably Thorisen, which was the
only antipsychotic at the time. He was screaming and moaning
and crying, and it was the scene out of a
horror movie. So I started to look at his records
this as well, before Hippo started to talk to the staff.
Although I will well candidly tell you i'd no idea
what I was looking at. I was seventeen and knew nothing.
But what I did find that shocked me. And when
I spoke to the staff, turns out that he was
not psychotic at all.
He was autistic.
Wow, that's amazing.
Here they were injecting and with antipsychotic medications.
What was the next step when this came to your attention.
While I was there, there was a group of advocates
touring the facility, and they found out that there was
a representative from a legislator's office, albeit a seventeen year
old who had no knowledge and no power, But they
insisted I take a tour of the facility. They brought
me downstairs to what looked like a dungeon. It was
like a jail cell, and I found these seven men
lying in their own theces while a guard. They were
naked and a guard stood there with a hose and
washed them down like they were animals in a zoop.
It was pretty traumatizing and pretty horrific. And while I
did not have much authority to help them, I was able,
with the help of the Senator to get the young
man out of the hospital and we got him placed
in a really wonderful, amazing adult living facility for other
young man with autism, and he was very well cared
for after that.
That's really good that you could help him. How did
that affect you?
It left a pretty indelible mark on me.
About seventeen years later, I got appointed to the bench,
and ironically, that hospital that I had been at seventeen
years earlier was closed. The jail across the street from
me started to become the psychiatric facility.
For our community.
So those fame folks there, type of folks that had
been the state hospital, they got released to the streets
without services, and many of them ended up in the
criminal justice system. In nineteen fifty five, they were about
maybe we estimated five thousand people with serious mental illnesses
in state hospitals. They were about excus me in jail.
There were about five hundred and fifty thousand at that
time in state hospitals. Today there's less than thirty thousand
civil psychiatric beds in this country. And last year we
had about one point five million people with serious mental
illnesses arrested in about two million incidents.
And so we never deinstitutionalized.
What we really did is we transferred responsibility from these
really terrible, crappy, horrible state hospitals to these really terrible,
crappy jails. And the problem is, in some ways it's
worse because now you end up with a criminal record,
and it's harder to get housing, and it's harder to
get employment.
Did you have any single case that stands out in
your mind You now look back on it and it
was the beginning of your journey of helping those with
autism and mental health.
When I got assigned to the criminal division, I ended
up having a case. This is the second part of
my story. I was getting ready to go on the
bench one morning and the assistant Public Offender and the
assistant State Attorney came to see me and they said
that there was a case that.
Was really mind boggling on my docket.
If I wouldn't mind, I speak to the defendant's parents
who were in court at the time. I was handling
what we call it jail misdemeanor division. These are people
on very low level charges who were still in custody.
There's kind of three types of folks in that division.
There are those with attached felonies.
Who are not allowed out of custody.
There are those that are too poor and they can
afford to bond out of custody. But mostly it's really
people with serious mental illnesses that don't know how to
get out of custody. The parents came in and they
started telling me this story about how their son was brilliant,
how he had gone to Harvard, how he had a
late onset of schizophrenia and he became homeless and started
cycling through.
The criminal justice system.
And as I started to go back into the courtroom,
they were pretty distraught. The mom was crying and the
dad was shaking, and they literally were begging me to
get their son help. Of course, being a new judge,
you think you have a lot more wisdom and a
lot more power than you do. I made a rookie
mistake and I promised them that I would get their
son help because I assumed there was a system in
place to treat them.
Sadly, there was not.
As I was going back back into the courtroom on
the mom stopped me and Judges, one more thing. I
need to tell you about my son. She said, not
only is he brilliant, but he probably knows more about
the mental health system than you did. And I was surprised,
and I looked at her, and I think she thought
the lawyers had told me the whole story. They had not,
And I said, excuse me, And she said, my son
is the former head of psychiatry at Jackson Memorial Hospital.
That was our is our largest public hospital in Florida.
And she said he didn't show up to work one
day and he was having religious ideations, so he cast
in his life insurance policy. He flew to Israel to
be closer to God, and within a few weeks he
was deported back because he was running around naked in
the Orthodox sections of Jerusalem and they were afraid for
his safety, so they sent him back to Miami, where
he became homeless and started cycling through our system.
What happened from there, I called this case. We had
a great conversation.
He ended up having a full blown psychotic episode in court,
screaming at the top of his lungs that his real
parents had died in the Holocaust and this couple sitting
in the back where from the CIA, and they'd come
to kill And after ordering a battery of evaluations and
adjudicating him incompetent to proceed, it turned out in Florida
that because it was only a misdemeanor, I literally had
no authority to get him help, and I had to
release them back to the street.
That was the beginning of my journey.
And during those two incidents, I think I became the forest.
Gump of mental health.
I started going through and trying to fix things the
best I could, given the wonderful moral authority I had.
To my great pleasant surprise, that has far exceeded all
of our expectations. We've been able to do some miracles
because I have an amazing staff and an amazing community
that has allowed me to make these structural changes that
were so necessary.
That's great that you have such supportive people around you.
Now I understand you are starting a crisis unit or
a facility along that line.
I'm already working on that.
It's not a crisis unit, but I appreciate you asking
about it because it's fascinating. It is the first of
its kind in the United States, possibly in the world.
It is a one stop shop for the most acutely
ill that continuously cycle between the most acute systems of
care such as homelessness, jail, and hospitalization, both primary and psychiatric.
It's the old competency restoration facility. It's one hundred and
eighty one thousand square feet and it's going to be
a mental health diversion facility for that population. Just back
up a little bit so your listeners understand the problem.
When community mental health was designed in the United States,
the most acutely ill we're still in psychiatric hospitals. Community
mental health was designed for people with moderate mental illnesses.
Not acute.
And so when we shut down the hospitals and we
went to the war on crime and the war on drugs,
and we went to sentencing guidelines and we massively cut
housing back in the eighties, this population got thrown into communities.
Into community mental health systems were never designed for them,
and so of course it didn't work.
And they didn't behave the way that we wanted them
to behave.
But instead of looking at how do we build a
better system for them. We instead started to incarcerate them,
and that's what happened.
So we are building this facility impact.
It's done to account for that population that never got
what they needed and understand that there's a smaller subset
of this population that are so sick, but they're using
up all the resources. We did one study with one
of our universities in Florida that looked at who the
highest users of criminal justice mental health services were. We
sent them the names of thirty three hundred people who
had come through our system, and they had access to
all the arrests in Florida and all of the civil
commitments in Florida, all the Medicaid, Medicare records.
That's very interesting. When you got the numbers back, what
did they tell you?
It narrowed it down to basically ninety seven people, primarily man,
primarily diagnosed with a severe psychotic disorder, primarily homeless, primarily
co occurring who Over a five year period, these ninety
seven people were arrested twenty two hundred times. They spent
twenty seven thousand days in the Dade County jail, thirteen
thousand days at a psychiatric facility cost taxpayers tens of
millions of dollars and we got nothing for it, and so.
This building is really for that subpopulation.
In fact, we've had this diversion program going on for
twenty four years, and I'll describe it a little bit
more in a minute, but we get a list every
day from my counting of who is eligible to be
diverted into the community, and because the lack of capacity,
we can't get to them all Over the last five years,
we just looked at the data because we're trying to
figure out who's going to go into this building. First,
we identified sixteen thousand people who over five years, they
were arrested thirty two thousand times. They spent one point
two million days.
In the Dade County jail.
That's thirty four hundred years, four hundred and fourteen million
dollars in taxpayer dollars waste, and we got nothing for it.
Those are just totally amazing numbers. What's this facility going
to look like when it's up and going.
So it's that type of population that this new facility
is for, and so the building will have a receiving facility,
a crisis stabilization unit, a short term residential facility, a
the activity program that will teach individuals self sufficiency, how
to manage your illness, a culinary supportive employment, vocational supportive
employment programs like computer labs. It will have a primary
health clinic, a dental clinic, an eye clinic, and a
pedietary clinic. They'll have tattoo removal because people do silly
things when they're psychotic is donned.
It has a courtroom.
In the facility so we can manage both criminal and
civil cases, and has something called the living room model,
so that for people who are high users, heavy users
of these services but they're not meeting civil commitment, they
can stay there voluntarily and we can engage them into
certain and it has two hundred and eight beds of housing.
They're not going to.
Be there permanently, so we'll probably Yiel to see quite
a few thousand a year, and there's a limited number
of these people. They just costing us the most because
they go through this deep end the most often.
If we can get our.
Arms around them, we can significantly change their trajectory and
we can break the cycle of incarceration, homelessness, and hospitalization.
That's great, My next question actually was this looks like
it's a facility where you're helping people. They're getting back
on their feet. Because of this, it should help the
legal system that they don't have to see these people
multiple times.
Correct, And that's the whole idea, is to make sure
that we're using the criminal system for people that need
to be in jail. Seventy percent of people in jail
today in the United States either have a serious mental illness,
a substance use.
Disorder, or both.
I always joke that we need specialty courts for the
thirty percent that don't, so that we can make sure
we have a therapeutic jewis prudence system for the seventy
percent that do, so we can make sure they get
treatment and stop cycling in and out of the system.
Now, as a judge, you have certain things that you
can do. Of course, you have certain limitations that you
have to adhere to. How do we get the empathy
from the DA side working with the defense lawyer so
they can help these people rather than being focused on
the number of convictions that they're able to get.
Yeah, and that's a wonderful question.
And I'm actually quite optimistic because it's changing and part
of the reason it's changing is I've been working very
closely over the last several years with something called the
Conference of Chief Justices and the Conference of State Court Administrators,
all the chief justices of all the state Supreme courts
in the United States and all the court administrators, and
they have made mental illness their primary.
Issue for the last four or five years. They are
having summits now, they are We have tours to Miami
quite regularly.
They come here, they learn about how to restructure their community.
They're going back and starting to put together plans on
how to do what we've done. Because we've been able
to reduce the arrest in Miami as a result of
our project from one hundred and eighteen thousand a year
to fifty three thousand. Our jail audit went from seventy
four hundred to forty four hundred.
We closed one of our three main.
Jails at an actual savings not caut shift of about
one hundred and sixty eight million dollars so far. And
one of the things that we hadn't anticipated. Our police
shootings have almost stopped here. And while it's possible that
race certainly can play a role in a police shooting.
It turns out that the reality maybe that many of
the police shootings have as much to do with PTSD
among law enforcement as anything.
They react as they get scared.
I've been talking with several different people. They actually go
into precinct's work and train with the police, so I'm
hoping that's going to help out a lot as well.
The woman that runs my training program for law enforcement,
we call it CI Crisis Intervention Team Policing. She gets
between one hundred and fifty and two hundred and fifty
calls a month from police officers for their own personal
mental health issues. It's tragic, but last year more officers
die from suicide than in the line of duty. We
set up a program to help get them treated when
they're having issues, and it has helped amazing and they've
become incredibly empathetic. And then as for the prosecutors, our
own prosecutors become a huge advocate because she's learned that
if you want to really improve public safety, we have
two choices. We can release this population without treatment, or
we can release them with treatment. You know what happens
when we release them without we might as well do
it the right way.
Get people what they need. Recovery is real.
Many mental illnesses have better recovery rates than heart disease
and diabetes. It's really just about making sure there's access, competent,
quality care for this population.
This sounds like you have just such a great model
to go by. You have the clinical side, you have
the prosecutors, the defense of course, the judges on the bench.
How do you get this from being a local to
a state to a nationwide process where it helps everyone
across the country.
And that's one of the things that we're doing with
the Conference of Chief Justices. So they've started off by
having four or five regional summits around the United States
where all the chiefs came and then.
It works so well most of them are.
Having statewide regional conferences and then it's breaking down specific
areas in their states.
Last year I probably put.
One hundred and fifty thousand miles on in the air
helping states do it because I want to focus my
time to help them set up similar programs in their
own states.
And it's exciting and it's a lot of work, but
we know that it's doable.
I think that you're correct, It certainly is very doable.
The hard work you're putting in is just outstanding. It
must just give you inner comfort knowing you're working on
a project that, when finished, will change so many lives
for the better.
I just feel very honored and blessed to have the
opportunity to do it. My court has been incredibly supportive
of me doing this work. My previous Chief Justice in
Florida helped me start this by signing me to cheer
a committee for the Supreme Court on this issue, and
actually for three years, pulling me off the bench and
assigning me to the Supreme Court to work on this
full time.
And it really gave me an opportunity to learn these
issues and figure out a way that we could do
it better.
But I have to tell you it's not rocket science.
A few weeks ago, a month ago, I got back
from Italy and I was part of a delegation that
was there to study the treest mental health system. I
was sponsored by the Help And Foundation, and they wanted
to see if it was a p that could be
replicated or scaled in the US. And the reason they
picked Trieste is because the World Health Organization has determined
that Trieste has the best mental health system in the world,
and after visiting it for a week, I.
Can unequivocally tell you it does.
They basically had no homeless They had few if any
people in jail with mental illnesses, few if any people
in their state psychiatric system, and few if any in
their friends existe.
It was really remarkable.
And they did it not through anything that should shock anybody.
They intervened early. If there was a break, the doctor
went to the house. They wrap around services, They get
you housing, They have a really great day activity program.
They don't define you by your illness.
They put you on a long term injectable medication, and
they make sure that you're incredibly well case managed and
you're working during the day so you have a life
and you have goals and hopes. Nothing that we all
all don't know works. We're so quick to try to
incarcerate before we treat that. It's absurd and it's expensive.
The United States spent almost a trillion with the T
dollars last year on costs related to incarceration. Could you
imagine what we could do with that kind of money
for mental health and autism.
You've had a tremendous amount of success in your area.
You're working on the new facility trying to work with
the legal system across the country. What are some of
the hurdles that has been presented to you that you
see that you've got to either go around or jump
over so that you can make a difference not just
in Miami but across the country as well.
It's a couple things.
The message is very important, but I'm finding equally important
as who delivers the message. And I think one of
the great things that's going on in the US right
now is the level of judges that have gotten involved.
Reality is that we're seen in Switzerland.
We don't have an ax to grind, we don't have
an interest or financial interest. By having judges become involved
in this issue has really opened a lot of doors.
It gets the right people to the table. I tell
people the best part of my job is that when
I invite people to a meeting, they come, and so
we need to use that moral authority, get people to
the table.
And explain to them what we're doing and why it works.
And look as cynical as I could be on days,
I do believe when you get a chance to meet
people one on one and you really get to talk
about these issues rationally instead of in the world we
live on where everything is argued.
Most people get this. They don't want to see.
People with mental illnesses in jail. They have loved ones,
they know people. They want to make sure that this
population is cared for, treated house and they know that
if you do that, we're going to get better outcomes,
and they're pining for it. They really want a system
that works, as opposed to trying to navigate one that doesn't.
Now, let's just take this in a slightly different direction.
I see where you got to meddle from the Pope.
Now that's pretty cool.
Yeah, that was pretty amazing. Talk about humbling and not
bad for a Jewish guy. It came as quite a shock,
quite a surprise. It was one of the most humbling
recognitions I've ever received. The Archbishop, unbeknownst to me, was
very familiar with my work and he nominated me, and
the Pope selected me, and I received this beautiful medal.
I was pretty stunning.
I think what I most appreciated about it was the level.
Of attention it has brought to this cause.
And I'm sure that's why they do it, because this
isn't one of those sexy issues with cute little kids.
People have a lot of stigma about this population. They're
afraid of this population. They think they're dangerous, they're not.
For him to do it meant a lot, but it
also meant a lot for the causm for the issue,
and for that I am eternally grateful, And I've ended
up having developing a wonderful friendship with our local archbishop
here in Florida. He actually had me give one of
the keynote beaches recently to all the new priests in Florida,
which was great, so we could talk to them about
mental health and what they can be doing when people
approach them.
Because I used to be on the.
Board of the American Psychiatric Association Foundation, and one of
the things that we learned is that by a wide,
far margin, more people go to their clergy for mental
health than they.
Do as psychiatrists.
And you want to make sure that the clergy are
well informed and they are well educated, and that they
don't try to convince people it's the devil or something
like that. The Gothic schurch's pretty sophisticated, but they really appreciated.
Learning about these issues. So it's been a wonderful experience.
With everything that you've done, the metal you received, the
facility you've been working on. What's next? What do you
see coming in the next three to five years that
can add to all your accomplishments. This new journey is
just underway. You've got so many things to do with
getting the lawyers, the judges, the police, getting everyone on
the same page to make a huge difference for all
these people that need help. So what's coming in the
next three to five years for you?
Now?
I'm actually optimistic.
I think many of us have been working and toiling
in this field for a good twenty years, and a
lot of groundwork and infrastructure has been made. And I
think the country, if we don't kill ourselves politically, I
think the country is this may be the last issue.
Everyone seems to agree on.
His poise to tackle this issue.
I think people, whether you're coming from the right because
you think it's ridiculous how much we're wasting in taxes,
or you come from the left and you think it's
horrible how we're treating this population, everybody agrees it's not
working and it needs and can be fixed through this
initiative with the Chief Justices through this other initiative, a
co chair of judges and psychiatrists, through the National Center
of State Courts and the Council of State Government and
the American Psychiatric Association Foundation, We've all partnered up and
we're really working to make the structural changes in each
community that are necessary to fix it. It's challenging because
every community is different. There's not a switch that you
can flip in Minneapolis or San Francisco or Mobile, Alabama.
Right They're all different.
You almost have to go community by community to fix it.
In our approach, and what I'm going to be doing
over the next three to five years with this initiative
is to go into the states first, get them to
buy in, show them how that they can save a
lot of money and save a lot of lives, and
then work towards making this structural change.
But it's going on.
There's examples all over the country right now that didn't
exist just five ten years ago. I remember when I
first started on the lecture circuit for the course, I'd
spend the first forty five minutes of my talk trying
to convince people there was a problem.
Now all they want to.
Know is how do they fix it and so we've
done a really good job and the media has done
a decent job of educating people about the problem. Now
we have to show people that it's really fixable and
these are the tools you need, and this is what
your system should look like. And while each community is different,
we all have the same essential elements that are necessary
to be able to get the desired outcomes everybody want.
It's just a matter of figuring out where you are
on that and what.
Changes you need to get you to the next level. Yeah.
In closing, what do you feel is important that the
listeners need to hear so they understand exactly what you're
trying to do across the country.
Yeah, and thank you for that.
One I would say is people with mental illnesses are
absolutely no more dangerous than the general population, and on medication,
they're much less dangerous than the general population. They are
much much more likely by a wide margin, to be
victims of violent crimes than perpetrators. And that recovery rates
for this population for many of these illnesses are actually
much better than heart disease and diabetes. That it's not
a lost cause that people can recovery, can get their
lives back.
What we need.
To do is create structures in the community that provide
them access, provide them quality of care, provide them an
opportunity to recover. We just don't do that, and really
bad American fashion, we punish them when it's not their fault.
And we need to set up a better system of
care so that people don't end up in the criminal
justice system that was never designed for people with these illnesses.
If you do that, you get much better outcomes, You
improve your public safety, you say tremendous tax dollars, and
you give people an opportunity to have a life of
hope and recovery. And I think that should be the
ultimate goal for every one of us in our society.
Why else do what we do. I'll tell you it's
been the honor of my life to be a judge
for almost thirty years. It afforded me an opportunity to
make change that I probably never could have done as
a legislator or someone in the executive branch. And it's
because in many ways we're first responders, like law enforcement.
We're on the front line seeing the population coming every day,
and we don't have to stand for something that's not working.
Our job is to do our best to administer justice,
and that doesn't mean just punishing people. It means figuring
out why they're in the system and what can we.
Do to keep them from ever coming back.
One of the things that most people don't know is
that trauma plays a significant role in triggering serious mental illness.
We know today that we didn't know just twenty years ago.
Said about ninety two percent of the women who are
in jail in prisons in the United States with serious
mental illnesses have horrific histories of trauma, mostly sexual abuse,
and that's sexual abuse ocures when they're quite young five
six seven years old. And about seventy five percent of
men who are in jail in prison with serious mental
illnesses also have horrific histories with trauma. Sometimes it's sexual abuse,
more likely they've been victims of long term domestic violence,
or they've been witnesses to violent crimes like a soldier
might see in combat. We know today that trauma is
not an emotional response, but physiological. Without getting people treated
after they've gone through this kind of trauma, the chances
are by a huge percentage that they're going to end
up with a substance use disorder and environ mental health disorder,
and we need to get ahead of that. We need
to be using tools to assess kids in elementary school
to see if they have histories of trauma, and if
they do, make sure we're getting them treated quickly. Because
if we had done that here, even in Miami we
weren't aware of trauma when we started, we would have
kept two three generations from ever coming into the criminal
justice system at all. And we got to get smarter
about it. We have to do what Triste is doing
and get ahead of this and get people treated, just
like we want to do with any other illness. We
don't want to wait for your skin cancer to metastasize
and get you so sick that you have to go
to an intensive cancer facility. We want to get it
at the beginning because it's going to be easier, cheaper,
and we're going to get much better outcomes. Mental unness
is no different. I would leave your listeners with that.
We need to get ahead of this, and if we do,
we'll get much better outcomes. We'll save a lot of money,
and we will improve our public safety and people won't
have to live a life cycling in and out of
acute systems like homelessness, jail, prison, and hospitalization.
Absolutely, I totally agree. This has been a great conversation,
great information. It's been a pleasure having you on. I
really appreciate you taking the time.
Well, I appreciate you having me.
You have such a nice voice for your podcast, it's great,
and your tone and your questions are just perfect. I'm
honored to be here today and thank you for inviting me.
The pleasure is online. Thanks again, thanks for taking the
time out of your busy schedule to listen to our
show today.
If we hope that.
You enjoyed it as much as we enjoyed bringing it
to you. If you know anyone that would like to
tell us their story, send them to tonymantor dot com
contact then they can give us their information so one
day they may be a guest on our show. One
more thing we ask tell everyone everywhere about why not me?
The world, the conversations we're having, and the inspiration our
guests give to everyone everywhere that you are not alone
in this world.