Miami Goes From Snakepit To Example For Others: I Return To See How The City Is Decriminalizing Mental Illness



The air in C wing stinks. It is a putrefied scent, a blending of urine, expectorant, perspiration, excrement, blood, flatulence, and dried and discarded jailhouse food. When the jail’s antiquated air conditioning breaks down during the summer, which it often does, some officers claim C wing’s pink walls actually sweat. It’s decades of filth and grime bubbling up, rising through coats of paint.

Those few lines are from my book, CRAZY: A Father’s Search Through America’s Mental Health Madness. They describe the barbaric conditions that I observed when I spent ten months inside the Miami Dade Pre-Trial Detention Center  (downtown jail) where inmates with serious mental illnesses were beaten, neglected, abused and treated little better than animals.

I observed the horrific conditions in the jail and troubling events during 2004/2005 and for the first time since then, I returned earlier this week to Miami to see what has transpired since my book was published.

What I observed was nothing short of a miracle. In the twelve years that have passed since I first walked into the jail, Miami has been transformed from being one of the worst examples of how prisoners with mental illnesses were treated into a model system that the rest of the nation should follow.

In my book, I describe how cells built for two prisoners were crowded with four or five. Many of the inmates were naked in cells with nothing else inside them. The cells were filthy. I still remember watching an inmate urinating into a toilet while another inmate was lying on the floor with his head butted up against the porcelain. He covered his face with his hands to deflect the spray. He was afraid to move out of the way because he might lose the only spot in the cell where he could lay down.

The cells that I toured this week at the Turner Guilford Knight Correctional Center, where prisoners with severe mental illnesses are now being housed, were one man units that were freshly painted and much larger than most cells that I’ve seen during my travels. Inmates were wearing coveralls and had mattresses. There were no bunk beds, like in the old jail. A psychotic inmate named William Weaver Jr., leaped headfirst off a top bunk breaking his neck while I was at the old jail, resulting in him becoming a quadriplegic.

Each cell at the new facility contained cameras that showed every inch of the entire cell. There were cameras in the old jail too, but they only showed the corridors and not what happened in the cells. While I was there, correctional officers went into the cells when they wanted to “put their hands” on an inmate.

Inmate: Don’t hurt me. I’ll be quiet. I’m sorry.

Officer: Oh, it’s just gonna hurt a little.

Inmate: I’m sorry, okay? you’re joking, right? You’re not going to hurt me?

Officer: Oh, the time for joking is long past, and yes, I’m is gonna hurt you…

None of the officers who worked at the old jail had received any special training to handle prisoners with mental illnesses. They had been assigned to work with the “crazies” because it was the worst job in the jail and their bosses hoped they would quit because they were viewed as trouble causing employees. All of the officers at the new facility had Crisis Intervention Team training, and not some CIT lite program that skimmed the surface. These officers had undergone the 40-hour Memphis gold standard model in training and then additional hours specifically designed for a correctional setting. More important, were the officers’ attitudes. “I look at these prisoners and see my brother, sister, father, mother,” one told me. Another said, “I wanted to work with this population because I know these inmates are here because of their illnesses. They are at their worst but that’s not them. There is a best and I want to help them bring that out.”


What a difference from officers who I saw taunt and belittle  inmates, offering them sandwiches in return for them singing or dancing as if they were dogs performing for treats.

When I spent time in the old jail, there was one part time psychiatrist.

There were 92 inmates on the ninth floor. His rounds took us 19 minutes. That was an average of 12.7 seconds per inmate…”A lot of people think someone who is mentally ill is going to get help if they are put in jail but the truth is that we don’t help many people here with their psychosis. We can’t.”

Dr. Patricia Junquera, the medical director at the new facility, is one of 13 psychiatrists — that’s right 13 psychiatrists working inside the jail!

At the old facility, inmates were discharged onto the street without a second thought. Now every inmate has a discharge plan, Dr. Junquera told me.

This radical transformation was prompted by a series of events. (After my book was published and the local CBS affiliate took its cameras into the jail, the U.S. Department of Justice launched a probe.) But the driving force behind these improvements was and remains to be Judge Steven Leifman, who was responsible for getting me access to the old jail for my book. (I was turned away from jails in Los Angeles, Chicago, New York, Baltimore and Washington D.C.)

In 2000, Judge Leifman created the Eleventh Judicial Circuit Criminal Mental Health Project (CMHP) and used that group to “persuade” his peers, the police, the corrections staff, the state attorney, public defenders, and mental health providers and stake holders to sit down together, share information and begin cooperating.  It has been an often thankless and difficult task, but Judge Leifman and the CMHP have literally transformed Miami’s mental health system.

When I visited, the Miami Police department had begrudgingly agreed to begin CIT training only after a public outcry about the fatal police shooting of a veteran who was psychotic and waving a pen knife at officers. The larger Miami-Dade Police Force stubbornly refused to institute CIT and the result was tragic, at least five fatal shootings by that department while I was doing my research. Today, both forces and the corrections department in Miami vigorously support CIT. Some 4,600 officers serving in Miami Dade’s 36 municipalities and in country public schools have been trained. When I did my book, officers at the Miami Beach Police Department broke the arm of a psychotic prisoners, who I was shadowing, because he was spray painting graffiti on buildings and repeated arrests didn’t discourage  him. This week, the Miami Beach Police Department’s CIT officers received an award from Judge Leifman and the CMHP for their exemplary service. Some CIT officers in Miami Beach patrol the streets during their off hours to help find homeless, mentally ill individuals and direct them into shelters and treatment, their supervisor said.

The results of CIT training have been breathtaking. In five years, officers from Miami Police and Miami-Dade Police forces have responded to more than 50,000 mental health crisis calls. 50,000!  Those calls resulted in 9,000 diversions to crisis units and only 109 arrests.

That’s right. 50,000 calls and only 109 arrests! That is phenomenal. It has become a badge of honor for an officer to avoid arresting someone who is psychotic, Judge Liefman told me. Even officers who have been spit on, pushed and shoved have not filed charges but have instead taken the offender to a treatment facility.

As a result, the average daily census in the county jail system has dropped from 7,200 to 4,000, one jail facility has been closed, and fatal shootings and injuries of mentally ill individuals by police officers have been dramatically reduced.

There’s more than CIT at play here.

Judge Leifman and the CMHP have created a jail diversion pre-booking program that diverts persons willing to undergo treatment who meet criterial for civil commitment. That program allows assisted outpatient treatment. If a person is arrested and jailed, that individual is identified through screening and use of a jail sequential intercept model. The post-booking program involves identifying people in acute psychiatric distress. Judges can approve defendants’ transfer from jail to a crisis unit, where they receive treatment while the court monitors their progress and case managers employed by the courts work with the South Florida Behavioral Health Network to arrange ongoing treatment and housing. 80 percent agree to participate in treatment. The annual recidivism rate for those enrolled in post jail diversion has been 20% compared to 75% among those not diverted. Initially, only people charged with misdemeanors were permitted in the program but in 2008, it was expanded to include defendants arrested for less serious, nonviolent felonies, who are screened by the state attorney’s office before enrollment to ensure that they have no significant history of violence and are unlikely to threaten public safety.

I am not the only journalist who has been impressed by what Judge Leifman and the Miami community have done. The accomplishments that I am citing and quoting here are chronicled by journalist John K. Iglehart in a May 5th, article entitled Decriminalizing Mental Illness–the Miami Model published in The New England Journal of Medicine.

And Judge Leifman and the CMHP aren’t finished. At a CIT awards luncheon this week — attended by more than 500, including state legislators, police chiefs, correctional officers, and local elected officials – Judge Leifman revealed that he has been working with the Japanese pharmaceutical company, Otsuka, to develop a program that will use predictive analytics to help mental health providers recognize when someone  is most likely to stop treatment. And for readers who are anti-drugs and the medical model, Leifman is exploring the Open Dialogue method in Finland and, before the awards luncheon, he invited Matthew R. Federici, executive director of the Copeland Center for Wellness and Recovery, to give an hour lecture about WRAP — Wellness, Recovery Action Plan — and how it helps individuals recovery through peer support and encouragement.  It is part of the judge’s recognition that there is no size fits all solution to individual treatment and that those who are sick should be offered a smorgasbord of options to help them recover.

Wait, there’s more. While in Miami, I also toured a facility that is being renovated to become a mental health all-purpose facility that Judge Leifman said will offer emergency crisis care, a clubhouse setting, culinary arts training, and temporary residential services. That facility, estimated to cost upwards to $40 million, will be a first of its kind in the U.S.

Judge Leifman’s leadership and the support of the community that he and the CMHP have rallied is transforming Miami from a place of suffering, abuse and despair into one of hope and recovery. Other communities should take notice. Miami is proving that you can end the inappropriate jailing of persons who are sick. You can help them recover. And Judge Leifman promises to soon release a financial data that will show that such services save taxpayers millions of dollars.

Thud, thud, thud. Then faster. Thudthudthud. Then louder. THUD, THUD, THUD. He was banging his forehead against a glass cell front.

“I ain’t cray!” he shouted.

“Then stop acting like you are,” an unconcerned officer called back…

A newly arrived prisoner was ordered to strip where he was standing in the center corridor. Inmates in the cells gawked at him. Once naked, he shielded himself with his hands while his clothing was stuffed into a brown paper bag… “Do you know what we call this cellblock? — we call it the Forgotten Floor.”

Finally, those cellblocks have been closed down. There is no Forgotten Floor anymore in Miami.

leifmanstepping up

(Judge Steven Leifman shown recently speaking at Stepping Up, a national initiative to reduce the population of prisoners with mental illnesses inappropriately incarcerated. Read more at Stepping Up.)

PLEASE DO NOT CONFUSE THE MIAMI JAIL SYSTEM WITH THE FLORIDA STATE PRISON SYSTEM WHICH WAS THE SUBJECT OF A STORY IN THE NEW YORKER CALLED MADNESS.  The state system is where guards used 180 degree water to punish a psychotic inmate who had smeared his cell with feces. He literally was boiled alive and died a horrific death. The facility where that happened is just outside Miami but unrelated to Judge Liefman’s reforms. It is a reminder the cruelty and ineptness that many face when imprisoned. 

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.