tell terrified they really were. night at 8:00 eastern on c-span. connect with c-span to personalize the information you get from us. good luck website and sign up -- go to our website and sign up to get the program guide gives you the most updated primetime schedule. word for word gives you the most interesting daily highlights. the book tv newsletter is an insiders look at upcoming authors and book festivals. the american history tv weekly newsletter gives you the upcoming programming exploring our nation's past. sign-up today. next, a look at mental illness and the criminal justice system. analysts discuss how those with mental health needs are treated in the courts and prisons.

it was hosted at new york university by the center for the administration of criminal law. rachel: thank you so much for being with us today. good morning. this is our 10th annual conference for our center, where we explore important topics in criminal law. today certainly meets that definition. this is a spin off from last year's conference on reentry. what we learned from that, with prosecutors and reentry experts from around the country and additional research, we printed a report on prosecutors that care about recidivism should be doing to help people reenter their communities. recidivism se doing to help people reenter their communities. year'ssult of last conference in that report, prosecutors and judges across the country are using the report and inquiring about what they can do to implement

recommendations. when we started working on these issues it became clear to us one obstacle for reentry for many, is that they have mental health issues. we wanted to convene another event focused specifically on that, which is today's. to look at that as a standalone topic. we are trying to figure out, what are the best practices for diverting those with mental health needs from the criminal justice system, so they do not keep cycling in and out of our judges and -- jails and prisons. i want to give you a quick update on what our center has done. in addition to that work on availabled the report online -- we can get you copies if you like, we have continued to work on clemency. we will put out a report highlighting the people, many

people, who are worthy of getting clemency, but did not, clemencysident obama's initiative. we hope the report will serve as a reminder it was incomplete and offer lessons and recommendations for improving the clemency process, to focus on those people left behind. also focus on state clemency as another avenue of relief for people in prison, working with the national association of criminal defense lawyers, and the new york state clemency project. have beent fellows representing people for serving in new york state prisons and seeking clemency from governor cuomo. we will let you know how it goes. students have been active, meeting and interviewing clients, they have interviewed trial counsel, family members, letters of support for those petitions. they have reviewed client

records and drafted clemency. they do amazing work on behalf of those who need it. about working on a guide compassionate release in the federal system. we held a successful conference in february and also issued a terrific report, on the history of bail practices in new york, and how that history should shed light on bail reform today. presented tontly the criminal agency and mayors office. -- mayor's office. directorng executive is also serving as a member of the brooklyn da's justice 2020 initiative, working on policy recommendations. we have been busy on other things, but today our focus is on mental health reforms, and we

are lucky to have a wonderful group of people representing us. among that group, marion krinsky. director of fair and just prosecution, and amazing partner. up fjp, sheng worked extensively on criminal justice reform in many different capacities. i could not give you all of them, or we would never start. she was executive director for excepted force by the sheriff's deputies in a lake county.- in l.a. she also worked as a special advisor assisting getting those reforms implemented. she spent five years at the children's law center of los angeles, a 200 plus person legal

services representation, which help to who were abused and neglected. off third more than 50 articles, lectured nationwide on a variety of issues. we are lucky enough to have her with us today to get us started and partner with us on criminal justice reform. please join me in giving her a warm welcome. [applause] >> thank you, rachel. that was a great introduction. i am glad you were able to read it all. good morning everyone. i will try it once again. good morning. it is great to see all of you here. i want to thank rachel, courtney from the center, for the administration of criminal law, for this incredible partnership, and my amazing team who made

today possible. i know for those participating as speakers and those who have traveled to be here, you probably felt you were in the middle of an an email onslaught .ith all you received thank you all and thank you to my team. this has been a wonderful partnership with rachel and courtney. we need to be working with them on an issue that is so vitally important. we are looking forward to continued partnership as we work together on other issues moving into the future, including one rachel touched on, this question of, how do we think about second chances for those serving sentences that no longer comport with our sentences of justice and fairness? today we are here because i

think we can all agree that we have a problem. there are too many individuals in our country struggling with mental illness and not receiving the treatment they need. homeless, dealing with co-occurring substance abuse issues. often we see they are vastly underrepresented in our criminal justice system. every year there are around 2 million individuals who cycle in and out of our criminal justice system. agree, thatan all wild jails have become the default mechanism for addressing the struggles of those in our community dealing with mental not the that is simply right place for us to be. i think we can agree the incarcerated response to mental andess is a failed response

it is not one any of us should become triple with. -- any bus should be comfortable with. -- any of o us should become triple with. -- comfortable with. we know that individuals with mental illness pose no greater risk to our community. in fact, they are more likely to be vick comes than perpetrators -- they are more likely to be victims than perpetrators. fall through the crack of our criminal justice system because it is overburdened and under resourced. as well as system our community mental health system. we are here is a community because, sadly, our mental

health crisis has become a criminal justice crisis. as we grapple with these issues we have with us prosecutors from a dozen offices around the country, leaders who have taken time from their busy schedules to join us today. many are here to join the conversation we're having. think they have committed and realized prosecutors can and should and need to be leaders in bringing about new thinking and collaborative reform. our organization, fair and just prosecution, brings together prosecutors like of these, committed to a new vision. one grounded on principles of fairness, equity, compassion. montht of that work, last to see the incredible

models judge life min -- judge leifman put together in miami. we continue the conversation and try to work toward concrete steps of implementation. we will hear from experts on how we got here, why this work is important, and how we learn from models of reform that have played out in other parts of the country. with the group of criminal justice leaders, we will roll up our sleeves and how we concretely craft changes in their jurisdiction that they can take back and run with. with the partners they have brought with them today. rachel andhank 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 thenizations, including council of state governments, ,he policy retreats associates joining us inr bringing technical assistance and new thinking to these leaders who are here. and i want to thank the inspiring guest and expert -- guests and experts. we need to stop living out the definition of insanity. we cannot keep doing the same failed things over and over again and expecting a different response. we will hear about alternative approaches that work. we need to come together to make them a reality. the communities, the struggles of individuals and

families dealing with mental to ass, and we also owe it system of justice we care deeply about, and that can and should have fairness, integrity and compassion as its northstar. it is my pleasure to turn the mantle over to steve leifman, who i think is a legend in the area of mental health reform. i could recite a list of his accomplishments, and hopefully you will look on the materials on him and read about how much he has done and is accomplished past, but it does not do justice energy andion and unending relentlessness he brings to everything he does. i think those of us who joined thein miami came away with notion that impossible and no

are words not in his lexicon. he has tremendous heart and passion. we are pleased to have you with us today. [applause] judge leifman: good morning. it is a pleasure to be here. i want to thank nyu and fair and just prosecution for not just putting a panel of reform together, but taking steps necessary to let us do structural changes so necessary, so once and for all, we can make the criminal justice system the last resort for people with mental health illnesses, not the entry point. i want to thank you for being here, your interest in the topic, so we can look at better ways and ideas to 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 introduce the panel, i would like to give a few remarks. a bit of my perspective and how i see how we have gotten here. maybe give us a window on how we should be going to turn this around. i was ans 17 years old intern for a state legislator in miami. fromd received a letter the editor of the miami herald from a local state hospital, they were not sure needed to be there.

my age corresponds with institutionalization in this country, about 40 years ago. grew up in a nice, middle-class family, did not see anything nice -- anything bad in my life/ -- life. i walked into a house of horror. bed,nd the young man in a in restraints. he was probably about 100 pounds overweight, probably because of the thorazine they were injecting him with. he was moaning and groaning. you could see he was living in his own personal hell, justin terrible pain and agony -- just in terrible pain and agony. 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. they heard they were the representative from a legislator's office, which did not happen too often. they asked me if i would take a tour of the facility. they brought me downstairs, which i still remember vividly. dungeon where i found seven men lying naked in guardown feces while a stood there washing them with a hose like they were animals in the zoo. you can see why we took the steps we did back then to shut down these hospitals. later i wasrs appointed to the bench.

the same horrors 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 the abuse going on in my own local jail. a judge i had no idea i was becoming the gatekeeper to the largest psychiatric facility in my state. sadly, that is the miami-dade county jail. i would like to say we were unique, but sadly, we were not. while the united states is 5% of the world's population, we have 25% of the world's inmates. 1/104 adults in the united states are behind bars. one in 33 adults are under correctional supervision.

since 1980, the number of people going to jail has tripled, and their sentences have increased by 166%. tryou peel back the onion, to figure out, what in the heck has happened, much of this is untreated mental illness and substance abuse disorders. many with mental illnesses will come into contact with the criminal justice system at some point in their life. it is a shameful american tragedy, one that must and can be reversed. 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 still in custody, charged with low-level misdemeanor offenses. there are three kinds of people in those divisions.

those with serious felonies not allowed out of custody, those of poor to bond out custody, and those with mental illnesses who do not know how to get out of custody. at the time, florida judges had no training on how to identify those with mental illnesses, what to do with them. dide did what the person before us without asking too many questions. i was approached by the assistant state attorney and public defender and they asked if i would speak to a couple a lowson was in jail, level offense, on a case i was about to hear. this lovely couple came into my chambers, they were very sophisticated, and horribly distraught. shaking,rying, dad was they begged me to get their son help. they told me he was brilliant, had gone to harvard, had late

onset schizophrenia, and was now homeless and recycling through our system, and they just did not know what to do. this was in january of 2000. i was relatively new at the time. when you are a new judge you think you have more wisdom and power than you really do. i made the mistake of promising them i would get their son help. deal in logic -- i logic. aknew that if someone had heart attack, we had a health care system that would take care of the individual. i assumed we had the same system for people with mental illness. i made one of the biggest mistakes in my career and promised to them i would get their son help. as i went back into the courtroom the mom stopped me and myd, judge, respectfully, son probably knows more about the mental health system then you do.

i was confused. 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 it be a shin's god wasideations that speaking to him. he did not show up for work, cashed his life policy, moved to israel to be closer to god. in three weeks is really -- israeli deported him back to florida. and he was now a homeless man in florida with a harvard degree. i followed his case. we had an amazing conversation. he was thoughtful, coherent, more respectful than the lawyers.

[laughter] judge leifman: i am thinking to myself, wow, maybe there is something wrong with the folks. except when i looked at him, he looked like a homeless man who had not bathed in three months. he was not in on a statutory offense, some little ordinance violation, that many homeless people often get charged. he said, judge, i did not do what i was charged with. even if i did, i would've been out of jail two weeks ago. it is ridiculous they are holding me here. he kept insisting there was nothing wrong with him, he had no mental disorder, and if i would only release him he would see a psychiatrist, get evaluated, and come back. keep him innt to

jail more than a few minutes. i said, can i ask you a question? of course, your honor, anything. i do not understand one thing. you keep insisting 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 i got day i die. a look of sheer horror and terror. what i imagine someone might feel the moment before they died. -- die. he started rocking back and went, cupping his ears, into a full-blown psychotic episode. backarted pointing to the

of the courtroom where his parents were standing and he started screaming. your honor,elling, you have to have the couple removed. aren't those your parents? no. 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, if someone acts strange or bizarre, order a psychological evaluation. i did not even know what to do once the evaluation came back. i have not kidding -- i am not kidding. 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. two more evaluation, another four weeks went by, he is in jail on possession. all three evaluation say the same thing, he is incompetent to proceed and meets criteria for involuntary hospitalization. i give that to the lawyers. they immediately agree. i begin to order him into involuntary hospitalization, not knowing how or where 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. [laughter] judge leifman: many of you will

appreciate this more than others. those magic words that can set a judge off, she said, your honor, -- it isdue respect how they give us the finger without going to jail -- [laughter] judge leifman: i said, excuse me. out a florida opinion that had come out the month before. said, the county court judges have no legal authority to involuntarily hospitalize anybody. 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. as much as i did not like it, i had to follow the law. i had to release them back to the street, florid leave -- floridly psychotic. not only was i unable to fulfill the promise to his parents, i put him at risk, the community at risk. i probably put my job at risk, but i followed the law. i went back to my chambers that morning. i got on the phone and learned three valuable lessons. we first lesson i learned,

truly have a very serious mental health crisis in my community. it turns out we have one of the highest percentages of people in the u.s.,llness three times the national average. 55,000 adults and children in my community live and suffer mental illnesses every day. we're 51st in per capita mental health funding. jails become mental illness housing in the state. 12 peoplee we had with serious mental illnesses died during encounters with police. $150 million ag people live in conditions you would not let your dog live in. and people in mental illnesses

in jails were staying four to eight times longer than those without mental illness with the same charge. problem,t just a local a 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 nothing silent about this epidemic. we hear their screams and cries every single day. the third and may be more difficult lesson, our community mental health system in this fragmented, painfully under resourced, 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 i can introduce this amazing panel, who will help us talk about how we will address the problems i see on a daily basis,

how are our law enforcement sees and deals with it on a daily basis, and how hopefully, we can turn this problem around. i would like to begin by , whoducing dr. fred osher thought he was retiring this year. we are incredibly honored to have him here today. i do not know if you're considered the former or current ofector for the council state government justice center. thank you for being here. i would also like to next ewstetter.rebecca n thank you for being here. after rebecca, justin. iftin is one of the reasons not the main reason for the successful jail diversion program we have in miami-dade county.

i will let him talk about his story in a few minutes. finally, i want to introduce laura usher, representing the national alliance for mental sharing the perspective of family members. thank you for being here, i am honored to have you. i would like to start with rebecca. a little can give us bit of an overview of some of the incarceration rates, what the picture looks like right now. rebecca: 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 is such a pleasure and honor to be in a room with so many friends and colleagues both the new and old. ism struck a bit that it friday the 13th and we're having this conversation.

i am truly inspired to see so many faces in this room. towill take a lot of people really start to take on these challenging issues. seeing the here early on a isday morning tells me there a lot of opportunity to move reform forward in positive directions. i will ground our conversation in statistics. havem and judge leifman started the conversation. too many people with mental illnesses are vastly overrepresented in the criminal justice system. we need to keep that truth with us as we think about these issues, vastly overrepresented. miriam mentioned 2 million people to read i will start us further back into thinking about police contact and police

enforcement, were mentally ill people are interacting with great frequency with the police. the incarceration thoseand lengths of time of mental illness spend in jails. relationship with officer-involved shootings and the burden on the public. it is find the start of conversation talking about data, but it is so important, we need to keep in mind they are human beings, many of whom are struggling and do not have advocate in the back of the courtroom like the gentleman judge leifman described. mind, for keep in many people, there are not advocates beyond organizations like nami and others that do wonder full 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 think about police responding to the scene of a crime, but take it back a little police becomeen involved in a situation, it usually starts with a 911 phone call. 911 data is one of the least involved 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. in to 911n calls, every single year.

that is not too far away from a call a person. it is probably not evenly distributed. we have many people who are frequent callers. others can talk about the amazing work that has been done in order to look at frequent users in jails and prisons, and our health care systems. we do not know much about the calls in the frequency. we hope to, at some point very soon. we haveew cities where been able to dig into the data, we realize only 25% of those made to 911 have anything to do with a crime at all. they are not emergency situations, they are people in crisis who have no one else to call. crisis is a 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 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 25 million police contacts, responding 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 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 a in court or pay fines, or 80 here to whatever the rules are -- or adhere to whatever the rules are, they may go to jail in even if they were not arrested in the first place. of people coming into our nation's prisons have a serious mental illness. 26% of individuals coming into our jails have a mental illness. as a serioused 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. serious mental illness can be

subjective, depending on the clinician and the diagnosis at hand. we can take those numbers as a conservative baseline. jails those entering our have a serious mental illness at the time they are entering. these are things we need to take , and think about how they are interacting with the criminal justice system. we are looking at the overreliance of enforcement at the hands of police and communities. we want to think about reducing mental illnesses, we have to reduce their likelihood of contact with police, because that interaction drives their relationship with prosecutors, judges, correction officials, probation, parole.

none of these things happen 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 clear data on individuals spend a longer time in prison or jail if they have mental illness diagnoses. some research suggests that this but othersorrelated, have not found such incidences. i imagine judge leifman and have information that suggests people with mental illnesses can get lost in the system, particularly if they are challenged and advocating for themselves. i will share one quick anecdotal story. i was working in the county with

a severe jail crowding problem. one of the very first things we analysis toed an see who had been in the jail the longest and why. we immediately found one gentleman who had been in the jail over 300 days, almost an was thatar, his charge he tried to sell an undercover police officer one pill of his psychotropicic -- medication. he just sat in the corner idly for almost a year, not speaking to anybody while at languishing in that facility. we aremportant to ensure focused on our court system in jails and prisons, that people do not get lost in the system,

that we have strong partners inside jails and communities to advocate for folks. recognize racial at the root cause of enforcement interaction as well as sentencing and prosecution decisions. nots unclear and there are good data to explore this issue when it comes to mental illness. what we know from a clinical people of color are much less likely to be diagnosed, to have access to health care. nonminorities are incredibly likely to be unhealthy in jails and prisons. we see stark disparities at the front end of this. muted as we becomes go through the system a bit. 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 shooting of people with serious mental illnesses? rebecca: thank you for that segue, that was next on my list to discuss. this is an important, pressing issue, on our minds right now. especially in new york city, there was a recent issue in brooklyn. we see issues quite frequently of police and directing with folks with mental illnesses. there are unfortunate and 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

have started to collect the data through crowdsourcing mechanisms. we have learned, typically in the year, there are 1000 people killed by the police. of that, 25% of those individuals have some sort of mental illness crisis happening in that engagement. it is a disproportionate contact. i think it is important we focused not exclusively on these 1000 cases. remember, there are literally hundreds of millions of interactions the police are having with communities and mentally ill people every single year. we want to prevent fatalities and harm. we have to focus on reducing the level of contact. judge leifman: thank you very

much. i want to come back to this later, because i think it is one of the unspoken issues involving police interactions we in miami had not contemplated. we found our police officers have extraordinarily high levels of ptsd themselves. this has been one of the big issues we have not addressed. one of the women that coordinates are crisis team policing gets 150 calls per month from police officers for their own personal mental health issues. study in a psychiatric journal three months ago that indicated law enforcement officers get six to nine more times cortisol per day then nonenforcement officers. i would like to turn to dr. what a bit and talk about trauma means to people, and talk

a little bit about how we got to where we are. dr. usher: thank you, i appreciate the specificity of the question. we certainly are aware of high rates of trauma. when one encounters that, there is a variety of changes one experiences at that point in time. it can have a long and in during impacts.-- enduring childhoodadverse events study in massachusetts that looked at kids who were abused or had genetic events, -- or had traumatic events. there were morphological changes

in their brains. it is not a surprise. our frontline providers also experience that is a reaction to what they see, even though they maintain their professional posture, it is not without an insult to their system. the crisis intervention team trainings we will hear about later on have to have a focus on trauma, its impact on the current interactions. importantly, our efforts should be focused on approaches that do not reach him at ties individuals who have long approaches that tize individuals who have long experiences. why are so many more people with serious mental illnesses in our

jails than in our general population, four to eight times? as likely toce have serious mental illness as their mental -- as their male counterparts. understanding these factors may show us a way forward in how to mitigate the likelihood of folks with mental illness getting in custody. morely, they get arrested often. two main factors contributed to that. one, our war on drugs. you look at the weapons increase, it can be directly attributed to changes in policy as a relates to possession, sale, trafficking of drugs. many individuals we bring into our systems have substance abuse disorders. if you have a mental illness problem, you are three times

more likely to have a substance abuse disorder. 3/4 have a co-occurring substance abuse disorder. it is important to recognize the implications for treatment and return to our communities. secondly, homelessness. we have about 2 million people this year that will not have an adequate roof over their head. when you are homeless, you are a very visible member of the community. the laws and policies communities have invoked to deal with the homeless have often in frequent arrests for minor misdemeanor crimes of survival. 45%ur homeless population, meet criteria for serious mental illness. lengths of stay -- 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. i am interested in the dialogue with our prosecutors about how that might reflect. there,ess of how you got they tend to get stuck there. they recidivate more often. a study done of 3000 probationers in california found 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. the conditions are difficult to -- keep your appointment, don't do drugs, those are tough conditions when you have a mental illness.

we need to think about what our response to those violations should be, and do they need to include incarceration and segregation are not? -- or not? i will not get -- i will not get too defensive about this. i stipulate that our criminal justice system is broken, too. billion taken out of our community mental health resource pool over several years. it was not a robust response to begin with. getting access to care is tough. there is a huge, uninsured population in our midst. we had an opportunity with the affordable care act to address 90% of those within our correctional system that meet our criteria to get a medicaid card.

means the world to your ability to respond to the individuals who come through that jail door. if you are not an expansion stay, i would ask you to reconsider. if you have a ticket to the theater, does not mean you necessarily will like the show. there is a large science to service a gap. -- service gap. we have thought about what works for whom and what circumstances. unfortunately, when you walk through the door, you might not get that evidence-based practice. not deliveright with fidelity to the models out there. you are not always guaranteed. how frustrated it must be to the court to have them discharged, released, not engaged, not helped in any way.

the last factor i want to highlight, that was underplayed in statements, 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 iminogenic.r i highlight that here to highlight the point, not all illnesses are alike. different strengths, different weaknesses, different needs. who among better rested population is more likely to have another crime? our arrested

population is more likely to have another crime? judge leifman: anything else you want to add? 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. we are aware of this phenomenon of deinstitutionalization. in the 1960's we had 550,000 state beds. now we are below 50,000. often people talk about institutionalization. they are no longer in hospitals, they are in jails. the story is not that simple. when researchers look at it, there are different people these days that access state hospitals. in the old days, it was individuals with chronic,

severe, unrelenting mental illnesses. in a state hospital they got treatment, housing, food, their needs met. said, we doscience 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 meat -- do not have their needs met. 75% of state hospital beds are now filled with forensic clients. it used to be the opposite of that. it is clear there is something that is broken. i am not suggesting the response should be, let's build a 500,000 hospital beds.

we need more, for sure, but we need to do better with the individuals we have. , the leifman in miami-dade 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 factors that contribute to it. i think the responses are myriad. we will talk about that later. justin, dr. osher mentioned engagement and how that is one of the criminal -- critical missing pieces. give us your be perspective on how you saw things, how you see things, and the role you now play on helping people navigate these complex systems? justin: thank you, judge. , somebody whoist

has lived experience. i suffer from mental health and substance abuse issues. funny enough you mentioned friday the 13th. friday the 13th 11 years ago i found myself on the ninth floor of the miami-dade jail, and a pile of urine, feces and vomit. i have been diagnosed six months before. supporters,reat found the jail diversion program. they got me out of jail, i got back on my meds, started doing better, feeling better. 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.

[applause] this is what people need come 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 is to assist people in the community and get them the help they need. an act as a supporter in the community. i also have the opportunity to help train a law-enforcement and assist in sharing a 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. you talk about distressed levels being high. nice to say ima

key member of the team. we have 20 employees who work tirelessly every day, not taking calls in dealing with families. bad situations, all the time. wherek in a great place the weather is ok, so we can smile about it. peopleserved almost 1000 . got them to rehab treatment centers. with people,eat 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 show up at the court this week. you give them things that would take them 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. a bad from living in neighborhood to now i own a house now. things are good and can get better. people 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? how you guard -- are you going to give people in recovery a job, people need money to pay their bills. that's all i wanted to share. a few. justin, if i: could follow up a little bit, one of the things we found that we did not anticipate, 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. one of the things we found that we had not anticipated is that so many with serious mental illnesses 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. thato the first thing almost has to be done is to reestablish relationships, because most of their relationships have been never with families and friends and anyone the have ever known -- have been severed with families and friends. one of the key roles that peers play, and if you could expand on that, talk a little bit about some of the individual stories in some of the high utilizer's we've had that you've been it to make a substantial difference, mention how you

convince them to give you a car. the bus in july has not been fun. like i was saying, we go out diagnosed with a serious mental illness, and to be depressed on top of it, i remember when i got in the program, the doctor 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 or so. i sent man, i just met this guy 10 minutes ago. that was depressing. and he told me i would never work again. person, but ient wasn't too happy with him, let me tell you. 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.

a lot that is missing. that we cannot fix things single-handedly, we all play a part, and i just play my part with my job. spende complains that i more money on homeless people than i do taking her out to eat, but you got to get back. you've got to give back. i've got a little car, they granted us a call or 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, 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 battled stuff myself, when i see them in the program. most of them think i am the police come at this point.

[laughter] which is also disturbing to me, because i am paranoid, you know. [laughter] 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 pulled me aside and they, take this kid to a meeting. to godges are trying above and beyond, because they know if they put them back in jail, it's going to be the same ink over and over. and what good is he 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. statey by the florida supreme court found that 97 people in miami-dade county were

,pending 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? primarily men, who in five years were arrested 2200 times. 27,000 days in the miami-dade county jail, 13,000 days at a psychiatric emergency room or crisis facility, and cost the 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 utilizer's. and this doesn't account for the 13.5 million people with prevalence of almost three times the national average, but 97 people were the highest utilizer's. justin: working with that, i

learned a lot. that was before the car, so tracking of people on foot that 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 ath, that i would show up 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 may major -- we made sure that he took it. this went on for months. we took them out to eat, but in close and 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?

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. judge leifman: justin's very humble about it, and we are very serious when we say the secret sauce of our success is really our peers. of the brain's most important functions is developing relationships with other human beings. when people lack the ability to have a relationship, they give up. what justin and the other peers have done is they have reestablished 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, had we break down some

of these stigmas that justin is referring to? laura: thank you, judge. i think the question i was grappling with as i was preparing for this was, what are sort of the values and what are the sort of big picture issues nami members come to with us, not so much the issues and the problems, but the aspirations that they have. i sort of state of 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 . alliance on mental illness. were the 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. we have a national helpline, one of our functions 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, etc. 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. [laughter] 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 are they resolve the crisis or they've come to peace that dice with the fact that what is happened has happened, and they want to fix it for somebody else, so they are calling and looking for solutions. what law do i try to get my legislation to pass? who do i partner with in the community? those other 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 in they come in .ontact with the justice system but what justin has beautifully demonstrated is that hope is possible, and particularly in relationships 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 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

, 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 i thinkty community, just in general, when you are talking about any kind of change 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 advisers, as leaders, is the way to ensure that you are really addressing the problems and the people that really matter.

and i think when people come to , they they come to nami are looking for that possibility to be included and to be empowered. i will just give a brief example, a good friend of mine is living in recovery, and he was incarcerated for several years in south carolina. -- he said one of the most powerful moments in his recovery is when he came out of jail, he came out of prison, and he spoke and he has gone on to give hundreds of presentations. about an officer who had arrested him, but who had done a really good job of arresting him and had not beaten him up, and he was really grateful. after the presentation, one of the officers in the room came up and said that was me you were talking about. thoughthe had never

that he would have the opportunity to educate and train in his community and it was an incredible moment of feeling like he had the power to do something and to give. i think that's what so many people want. 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 the solution, and they want to rally behind something positive. last value i want to talk about is dignity. last year, i had the pleasure of nameviewing a nami member ray. and he has been incarcerated. he works now as a peer specialist, working with other veterans. part of the interview, i asked ray, what do you want people to

know about how you should treat who are living with mental illness? pauseere was a law's -- a , and he said the only way to treat someone with mental illness is like a person. and actually that became the title of the article. and it was not revolutionary, but it kind of was. i guess am thinking back to what the judge that about the similarity in the way people were treated in the hospital so many years ago and in the jail many years later, and the fact is that people are often treated as if they are animals, or is it as if theynsters, are incapable of making their and that is 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 is really important to know the scope of the problem. it is really important to have all the facts, but it is also important to know who you are talking about and the interacting with people that you are talking about. i guess the last thing i will another dignity is that way we can treat people with dignity is to avoid stereotypes, and particularly to avoid stereotypes around violence area 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 violence, although someone with mental illness can be violent, but it doesn't necessarily mean that mental illness is a cause of the violets are the cause of criminal behavior. that assumption plays out in really interesting ways. 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's missing illness is not t, theyrily more violenc feel safer in that interaction so they can slow down and be

more likely to resolve that the duration safely. in the courtroom, i think it gets someone who is afraid to disclose that they have a mental illness, gives them 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 are at risk of being viewed as a danger to society, simply because they have a mental illness. ofhink that assumption causal relationship around violence can play out in a variety of ways throughout the justice system. i think it is is really important to keep that in my, that we should be having a conversation that's based around that and compassion and not around stereotypes. judge leifman: thank you very much. i had that same

experience, the officer that arrested me, i got to train in cit, and he looked at me and he said, i'm surprised you are still alive. i said i told you i wanted to go to the hospital and not jail that night. our cit program with the peers, it breaks down that barrier of stigma. if the police officers can relate when they see a person coming dressed normally, not homeless on the street, not disheveled, and they can relate more. in you have officers, and share their own struggles. process.eally growing in miami, the culture has changed a lot since i started my speaking career doing cit in 2008. the other officers were hardened and didn't want to think about ago, the and two weeks last cit class we had, we were doing mindfulness, meditation,

and yoga with the officers. [laughter] judge leifman: come to miami. [laughter] we've talked a lot about some of the wonderful successes, but also some of the depressing aspects in the statistics surrounding these issues. i would like to have dr. osha -- dr. osher talk about some of the hope for the future and the good programs we've seen a there, and i would like to wrap up with some of the statistics of our successes. i want you to leave on a note understanding that this can be fixed. i appreciate the opportunity to end on a hopeful note, because i believe it is justified. colleaguesking with earlier about how we have been watching over the last 20 years, this conversation if all. it has got to a point where it is much more sophisticated and a whole celllly

that cross system collaboration actually can make a difference for folks. towards that end, i just wanted to highlight one initiative sponsoredtepping up, jointly by the american psychiatric association foundation and council of state justice and government center. it was a call to action to counties three years ago. the status quo was on acceptable. can you join us in passing a resolution that will address in a long-term way the prevalence of mental illness within your jail settings. to date we have over 400 counties that have passed resolutions, from miami to new york city to los angeles to johnson county, kansas, to north carolina, rural, urban, suburban, and metropolitan, all focused on how can we end this tragedy in our midst? and they have a guidebook with six questions they focus on.

i just want to highlight the importance of data. key metrics we are asking counties to consider. don't bring them to the jail door if they don't need to be there. if in jail, keep their length of stay as short as possible. when they leave jail, assure that they are connected to reasonable care, and while they are in the community, help them to avoid recidivism. if we can focus on those four metrics, and we will have a waysrsation to detail those who have positive outcomes, i think we have a chance make a difference for this population. it has been heartening to see the cross collaboration, the coordinating councils, the way the systems are coming together. conferences and dialogs and meetings like this that are really sort of putting up mark in the sand saying enough is enough. if you don't need to be there, if you are not a public safety risk, let's assure you get the

help you need to stay on your feet and move forward. i just want to share that progress is being made. but thees are numerous, thoughtful conversation today is part of the solution. judge leifman: we have been asked -- we've been at this for good friend mr. evans likes to say, it's an 18 year overnight the test. ,ut in miami-dade right now because of that situation involving the psychiatrist, if you get arrested on a misdemeanor, you are now evaluated at the jail with a new screening tool. , withineet criteria three days you are out of the jail, your transferred to a crisis stabilization unit and given an opportunity to stabilize. if you agree to go into the , you're not read

books, you're taken directly into the courtroom where a peer is waiting for you, where your housing is there, clothing, medication, treatment, transportation, everything you need to begin recovery. ourrecidivism rate of mental health population went from 72% to 20%. so successful that the state attorney in miami-dade allow us to expand it to nonviolent felony cases. that program has a recidivism rate of only 35%, and over the last six years, it's a the -- we have the largest train squad of cit officers. 6000 officers trained in miami-dade county at all 36 police department. handle 2010-2016, we 83,427 mental health calls and only made 149 arrests.

rates went from 118,000 will restart the program to 56,000 this year, and trust me, our population has not shrunk. our daily audit has dropped from over 7300 to 4000. police shootings have almost stopped. work -- if that you you work collaboratively and you give people an opportunity to have hope, opportunity, and recovery, they can and they will. we believe it is a model, it may not be the best model for every community, but each community can figure out on its own with the data that is now out there how to collaborate, how to develop assistance of care so that we can keep people out of the criminal justice system. please join me in thanking our amazing panel. [applause]

judge leifman: i think i have time for one question, if anybody has a question. >> i would like to know what is the program that have she realize that it is ok to need help and [indiscernible] if they are willing to get help and things like that. willis it that [indiscernible] judge leifman: i'm going to repeat the question so they can hear it. what was the key intervention that allowed you, or how you help other people get past some

of the denial they may have about their own illness. >> it is a combination of things. for me personally, i had hit my rock-bottom that summer as well and i wanted to get the help that i needed. secondly, it was nonstop people trying. people deserve second chances, third chances. it may not be this arrest that someone gets help, it may be another one. but if the support is continued and offered, the chances to succeed are more likely. you sound like you are speaking personally, and i know it is very tough to deal with. all can do is keep trying. judge leifman: we have just started a new training of our staff through a program called leap, that's training or staff on how to talk, speak differently to people that have been very resistant to treatment. so there are some new tools out there that we are trying to use

and be very innovative and we are hopeful that some of these new tools will help us get to that point. thank you all very, very much. [applause] [captions copyright national cable satellite corp. 2018] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> i would like to thank again an and that incredible group of panelists who i think, in just such a powerful way, gave us a sense what a new paradigm can look like if we cast our eyes on what has been happening in miami, what the experiences of those who have been through our system and really are pleading with us to try to do things differently, what sense of urgency that createan