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Feature Story: Criminal Justice Leaders Develop Plan to Transform Florida's Mental Health System

Contributor: Laura Usher

In response to a crisis in community mental health care, compounded by a growing population of people with serious mental illnesses in Florida's jails and prisons, the Supreme Court of Florida has produced a proposal for the reform of Florida's criminal justice/mental health system.  The report, entitled "Mental Health: Transforming Florida’s Mental Health System," focuses on improving care for Floridians most at risk for criminal justice involvement. This report is the product of a criminal justice/mental health partnership that benefited from unprecedented leadership from the highest levels of the Governor’s office and the judiciary.

The report argues persuasively that, in the absence of an adequate system of community mental health care, jails and prisons have become warehouses for people with the most severe mental illnesses. Calling jails and prisons "the asylums of the new millennium," the report paints a stark picture of the history of mental health "care": cycling from prisons, to asylums, to hospitals, and back to prisons.

The proposal argues for evaluating people receiving mental health services for a history of justice involvement, and those with certain factors that make them at risk for justice involvement – including a history of repeated use of crisis services, co-occurring substance abuse, and history of treatment non-compliance.  Once identified, these groups would receive targeted treatment and services designed to avoid future justice involvement. For those coming out of jails, prisons and psychiatric hospitals, services would involve in-reach prior to release, and coordination of housing, community services and access to medications, both before and after release.

The plan calls for a 6 year, phased roll-out, during which Integrated Specialty Care Networks (ISCN) would be developed. ISCN’s would employ highly-qualified providers to deliver targeted services to people with a history or risk of justice involvement. In the first two years, implementation would be limited to three sites, with no more than a 1000 participants per site. Over the course of implementation, the goal would be to serve about 25,000 annually.

The report proposes to fund these efforts through Medicaid, and through general funds from the Department of Children and Families. The justices propose maximizing enrollment in Medicaid and SSI/SSDI using promising practices that increase the initial acceptance rates for applications. In addition, they suggest recalling $48 million currently contracted to invest in forensic competency restoration, and investing that money instead in preventive services.

The report also offers a vision for how communities can plan for locally appropriate services, and addresses issues relating to acute care, emergency holds, and evidence-based practices. The justices refers to a variety of existing models, including the Criminal Justice Mental Health Consensus Project Report, and the Sequential Intercept Model, a framework for engaging people at every stage of criminal justice involvement.

The report calls for effective services for youth involved in juvenile justice, foster care and child protective services. Because children involved in all of these systems experience significant emotional problems and are especially vulnerable, the justices propose a coordinated response designed to address mental health needs and reduce the risk of later justice involvement. The justices support the recommendations of Florida’s Blueprint Commission on the juvenile justice system, and the National Center for Mental Health and Juvenile Justice’s report on comprehensive services for youth with mental illnesses involved in the criminal justice system.

Because mental illnesses and substance abuse disorders underlie so many of the cases in criminal, family, juvenile justice and other courts, the justices call for judges to be educated on mental illnesses and the mental health system. They also call for further education throughout the judicial system, including for lawyers and court personnel.   Finally, the report calls on judges to take a leadership role in the creation of community collaborations around mental health and criminal justice issues.

The Florida Supreme Court’s report on transforming the mental health system presents a powerful vision for future action. The combined efforts of stakeholders across Florida, and leadership by the Florida Supreme Court, promise to create a more effective, responsive system that keeps people with mental illnesses out of the criminal justice system. We look forward to updating you on their progress.