In Montpelier, Judge Steven Leifman of Florida keynoted what the Vermont Judiciary Commission on Mental Health and the Courts called its first annual summit. Leifman’s speech described how Miami-Dade County’s decision to prioritize mental health treatment for low-level criminal defendants, rather than prosecution, had saved money and reduced repeat offenses.
The Vermont Supreme Court established the Commission last year “to propose measures to respond to the needs of court-involved individuals with mental health issues.” Its September summit at the State House convened all three branches of government, as well as mental health providers, for a full day of discussion.
According to Leifman, Vermont can learn something from Florida, which, until recently, focused on bringing arrestees deemed mentally ill to trial through a narrowly focused procedure called competency restoration. This process, in his view, did little to help them heal.
“We have a statute that says that once you are adjudicated incompetent, the state of Florida has 15 days to physically take you from jail and send you to a competency restoration facility,” Leifman said. “Because of the growth of people with mental illnesses going into the criminal justice system, we ran out of competency restoration beds, and it created this terrible backlog of individuals in jails waiting to be transported to the facility for restoration, and really horrible things happened.”
“At the time, the State of Florida was spending about $220 million, about one-third of its entire adult mental health budget, to restore competency for about 3,000 people,” he added.
In the vast majority of cases where these defendants became competent to stand trial, the trials didn’t amount to much by Leifman’s account.
“Three things happened to them. They had their charges dropped, they received credit for time served, or they received probation and they walked out of the front door of the courthouse without any access to treatment,” Leifman said.
Leifman dedicated himself to reforming the system. A new approach, he believed, would start with fewer arrests of people in mental health crisis.
Miami introduced a model called Crisis Intervention Team policing, which Leifman characterized as “a 40-hour training program that teaches law enforcement how to identify people in crisis, how to de-escalate situations, and where to take people instead of arresting them.” He called it “stunningly successful.”
“The number of arrests in Dade County went from 118,000 a year to 53,000,” Leifman boasted. “Our jail audit went from 7,400 to 4,400. Our police shootings almost stopped.”
When arrests of people deemed to have mental health challenges still occur in Miami-Dade County, the arrestees now face a different process than they did in the past. The difference owes to a practice sometimes called “pre-charge diversion.”
“Instead of ordering a competency evaluation – which we stopped doing, saving the county almost $2 million a year – we have an assessment done at the jail,” Leifman said. “If they meet criteria for some type of civil commitment or treatment, instead of going through a competency system, what we do is we transfer them within usually three days of their arrest to one of our crisis stabilizations.”
Once they’ve stabilized, they receive an offer to participate in an outpatient treatment program. Upon its completion, prosecutors drop the charges against them.
Leifman urged Vermont to follow this example.
“Vermont is sitting in a very unique time right now. You do not have an inpatient competency restoration system, and I strongly personally encourage you to keep it very, very limited if you go that route,” he advised. “The Justice Department is involved in lawsuits against most of the states right now because people are sitting too long to get an evaluation and sitting in custody too long to get restored.”
Earlier this year, the Vermont General Assembly authorized the establishment of the state’s first forensic mental health facility, which will separate patients committed by criminal courts from those committed by civil courts. In December, the Vermont Department of Mental Health will release a report that may recommend the development of an accompanying competency restoration program.
Vermont Supreme Court Justice Karen Carroll, who had led the Commission’s Competency and Sanity Evaluation Committee, described competency restoration as a process of “preparing people to be in court – in other words, less treatment but more teaching them how they can better understand the charges against them, how they can better work with their attorney.”
“People can differ about whether that is a better program than what we’re doing here in Vermont, which is essentially treating people until they’re better and able to come to court,” Carroll said.
Another new Vermont law this year aimed to resolve a backlog of court-ordered competency evaluations by expanding the number of mental health professionals who can perform them: not just psychiatrists, but also, at least until summer 2024, doctoral-level psychologists. At the summit, Sen. Ginny Lyons forecast an extension of this pilot program.
“One of the preliminary decisions made at our meeting on Tuesday at the Justice Oversight Committee was to allow for doctoral-level psychologists with forensic training to continue beyond the next year to provide competency evaluations,” Lyons revealed.
Another topic of discussion at the summit was pretrial services, which, in Vermont, provide risk assessment screenings of defendants and referrals to services for mental health and substance use. A committee led by Vermont Superior Court Judge Kate Hayes had examined the subject.
Hayes reported that the committee had agreed to “strongly recommend to the Commission that we all work on getting peer supports added as a specific part of pretrial services statewide – that each pretrial services office should have available to it peer support for anybody who is given a pretrial services order.”
Two peers, Pathways Vermont Training Coordinator Alexander Ferguson and Recovery Vermont Executive Director Will Eberle, later participated in a panel overview of “peer support strategies.”
The Commission’s work will continue. On Sept. 8, it posted a recruitment notice for a “behavioral health project consultant,” a three-year position that will “assist with expanding and improving the judicial response to mental and behavioral health issues.”
Many psychiatric survivors have long objected to the term “behavioral health.” The Commission did not respond to an email highlighting what Counterpoint views as the offensive nature of the phrase.