My Evening at the Supreme Court and APA’s Impact on National Policy

On November 19, 2015, I attended an event at the U.S. Supreme Court honoring Judge Steven Leifman, an associate administrative judge from Miami-Dade County in Florida. Judge Leifman, who has worked closely with the American Psychiatric Association Foundation to help our patients who wind up in the judicial system, received the William H. Rehnquist Award from Supreme Court Chief Justice John Roberts (Psychiatric News, December 18, 2015). One of the nation’s highest judicial honors, the William H. Rehnquist Award is presented annually to a state court judge “who exemplifies judicial excellence, integrity, fairness, and professional ethics.” The event was in the Great Hall of the U.S. Supreme Court, a majestic setting lined with marble columns.

Judge Leifman was honored for his “transformational work in the way people with mental illnesses are treated in the criminal justice system.” Judge Leifman gave a passionate speech at the event, noting his realization that being appointed a judge meant that he was also being appointed as the gatekeeper for the largest psychiatric hospital in Miami—the Miami-Dade County jail.

He described a defendant who came to his courtroom after being charged with a minor offense. The defendant started repeating what was said to him (echolalia) and was clearly incompetent to stand trial. Judge Leifman related that the defendant was a Harvard-educated psychiatrist who had had a psychotic break after his training. After being restored to competency, Judge Leifman wanted to order him to a psychiatric hospital for further treatment and was told that judges did not have the authority to do so. The defendant/patient had to be released without any ongoing treatment.

Judge Leifman began a crusade to reform the mental health and criminal justice system in Miami-Dade County. He brought stakeholders together, and now Miami-Dade County has a network of collaborative courts and Crisis Intervention Training (CIT) for police officers. Judge Leifman reported that the recidivism rate for misdemeanor offenses dropped from 72 percent to 20 percent and for nonviolent offenses from 70 percent to 6 percent. He also said that Miami-Dade County was able to close one of its jails and save $12 million a year.

APA and our Foundation are working with Judge Leifman, other judges, and other stakeholders to reduce the criminalization of patients with mental illness. Counties across the United States spend $70 billion annually on jails. This is one of the reasons that county governments are motivated to decrease the number of people with mental illness who are in jails. APA is partnering with the National Association of Counties and the Council of State Governments in the “Stepping Up” initiative to develop programs to decrease the criminalization of people with mental illness. APA is also highlighting these efforts in its first-ever APEX (American Psychiatric Excellence) Awards event on April 18 in Washington, D.C.

Prior to the Supreme Court event, I participated in a press conference with Sen. Al Franken and Judge Leifman. Sen. Franken spoke about the Comprehensive Justice and Mental Health Act, a bipartisan bill that he co-sponsored and APA supports. The bill improves access to mental health services for people in the criminal justice system and supports mental health courts and crisis intervention teams as well as transitional services and re-entry programs after incarceration that reduce the likelihood of recidivism.

As APA president, I am thrilled that we are addressing a national problem that affects our patients with serious mental illness and are partnering with other stakeholders including judges, legislators, and even the U.S. Supreme Court to highlight and address this issue. Through our efforts, I am hopeful that we will be able to change national policy and to help our patients, some of whom have tragically moved from the outpatient and psychiatric hospital system to the criminal justice system. ■