>> this year, we have electronic mail test that's going into a number of congressional offices so pretty soon it will transform all the district offices at the same time. and what happens? we become more efficient, we get better data, we understand where how we can follow it and we become more accountable to our constituents. >> now a discussion on how to reduce the rates of arrests, prosecution, and incarceration of the mentally ill in the u.s. this was part of a forum hosted by the center of criminal law at new york university. it's 90 minutes. >> all right, thank you so much for being with us today, and good morning. this is our 10th annual conference for our center, where we explore important topics in criminal law, and today certainly meets that -- as a

result of what we learned from that conference, as well as a closed door round table that we had with prosecutors and re-entry experts from around the country, and additional research we did, we produced a report about recidivism to be able to help people return to their communities. many prosecutors and even some judges from around the country are using the report and have been inquiring about the things they can do to implement the recommendations. when we started working on these issues, it became clear to us that one obstacle for re-entry for so many people returning to the criminal justice system, is that they have mental health issues. so we wanted to convene another event specifically focussed on that, which is today, to look at these issues as a stand alone topic, and what we're trying to

do is figure out what are the best practices out there to help people who have mental health needs so they don't keep cycling in and out of their jails and pri prisons because the problems they are having are going unaddressed. just to keep you up to speed, so addition to that work on re-entry, and that report which is available online and we have it available if you like. we have continued to work on clemency, we are going to be putting out a report. and we hope that the report will serve as a reminder that that report was incomplete and we want to improve the mental health issue. we're also going to beclemency,

against mandatory minimums and the new york state clemency project, our student fellows have been representing people who have been serving sentences in new york state prison and seeking clemency from governor cuomo. we'll let you know how it goes. as part of its work, the students have been active, they have been meeting and interviewing their clients. they have assembled letters of support for those peats, they have reviewed clients records and drafted summaries. our fellows continue to do things -- we're also committed to worksing with families against mandatory minimums as a guide for compassionate release in the federal system and we have a comprehensive discussion on -- on the history of bail practices in new york. and how that history should shed

light on bail reform today. that report was recently presented to the new york criminal justice. working with other launch committee members working on policy launch. today our focus is certainly on mental health reforms and we're very, very lucky to have a wonderful group of people helping us. before heading up fjp miriam worked extensively on criminal

justice reform on many different capacities and i couldn't give you all of them or we would never start. she was the executive director of the citizen's commission on jail violence that was charged with investigating allegations of excessive force in l.a. county and then after that, she spent a year working inside the sheriff's department, as a special advisor, assisting in getting those reforms imp plentied. she had a 200-plus legal services organization that represented more than 20,000 children who were abused and neglected. she's testified before national and state legislative governmental and judicial bodies, she's authored more than 50 articles, she's lectured nationwide on a variety of issues and we're lucky enough to have her here today to get us started and to partner more generally on criminal justice reform. so please join me in giving

miriam quincy a very warm welcome. >> so thank you, rachel, i think my mother wrote a great introduction, so i'm glad you were able to read it all. so cornigood morning, everyone. let's try it one more time, good morning, everyone. so it is great to see all of you here, and i want to thank rachel, and i want to that the administrato administrator -- and my amazing team that made today possible. i know for those who -- you may have felt like you were in the middle of an email onslaught from all that you received from all the rest of them, but thank you all, and thank you to my team, so this has been a wonderful partnership with

rachel and courtney and we are pleased to be working with them on an issue that is so vitally important, i know to all of us. we're also looking for a continued partnership as we work together on other issues moving into the future, including one that rachel touched on, this question of how do we think about second chances for those who are serving sentences that no longer really comport with our sense of justice and fairness. so today, we're here because i think we can all agree that we have a problem. there are too many individuals in our country who are struggling with mental illness and not receiving the treatment they need. too many of them are homeless, too many of them are dealing with co-occurring substance abuse issues and too often, we see that they're vastly

overrepreseove overrepresented in our criminal justice system. we know that every year, there are around 2 million individuals who cycle in and out of our criminal justice system. and i think we can all agree that while jails have become the default mechanism, for addressing the struggles of those in our community, who are dealing with mental illness, that that is not simply the right place for us to be. it i think we can agree that the incarcerative response to mental illness is a failed response. and it's not one that any of us should be comfortable with. too often that cycle of incarceration does nothing to address the individuals needs and problems, it does nothing to help their family and loved ones. and most importantly, it does nothing to help our community or to further the interest of public safety. we know that individuals who struggle with mental illness,

pose no greater risk to our community, and in fact, they're more likely to be victims of crime than they are to be perpetrators of crime. we also know that those who suffer from mental illness who do pose a threat to the public are the exception rather than the rule and that they often fall through the cracks of our criminal justice system because it's overburdened and underresourced, both our justice system as well as our community health and mental health systems. so we're here today all of us as a community because sadly, our mental health crisis has become a criminal justice crisis. as we grapple with these issues, we have leaders that are here as a part of a conversation we are having and i think as they have

committed and realized, prosecutors can and should and need to be leaders in bringing about now thinking and collaborative reforms. our organization, fair and just prosecution brings together prosecutors like these, who are committed to a new vision for our justice system. to one that's grounded on the principles of fairness, equity and compassion. last month we had the privilege of gathering with judge liseman, and talking about the measures that judge liseman has put in place single handedly in his district. we're going to hear this morning from experts on how we got here, why this work is important, and how we learn sfrom models of

reform that are being used across the country. we're going to close our doors, roll up our sleeves and we're going to think about how we concretely craft changes in their jurisdictions so they can take back and run with, with criminal justice and mental health and law enforcement partners they have brought with them today. so again, i want to thank rachel and courtney and the center for the administration of criminal law for helping host such an important dialogue today. i want to thank the many partners, and national organizations, including vera, the council of state governments, the policy research associates, the brennan center. and others for joining us in trying to help bring technical assistance and new thinking to his leaders who are here, and i want to thank the aspiring

guests and experts who are going to share their insight. so in closing, i think this is a moment where we need to recognize that we need to stop living out the definition of again and expecting a different response. we know that new strategies are responsible. we'll hear about alternative approaches that work. and we need to come together to make them a reality. we owe that to our communities, we owe that to the struggles of individuals and families dealing with mental illness, and we also owe it to a system of justice that we care deeply about, and that can and should continue to have fairness, integrity and compassion as its northstar. it is my pleasure to turn the mantle over to judge steve leifman, who really i think is a

legend in the area of mental health reform. i could recite a long list of his accomplishments, and hopefully you will look at the materials on him and read about how much he has done in his accomplished past, but it does not do justice to the passion and energy and unending relentlessness that he brings to everything he does. i think those of us who joined him in miami came away with the notion that impossible and no are two words that are simply not in his lexicon. he has tremendous heart and passion. we are pleased to have you with was again today. >> thank you. [ applause ] >> good morning. it is really a pleasure to be here. i want to thank nyu and fair and just prosecution for not just

putting a panel and forum together, but taking steps necessary to let us do the structural changes so necessary, so once and for all, we can make the criminal justice system the last resort for people with serious mental health illnesses, not the entry point. i also want to thank you for being here, for your interest in the topic, so that we can look at better ways and ideas on how we can really turn around this embarrassing what we call system of care, which is put people who should not be in our system into the criminal justice system. we have an excellent panel today. they will bring a smart and unique perspective to this issue. they will help us understand how we got here, what is being done to address these issues, and where we need to go to finally end this horrible american tragedy. before i introduce the panel, i would like to give a few remarks.

a little bit of my perspective and how i see how we have gotten here. and maybe give us a little bit of window on how we should be and where we should be going to turn this around. when i was 17 years old i was an intern for a state legislator in miami. he had received a letter from then-editor of "the miami herald" from a local state hospital, they were not sure needed to be there. my age directly corresponds with institutionalization movement in this country, about 40 years ago. i was young and naive, grew up in a nice, middleclass family, did not see anything bad in my life. i was asked to go to state hospital to see what was going on with this young man. i walked into a house of horror.

i found the young man in a bed, in all four-point restraints. he was probably about 100 pounds overweight, probably because of the thorazine i imagine they were injecting him with. he was moaning and groaning. you could see he was living in his own personal hell, just in terrible pain and agony. i began to figure out what was going on with his situation. and as it turned out, he was not even psychotic, he was just autistic. which is part of the reason we shut down our terrible state hospital. while i was there there was a group of advocates that day. at the facility. they heard they were the representative from a legislator's office, which did not happen too often. and they asked me if i would take a tour of the facility. they brought me downstairs,

which i still remember to this day vividly. it looked like a dungeon where i found seven men lying naked in their own feces while a guard stood there with a hose washing them down like they were animals in the zoo. and you can see why we took the steps we did back then to shut down these hospitals. about 17 years later i was appointed to the bench. and the same horrors that i had seen in the state hospital were now occurring across the street from me in my own jail, except people were actually dying from not only the lack of care, that but the abuse going on in my own local jail. because when i became a judge i

had no idea i was actually becoming the gatekeeper to the largest psychiatric facility in my state. sadly, that is the miami-dade county jail. i'd like to say we are unique, but sadly we are not. while the united states is 5% of the world's population, we have 25% of the world's inmates. as we sit here this morning, 1 out of 104 adults in the united states are behind bars. one in 33 adults in the united states are under correctional supervision. since 1980, the number of people going to jail has tripled, and their sentences have increased by 166%. and as you peel back the onion, and you try to figure out, what in the heck has happened, much of this is due to untreated mental illness and substance abuse disorders. the fact that 40% of people with serious mental illnesses will come into contact with the

criminal justice system at some point in their life. it is a shameful american tragedy, and it's one that must and can be reversed. my personal journey as a judge into the mental health world began one morning when i was getting ready to go on the bench. at the time i was handling what we call a misdemeanor jail division. those are people that are still in custody, charged with low-level misdemeanor offenses. there are basically three kinds of people in those divisions. those with serious felonies not allowed out of custody, those who are too poor to bond out of custody, and those with mental illnesses who do not know how to get out of custody. at the time, in florida judges had no training on how to identify those with mental illnesses, what to do with individuals with serious mental illnesses. so we did what the person did before us without asking too

many questions. i was approached by the assistant state attorney and assistant public defender and they asked me if i would speak to a couple, whose son was in jail, a low-level offense, on a case i was about to hear. this lovely couple came into my chambers, they were very sophisticated, and horribly distraught. the mom was crying, the dad was shaking, they literally begged me to get their son help. they told me he was brilliant, had gone to harvard, had late onset schizophrenia, and he was now homeless and recycling through our system, and they just did not know what to do. this was in january of 2000. and i was relatively new at the time. when you are a new judge, you think you have more wisdom and a lot more power than you really do. i made the mistake of promising

helping for their son. i deal in logic. i knew that if someone had a heart attack, we had a health care system that would clearly take care of the individual. i assumed we had the same system in place for people with serious mental illnesses. i made one of the biggest mistakes in my career and promised them that i would get their son help. as i went back into the courtroom the mom stopped me and said, judge, respectfully, my son probably knows more about the mental health system than you do. and i looked at her. i was a little confused and i said, excuse me. she said, well, my son is the former head of psychiatry at jackson memorial hospital. this is our largest public hospital in the state of florida. he had a late onset. he started having ideations that god was speaking to him. and he needed to be closer to god.

he did not show up for work one morning, he cashed his life policy, he got on airplane to israel to be closer to god. in three weeks israeli deported him back to florida. he was now a homeless man in miami, florida, with a harvard degree. i went into the courtroom. and i called his case. and we started to have an amazing conversation. he was thoughtful, he was coherent, he was more respectful than the lawyers. and i am thinking to myself, wow, maybe there is something wrong with the folks. the guy seems to be pretty good to me. except when i looked at him, he looked like a homeless man who had not bathed in probably three months. he was not even in on a

statutory offense, some little ordinance violation, that many homeless people often get charged. he said, judge, look, i did not do what i was charged with. even if i did, i would've been out of jail two weeks ago. this is ridiculous that they are holding me here. and he kept insisting there was absolutely nothing wrong with him, he had no mental disorder, and if i would only release him he would go see a psychiatrist, he would get evaluated, and come back. i did not want to keep him in possession for more than a few minutes. i said, can i ask you a question? of course, your honor, anything. i said, i just don't understand one thing -- you keep insisting that there is nothing wrong with you, you have no mental health disorder, but if that is the case, why would a harvard-educated doctor be homeless, be in jail, and recycling through our system?

all of a sudden, he got a look on his face that i will not forget until the day i die. it was a look of sheer horror and terror. a look i could only imagine someone might have the moment before they die. he started rocking back and forth, cupping his ears, and he went into a full-blown psychotic episode. he started pointing to the back of the courtroom where his parents were standing and he started screaming. everything he was screamed in sixes. he started yelling, your honor, you have to have the couple removed. aren't those your parents? no, no, no, no. real parents. real parents real parents. holocaust, holocaust, holocaust.

they are from the cia, cia, cia, they came to kill me, kill me, kill me. the only thing i had been taught as a judge at that point in my career, if someone acts strange or bizarre, order a psychological evaluation. i did not even know what to do once the evaluation came back. i am not kidding. i immediately ordered an evaluation. four weeks go by, he's in possession. the evaluation says not only is he incompetent, he meets criteria, he is imminently dangerous to himself and others. i am thinking, this is great, i can get this guy help and fulfill the promise i made to his parents. the time i needed three evaluations the lawyers to stipulate or agree. then i ordered two more evaluations, another four weeks went by, he is in jail on possession. all three evaluations say the exact same thing, he is

incompetent to proceed and meets criteria for involuntary hospitalization. i immediately give the evaluations to the lawyers, they immediately agree. i begin to order him into involuntary hospitalization, having no idea where or how he would go. i looked down and noticed the assistant public defender has a little grin on her face. i will tell you as a former assistant public defender, the grin is a really bad sign. since i'm out of law school, many of you will appreciate this more than others. she then uttered those magic words that can set a judge off, she said, your honor, with all due respect. it is how they give us the finger without going to jail. [ laughter ] and i said, excuse me. she brought out a florida

opinion that had come out the month before. of course i hadn't read. it said, the county court judges which i am have no legal authority to involuntarily hospitalize anybody. that my only option was to release him back to the street to do exactly what he told me needed to be done 12 weeks earlier, and to have him go see a doctor, get evaluated, and restore his competency in the community, if that is what he needed. there is a footnote that says, we do not like this opinion and strongly urge the florida legislature to address this problem. that was in 1999. we were just starting to get around to it now. i will tell you, we do not become judges or professionals to be part of that kind of problem. because as much as i did not like it, i had to follow the law. i had to release them back to

the street, floridly psychotic. not only was i unable to fulfill the promise to his parents, i put him at risk, i put the community at risk. i probably put my job at risk, but i followed the law. i went back to my chambers that morning. and i got on the phone and i learned three valuable lessons. the first lesson i learned, we truly have a very serious mental health crisis in my community. it turns out we have one of the highest percentages of people with serious mental illness in the u.s., almost three times the national average. 197,000 adults and 55,000 children who live in my community live and suffer with very serious mental illnesses every day.

in florida we're 51st in per capita mental health funding. your james jails become the mental illness housing in the state. at the time we had 12 people with serious mental illnesses died during encounters with police. we were spending $150 million a year to let people live in conditions you would not let your dog live in. and that people in mental illnesses in most jails were staying four times to eight times longer than those without mental illness with the same charge. that was my first lesson. the second lesson i learned, it was not just a local problem, it's a state and national one as well. one called mental illness the silent epidemic of our times, but if you work in the criminal

justice system, there is absolutely nothing silent about this epidemic. we hear their screams and cries every single day. the third lesson, and may be more difficult lesson, our community mental health system in this country are fragmented, painfully underresourced, they do not reflect modern science, research and medicine, and they need to be overhauled, which is a perfect place for me to stop so that i can introduce this amazing panel, who will help us talk about how we will address the problems that i see on a daily basis, how are our law enforcement sees and tries to deal with it on a daily basis, and how hopefully, we can turn this problem around. i would like to begin by introducing first, dr. fred osher, who thought he was retiring this year. who's the dean of this issue. blessed to have him here today.

we are incredibly honored and blessed to have him here today. i do not know if you're considered the former or current director for the council of state government justice center. thank you for being here. i would also like to next introduce rebecca newstetter. the policing program director for the vera institute. thank you for being here. after rebecca, i want to introduce justin volpe. justin is one of the reasons if not the main reason for the successful jail diversion program we have in miami-dade county. i will let him talk and his story in a few minutes. finally, i want to introduce laura usher, who's representing nami, the national alliance for mental illness, sharing the perspective of family members. thank you for being here, i am honored to have you. i would like to start with rebecca. maybe you can give us a little bit of an overview of some of

the incarceration rates, what the picture looks like right now. >> absolutely. thank you. good morning, everyone. thank you for allowing me the opportunity to be here with you today. and the center on administration of criminal law here at nyu. it really is such a pleasure and honor to be in a room with so many friends and colleagues both new and old. i am struck a bit that it's friday the 13th and we're having this conversation. i am truly inspired to see so many faces in this room. i recognize it will take a lot of people to really start to take on these really challenging issues. and seeing you all here early on a friday morning, tells me that there's a lot of opportunity to move reform forward in very positive directions. i will ground our conversation

today in some of the statistics. miriam and judge leifman have started the conversation. too many people with mental illnesses are vastly overrepresented in the criminal justice system. or her opening remarks. we need to keep that truth with us as we start to think about these issues, vastly overrepresented. miriam mentioned 2 million people. i'm going to start a further back into thinking about police contact and police enforcement. where mentally ill people are quite vulnerable in interacting with great frequency with the people. we'll also then discuss a little bit about the incarceration rates and lengths of time those of mental illness spend in jails, and their relationship to officer-involved shootings and the burden on the public.

it's always fun to start a conversation talking about data. but it is so important, right,a nd we need to keep in mind they are human beings, many of whom are struggling and do not have advocates in the back of a courtroom like the gentleman judge leifman described. we really need to keep in mind, for many people, there are not advocates beyond some of the wonderful organizations like nami and others that do wonderful service making sure all are not forgotten, despite their challenges and advocating on behalf of themselves. the police truly our first responders. when we think about first response we often think about police responding to the scene of a crime, but take it back a little bit further, to when police actually become involved

in those situations, it usually starts with a 911 phone call. 911 data is one of the least explored, least understood area. there is not data to let us understand their volume. we know from the crude statistics, on a very conservative level, we receive over 250 million calls to 911 every year. i'm going to repeat that -- 250 million calls come in to 911 every single year. that is not too far away from a call a person. we also likely know that it's -- it's probably not evenly distributed. these calls. and that we have many people who are frequent callers. fred and others can talk about the amazing work that's been done in order to look at frequent users in james and prisons and our health care systems. unfortunately, we do not know

much about the calls in the frequency. we hope to, at some point very soon. and in a few cities where we have been able to dig into the data, we realize only about 25% of those calls made to 911 have anything to do with a crime at all. they are not emergency situations, they are people who are in crisis who have no one else to call. crisis is a bit subjective term, isn't it? again, we do not know nationally what this looks like, as far as police responding to mentally ill folks, but we have seen in a handful of cities pretty consistently, that about 10% of all of those 911 calls are directly related to the police responding to an individual who is in crisis and mentally ill. we can conservatively say that is about 25 million police

contacts where police are directly interacting to someone in the middle of a mentally ill crisis. that is a huge number of interactions. we also know there are about 12 million people arrested every single year, and far, far more people each year are involved in other kinds of enforcement activities that may result in a subsequent incarceration or detention. for instance, someone who was issued a summons or a citation, if they fail to appear in court or to pay fines, or to adhere to whatever the rules are, they may enter our jails and prisons even if they weren't arrested in the first place. now i'm thinking about our incourse rated settings as a whole. we know that about 13% of people

who are coming into our nation's prisons have a serious mental illness. it's twice that rate, over 25% -- about 26% of individuals who are coming into our james have a mental illness. and this is defined as serious mental illness at the time of entry. we know there are real problems with those of statistics in that not everyone receives the diagnosis, a lot of people are misdiagnosed. or undiagnosed. serious mental illness can be subjective, depending on the clinician and the diagnosis at hand. but, so, again, we can take these numbers as a conservative baseline. a quarter of those people entering our jails at least have a serious mental illness at the time that they're entering. these are things that we really need to take into account, and to think about how they are

interacting with the criminal justice system. and the work that we're doing in policing trying to look at the overreliance of enforcement at the hands of police and communities. we want to think about reducing mental illnesses in our criminal justice system, we have to reduce their likelihood of contact with police, because that interaction drives their relationship with prosecutors, with judges, with correction officials, probation, parole. none of these things happen in the criminal justice system unless a police officer makes a decision or is forced, because of a nondiscretionary statute of some sort, that they have to enforce and make an arrest. there is not very clear data on whether or not individuals spend a longer time in prison or jail if they have mental illness diagnoses.

some research suggests that this is highly correlated with longer detentions, but others have not found such incidences. i imagine judge leifman and other panelists have lots of indications that suggests people with mental illnesses can get lost in the system, particularly if they are challenge and advocating for themselves. i will share one quick anecdotal story. several years ago, i was working in a country that had a severe jail crowding problem. they brought us in to help understand that. one of the very first things we did, we conducted an analysis to see who had been in the jail the longest and why. and we immediately found one gentleman who had been in the jail for over 300 days, almost an entire year, and his

underlying charge was that he tried to sell an undercover police officer one pill of his own psychotropic medication. he got completely lost in the jail. didn't go to his court appearances. he just sat in the corner idly for almost a year, not speaking to anybody while at languishing in that facility. that's a major, major problem and how important it is to ensure that we are focused on our court systems and our jails and prisons, so that people do not get lost in the system, that we have strong partners inside jails and communities in order to advocate for folks. when we talk about the criminal justice system, we have to recognize racial disparities at the root cause of enforcement interactions as well as sentencing and prosecution decisions. it is bit unclear and there are not good data in order to explore this issue when it comes to mental illness.

what we do know from a clinical perspective, people of color are much less likely to be diagnosed, to have access to health care. nonminorities are incredibly likely to be unhealthy and to be in jails and prisons. we see some pretty stark disparities at the front end of system. some of that becomes muted as we go through the system a bit. but there are detection issues that make this a complicated question to explore. >> rebecca, can you give us any information or data you might have regarding police-involved shootings of people with serious mental illnesses? >> yeah, so -- thank you for that segue. that was next on my list to discuss. this is a really important,

pressing issue that's on our minds right now. especially in new york city, there's a recent issue in brooklyn. we see issues quite frequently of police interacting with folks with mental illnesses and there are really unfortunate and sometimes fatal outcomes that result. there is not national data collected on officer uses of force and fatalities that the federal government keeps. "the washington post" and a handful of other organizations and journalists across the country have started to collect this data through crowdsourcing mechanisms. and what we have learned is, typically in the year, there are 1000 people killed by the police. of that, it seems 25% of those individuals have some sort of mental illness crisis happening in that engagement.

it's an unfortunate decisintuna disproportionate contact. i think it is important we focused not exclusively on these 1000 cases. remember, there are literally hundreds of millions of interactions that the police are having with communities and mentally ill people every single year. we want to prevent fatalities and harm. we really have to focus on reducing the level of contact. >> all right, thank you very much. i want to come back to this a little bit later, because i think it is one of the unspoken issues involving police interactions we in miami had not even contemplated. we found that our police officers have extraordinarily high levels of ptsd themselves. and this has been one of the big issues that we have not addressed.

the woman that coordinates our crisis team policing, she gets 150 calls per month from police officers for their own personal mental health issues. and there was a study in a psychiatric journal about three months ago that indicated law enforcement officers get six to nine more times cortisol per day then nonlaw enforcement officers. i would like to turn to dr. osher a bit and have him talk about what trauma means to people, and talk a little bit about how we got to where we are. >> thank you. i appreciate the specificity of the first question. >> you are the psychiatrist on the panel. >> indeed. i want to make some general comments about how we got there. we certainly are aware of high rates of trauma. both in the arrest population and the arresters.

once one encounters that, there is a variety of changes one experiences at that point in time. we know that those can have a long and enduring impacts. we had an adverse childhood events study in massachusetts of 20,000 individuals that looked at kids who were abused or had traumatic events. followed them forward. saw indeed there were morphological changes in their brains. as well as behavioral problems associated with that. it is not a surprise. our frontline providers also experience that as a reaction to what they see, even though they maintain their professional posture, it is not without an insult to their system. your awareness of this, the crisis intervention team trainings that we'll hear a little bit about later on, have

to have a focus on trauma, its impact on the current interactions. but more importantly, our efforts should be focused on trauma-informed approaches that do not traumatize individuals who have long experiences. but i'd also like to comment on the stats that we're hearing and the vs. overrepresentation that rebecca alluded to and cited here. what the heck is that about? why are so many more people with serious mental illnesses in our jails than in our general population, four to eight times? i'd add a gender data point. women are twice as likely to have serious mental illness as their male counterparts. there are a variety of factors that contribute to this. understanding these factors may show us a way forward in how to mitigate the likelihood of folks with mental illness getting in custody.

but clearly, they get arrested more often. two main factors contributed to that. one, our war on drugs. when one looks at the rapid increase in our corrections population, it can be directly attributed to changes in policy as it relates to possession, sale, trafficking of drugs. many individuals we bring into our systems have substance abuse disorders. if you have a mental illness, you are three times more likely to have a substance abuse disorder. three-fourths have a cooccurring substance abuse disorder. it's important to recognize that as implications for treatment and return to our communities. secondly, as alluded to earlier, homelessness. we have about 2 million people this year that will not have an adequate roof over their head.

when you are homeless in our communities, you are a very visible member of the community. the laws and policies communities have invoked to deal with the homeless have often resulted in frequent arrests for relatively minor misdemeanor crimes of survival. in our homeless population, 45% of people meet criteria for serious mental illness. longer lengths of stay, while there's a lot of data. when we had an opportunity to look at rikers island, we found those individuals with mental illness stayed at pretrial and sentence, two times longer than those without. with a whole variety of issues that could contribute to that and i'm really interested in the dialogue with our prosecutors about how the factors that that might reflect. regardless of how you got there, they tend to get stuck there. for a variety of reasons.

that contributed to that. they recidivate more often. following them back into the community. a study done of 3000 probationers in california found that those with serious mental illness were no more likely to be arrested than their counterparts, but 1.5 times more likely to be revoked on technical violations. so, we understand what the conditions of release look like when you leave. they're very difficult to adhere to. keep your appointment, don't do drugs, those are tough conditions when you have a serious mental illness. we need to think about what our response to those should be, and do they need to include incarceration and segregation or not? fourth factor, inadequate access to care. i will not get too defensive about this. i will accept that the behavi behavioral system is broken. i stipulate that our criminal justice system is broken, too.

that, you know, we have had $5 billion taken out of our community mental health resource pool over several years. that's a hole that's real deep. it was not a robust response to begin with. and getting access to care is tough. there is a huge, uninsured population in our midst. we have this wonderful opportunity with the affordable care act to address 90% of those within our correctional system that meet our criteria based on income or lack thereof, to get a medicaid card. it means the world to your ability to respond to the individuals who come through that jail door. if you are not, i'd ask you to reconsider. if you have a ticket to the theater, does not mean you necessarily will like the show. what we have to acknowledge, there is a large science to service gap.

i know. there's a ton of research to learn what works for whom and under what circumstances. unfortunately, when you walk through the door, you might not get that evidence-based practice. the clinicians might not deliver with fidelity to the models out there. you are not always guaranteed. and how frustrating it must be to the court to have them discharged, released, not engaged, not helped in any way. it happens all too frequently. the last factor i want to highlight, because it was underplayed in statements, when individuals with mental illness get arrested for a lot of reasons people without mental illness do. they make bad decisions, hang out with the wrong people, are in the wrong place at the wrong time. we call that propensity for arrest -- criminogenic. there's a way to measure

crimonogenic risk factors. i highlight that here to highlight the point, not all people with mental illnesses are alike. different strengths, different weaknesses, different needs. that one of the things that we want to be concerned about, is, who among better rested population is more likely to have another crime? we can identify those individuals and we can provide them with a supported, coordinated, supervision and treatment response that mitigates the likelihood of their re-arrest. >> thank you. anything else you want to add? >> the frequent question i get -- thank you for the opportunity, judge. isn't it the case we just need more hospitals? if we just had more hospital beds, we would have fewer individuals in jails and prisons. that we are aware of this phenomenon of

deinstitutionalization. in the 1960s, we had 550,000 state beds. in our commune tigs. now we are below 50,000. often people talk about a stark reduction. they are no longer in hospitals, they are in jails. the story is not quite that simple. when researchers look at it, there are very different people these days that access state hospitals. in the old days, it was those individuals with chronic, severe, unremitting mental illnesses. in a state hospital they got treatment, housing, food, their needs met. our advances in our science allow allowed us to say, we do not all need to be here. let's bring them out. the concept is a sound one. the implementation of this

policy failed miserably. we never brought the resources into our community. as a result, we have a bunch of individuals who do not have their needs met. often ending up in the courts. our state hospitals are packed with restoration. 75% of state hospital beds are now filled with forensic clients. that was not the case 30 years ago. it was the opposite of that. it is clear that there is something that is broken. i am not suggesting the response should be, let's build 500,000 state hospital beds. we need more, that's for sure, but we also need to do better with the individuals we have in our community. judge leifman in miami-dade, the state of florida, they have done a great job taking this issue out of the jail and putting it back into the community. these are some of the factors that contribute to it. i think the responses are myriad. we will talk about that later. >> appreciate it.

justin, dr. osher mentioned engagement and how that is one of the critical missing pieces. on helping people navigate these very complex, fragmented systems of care. could you may be give us your perspective on how you saw things, how you see things, and the role that you now play on helping people navigate these very complex systems? >> well, thank you, judge. thank you, everybody, for inviting us here. i am a specialist, somebody who has lived experience. i'm a person who suffered from mental health and substance abuse issues. funny enough you mentioned friday the 13th. friday the 13th 11 year ago, i found myself on the ninth floor of the miami-dade jail in a pile of urinefeces and vomit.

it was hard. it was hard. i have been diagnosed six months before. sure enough my family, great supporters, found the jail diversion program. worked with judge leifman. they got me out of jail, i got back on my meds, started doing better, feeling better. they closed out my court case. the day they closed out my court case, they offered me a job working for the courts. i said, i am paranoid, delusional. they said, no, you will fit right in here. i mean, this is what people need. they need opportunities to recover, decent job opportunities. i went from having no insight on myself having a mental illness, to working with other people in the same situation. my job there is to assist people in the community and get them

the help that they need, i not only act as a supporter for people in our community, i also have the opportunity to help train a law enforcement and assist in sharing my personal recovery story. it has been a great journey. the one thing i can say is that there is no one size fits all like you guys talk about. everybody has different needs. this job -- you talked about the stress levels being high. judge, you were nice to say i'm a key member of the team. but we have a team. we have 20 employees who work tirelessly every day, taking calls and dealing with families. bad situations, all the time. we work in a great place where the weather is okay, so we can smile about it. i have served almost 1000 people the last ten years and work with them in the community. got them to rehab treatment

centers. you know, but we go out to eat with people, bring them coffee. this is what people need. what people do not need is another people telling them, you have a doctor's appointment, you have to be in court this day, you have to show up this week. you just give them a list of things that would take me a month to do, and they are dealing with so many issues on top of it. the peer specialist has the shared experience. i am honored to be a part of my community now. i have a family. i went from living in a bad neighborhood to owning a house now. things are good and can get better. what people need, they need opportunities. if you are going to overly incarcerate people, they will never be able to work again. how will we have people helping

other people? i had a brush with the law. but how are you going to give somebody a jail in recovery, people need money to pay their bills. so that's all i wanted to share. thank you. >> justin, if i could follow up a little bit, one of the things that we found that we did not anticipate, again, when you get involved in these issues, there's no manual and no blueprint, and most of the ridiculous preconceptions you have are just that, and they are not usually accurate. but one of the things that we found that we had not anticipated is that so many people with serious mental illnesses that get involved in the criminal justice system, by the time they get into the system with us, they seem to have clinical depression on top of their serious mental illness. people think if they just take their medication, they are going to be fine. they don't care about getting up in the morning anymore.

and so the first thing that almost has to be done is to re-establish relationships, because most of their relationships have been severed with families and friends. one of the key roles that peers play, and if you could expand on that, maybe you can talk a little bit about some of the individual stories in some of the high utilizers we've had that you've been it to make a substantial difference, and you can mention how you convince our county to give you a car. >> taking the bus in miami in july isn't too fun. you know, like i was saying, we go out with people. but to be diagnosed with a serious mental illness, and to be depressed on top of it, i remember when i got in the program, the doctor had basically told me, you are sick, you have an incurable disease, and you have to take this pill

for the rest of your life. i was 23 years old and i said, man, i just met this man ten minutes ago. that was depressing. and he told me i would never work again. i was like, man, i'm not a violent person, but i wasn't too happy with him, let me tell you. you know, to be put through that system time and time again, for years, for decades, and then to go home to a bad neighborhood or bad situation, you know, it doesn't give you much hope. and i think that's a lot that's missing. that we cannot fix things single-handedly, we all play a part, and i just play my part with my job. you know, my wife complains that i spend more money on homeless people than i do taking her out to eat, but you've got to give back. you've got to give back. i've got a little car, they

granted us a car in 2015. it is a little hybrid car, it gets us around. the county leased it to us at a very good deal. i am able to pick guys up, i take them to play basketball, we go to the park, you know, we do normal stuff. nobody wants to sit through groups the rest of their life. nobody wants to be lectured on how they are sick and they have to take medicine forever. we need to let people know that, people don't even believe that i have battled stuff myself, when i see them in the program. most of them think i am the police at this point. which is also disturbing to me, because i am paranoid, you know. but once i break that barrier down and we do normal stuff, it helps relate to the program and i have rapport with the judges in felony and misdemeanor courts. they pull me aside and they say,

take this kid to a meeting. our judges in miami are trying to go above and beyond, because they know if they put them back in jail, it's going to be the same thing over and over. what good is it going to do? they are going to do six more months, they will get out, and be right back where they started. there was a grant that i worked within the program to deal with, to serve the severely mentally ill. what a study by the florida state supreme court found is that 97 people in miami-dade county were spending most of the services, they narrowed it down to a little under 100 people, and these people spent about three-quarters of the year in and out of hospital or the jail. how much, $11 million? >> 97 people, primarily men, who over 5 years were arrested 2200 times. they spent 27,000 days in the

miami-dade county jail, 13,000 days at a psychiatric emergency room or crisis facility, and cost taxpayers minimally $13.7 million, with really no outcome. so we assigned justin to try to specifically deal with that population that were are highest utilizers. this is an economy with 3.5 million people. but 97 people were the highest utilizer's. >> but working with that, i learned a lot. that was before the car, so tracking down people on foot who like to walk a lot was very discouraging, but when i would meet up with them, there was one case that i worked very heavily with, that i would show up at his assisted living facility with coworkers at 7:30 in the morning to make sure he got his medication, even though i could not administer medication, we made sure that he took it.

and this went on for months. we took him out to eat, but bought him clothes, hygiene stuff, got him a haircut, little stuff like that. sadly, this is the same gentleman who has been in the state hospital for 11 months, for about five or six months, we saw a light in this guy, and people need that kind of care. people need that kind of chance. what if we had people doing that for the other 96 people? what if we had a team of six people doing that for everybody? you talk about budgets and more money for mental health, we just need more people that care. you know. >> thank you. justin's very humble about it, and we are very serious when we say the secret sauce of our success is really our peers. because one of the brain's most important functions is developing relationships with other human beings.

and when people lack the ability to have a relationship, they give up. what justin and the other peers have done is they have re-established relationships to help people become incentivized to want to begin to get better, and that is the critical first step of any success, which is a wonderful segue to turn it over and talk to lara about some of the challenges of family members, some of the myths that they see, and how do we break down some of these stigmas that justin is referring to? >> thank you, judge leifman. i think the question i was sort of grappling with as i was preparing for this was, what are sort of the values and what are the sort of big picture issues that nami members come to with us, not so much the issues and

the problems, but the aspirations that they have. i sort of stayed up pretty late last night trying to condense all that into a few minutes to talk about it, so i will try to be brief. but first, i guess i will just tell you a little bit about nami, it's national alliance on mental illness. we're the nation's largest grassroots organization of people living with mental illness and family members, and we have a network of local chapters and state organizations around the country. and we have a national helpline, one of our functions at our national office is a helpline, people call in, and they call us about a whole variety of issues from how do i get a psychiatrist, to where to find housing for my child, to what if my family member won't take their medication, etcetera. but the most common thing people call our helpline about, and this is thousands of times every

month, is a family member has been arrested, i don't know what to do. and the other reason that people call us -- well, there are many reasons, and i think they all have my phone number. the other reason that people call us is that they are really engaged in their community and they want to do something to make a difference. they want to know, how do i fix this system? and they are kind of at the other end of that crisis. it's either they resolve the crisis or they've come to peace with the fact that what's happened has happened and they want to fix it for somebody else. so they are calling and looking for solutions. what policy do i change? what law do i try to get my legislation to pass? who do i partner with in the community? those are the people whose values i want to try to talk about a little bit. i think that they come to us

looking for hope and looking for inclusion and looking for dignity. i think the entire panel has really laid out how much adversity people can face. especially when they come in contact with the justice system. but what justin has beautifully demonstrated is that hope is possible, and particularly in relationship and particularly when people care. and i think that there are countless other people around the country who are experiencing recovery and who are sharing that hope with each other, and i think it is really incumbent on us as community leaders, as advocates, as elected officials, that whenever we talk about the adversity and the struggle, that we also talk about the hope and that we lift up the individuals who are doing really well,

because it is very hard to demand change for something better if we don't have a clear vision of what we are wanting to see. if we don't really believe that it's possible, and i think a lot of nami members and a lot of family members have struggled with that for many years because their family situation does feel very hopeless. and when they see someone else's family, when they see a peer who is doing really well, it's like a light goes on, and they think, i don't know what's going to happen to my child or to my family member, but i know that things can get better for others. and that's incredibly motivating. so hope i think is the first thing, and that segues very beautifully into inclusion. there is an expression in the disability community, i think

just in general, when you are talking about any kind of change in the community, making sure that people who live with mentae in the community, making sure that people who live with mental illness, family members, people who have been directly impacted by the justice system are involved as speakers, as presenters, as policy advisors, as leaders, is the way to ensure you're really addressing the problems and the people that really matter. i think when people come to me and nami, they're looking to be empowered. a good friend of mine is living in recovery and he was incarcerated for several years in south carolina and he said one of the most powerful moments

in his recovery was when he came out of prison and he spoke at a cit training, his first cit training and now he's gone onto give hundreds of presentations. he talked about an officer who arrested him and did a really good job and he was really grateful. the officer came up to him in the room and said, hey, that was me you were talking about. he said he never thought he would have the opportunity to educate and train somebody that important in his community, and it was an incredible moment of feeling like he had the power to do something and to give back. people don't want to be victims. they don't want to be passive. they want to make a positive

change and they want to be part of a solution and they want to rally behind something positive. and i guess the last value that i want to talk about is dignity. last year i had the pleasure of interviewing a nami member named ray lay. ray is a veteran and he's also a peer who's been incarcerated. he works now as a peer specialist working with other veterans. i asked ray, what do you want people to know about how you should treat people who are living with mental illness. there was this pause and he said, well, the only way to treat somebody with mental illness is like a person. actually, that became the title of the article. it wasn't revolutionary, but it

kind of was. i'm thinking back to what judge lifeman said about the similarity in the way that people were treated in that hospital so many years ago and in the jail many years later, and the fact is people are often treated as if they're animals or as if they're monsters, as if they're incapable of making their own decisions. and that's just wrong. but even in the best of circumstances, people can sometimes be treated as statistics or a problem or an issue and not treated as human beings. so i think it's really important to know the scope of the problem. it's really important to have all the facts, but it's also important to know who you're

talking about and to be interacting with the people that you're talking about. and i guess the last thing i'll say about dignity is that another way that we can treat people with dignity is to avoid stereotypes and to particularly avoid stereotypes around violence. and i think this is a particularly important issue in the justice system where you do see a lot of people, you see a lot of very concerning behavior, you do see a lot of violence, and making the automatic connection between mental illness causing violence is very problematic. we know that most people with mental illness are not violent. we know that mental illness is

typically not the cause of the violence. someone with mental illness could be violent, but that doesn't necessarily mean that the mental illness is the cause of the criminal behavior. when you challenge that, i think a police officer has the opportunity, for example, to slow down and feel a little bit safer when they realize that someone with mental illness is not necessarily more violent. they feel safer in that interaction so they can slow down so they're more likely to resolve a situation safely. in the courtroom i think it gives someone who is afraid to disclose that they have a mental illness a little bit more freedom to disclose that to their attorney or to the judge so that in the best of circumstances maybe that person can get help rather than feel like they're at risk of being

viewed as a danger to society simply because they have a mental illness. i think that assumption of causal relationship around violence can play out in a variety of ways throughout the justice system. so i think it's just really important to keep that in mind, that we should have a conversation that's based around facts and compassion and not around stereotypes. >> thank you very much. justin, do you want to say something? >> i just wanted to talk a little bit about cit with miami. i had that same experience. the officer that arrested me, i got to train in cit. he looked at me and he said, i'm surprised you're still alive. i said i told you i wanted to go to the hospital, not jail that night. our cit program with the peers, it breaks down that barrier of stigma, because the police officers with relate to what they see a person come in

dressed normally, not homeless on the street, not disheveled and they can relate more. and then you have officers come up and share their own struggles. it's a really growing process. in miami the culture has changed a lot since i started my speaking career doing cit in 2008. the officers were very hardened and didn't want to think about recovery. and two weeks ago, the last ci, the class we had, we were kind mindfulness, meditation and yoga with the officers. [ laughter ] >> come to miami. [ laughter ] >> we talked a lot about some of the wonderful successes, but also some of the depressing aspects and the statistics surrounding these issues. i'd like to have dr. oesher talk

about the hope for the future, some of the good programs you see out there. then i'd like to wrap it up with some of the statistics of our successes, because i want you to leave on a note understanding this can be fixed. >> i appreciate the opportunity to end on a hopeful note, because i believe it is justified. we were talking with colleagues earlier about how we've been watching over the last 20 years this conversation evolve. it's really gotten to a point where it's quite nuanced, it's much more sophisticated and there are really a wholesale belief that cross-system collaboration can make a difference for folks. towards that end, i just wanted to highlight one national initiative, which is stepping up, which is sponsored jointly by the american psychiatric association foundation and two others. it was a call to action to

counties. the status quo was unacceptable. can you join us in passing resolutions that will address in a long-term way it will prevalence of mental illness within your jail settings. t to date, we have over 400 counties that have passed resolutions from miami to new york city to los angeles to johnson county, kansas, rural, urban, suburban and metropolitan, all focused on how can we end this tragedy in our midst and that they have a guide book with six questions they focus on. i just want to highlight the importance of data. four key metrics, don't bring them to the jail door if they don't need to be there, divert when possible. if in jail, keep their length of stay as short as possible. when they leave jail, assure they're connected to reasonable care. and while they're in the community, help them to avoid

recidivism. if we can focus on those four metrics -- and we've have a chance in conversations going forward to explicate ways those have positive outcomes. it has been heartening to see the cross collaboration, the coordinating councils, the way in which systems are coming together, conferences and dialogues and convenings like this that are really sort of putting a marker in the sand to say enough is enough. if you don't need to be there, if you're not a public safety risk, let's assure you get the help that you need to stay on your feet and move forward. in the waning periods of this conversation, i want to share that progress is being made. it isn't going to happen overnight. challenges are numerous. but the thoughtful conversation today is a part of the solution. judge? >> thank you. we've been at this for 18