U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001

34–359 PDF 2007

CRIMINAL JUSTICE RESPONSES TO OFFENDERS

WITH MENTAL ILLNESS

HEARING

BEFORE THE

SUBCOMMITTEE ON CRIME, TERRORISM, 

AND HOMELAND SECURITY

OF THE

COMMITTEE ON THE JUDICIARY 

HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

MARCH 27, 2007

Serial No. 110–32

Printed for the use of the Committee on the Judiciary

(

Available via the World Wide Web: http://judiciary.house.gov 

(II)

COMMITTEE ON THE JUDICIARY 

JOHN CONYERS, JR., Michigan, Chairman 

HOWARD L. BERMAN, California 

RICK BOUCHER, Virginia 

JERROLD NADLER, New York 

ROBERT C. SCOTT, Virginia 

MELVIN L. WATT, North Carolina 

ZOE LOFGREN, California 

SHEILA JACKSON LEE, Texas 

MAXINE WATERS, California 

MARTIN T. MEEHAN, Massachusetts 

WILLIAM D. DELAHUNT, Massachusetts 

ROBERT WEXLER, Florida 

LINDA T. SA ́ NCHEZ, California 

STEVE COHEN, Tennessee 

HANK JOHNSON, Georgia 

LUIS V. GUTIERREZ, Illinois 

BRAD SHERMAN, California 

ANTHONY D. WEINER, New York 

ADAM B. SCHIFF, California 

ARTUR DAVIS, Alabama 

DEBBIE WASSERMAN SCHULTZ, Florida 

KEITH ELLISON, Minnesota 

[Vacant] 

LAMAR SMITH, Texas 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

HOWARD COBLE, North Carolina 

ELTON GALLEGLY, California 

BOB GOODLATTE, Virginia 

STEVE CHABOT, Ohio 

DANIEL E. LUNGREN, California 

CHRIS CANNON, Utah 

RIC KELLER, Florida 

DARRELL ISSA, California 

MIKE PENCE, Indiana 

J. RANDY FORBES, Virginia 

STEVE KING, Iowa 

TOM FEENEY, Florida 

TRENT FRANKS, Arizona 

LOUIE GOHMERT, Texas 

JIM JORDAN, Ohio

PERRY APELBAUM, Staff Director and Chief Counsel 

JOSEPH GIBSON, Minority Chief Counsel 

SUBCOMMITTEE ON CRIME, TERRORISM, AND HOMELAND SECURITY

ROBERT C. SCOTT, Virginia, Chairman

MAXINE WATERS, California 

WILLIAM D. DELAHUNT, Massachusetts 

JERROLD NADLER, New York 

HANK JOHNSON, Georgia 

ANTHONY D. WEINER, New York 

SHEILA JACKSON LEE, Texas 

MARTIN T. MEEHAN, Massachusetts 

ARTUR DAVIS, Alabama 

[Vacant] 

J. RANDY FORBES, Virginia 

LOUIE GOHMERT, Texas 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

HOWARD COBLE, North Carolina 

STEVE CHABOT, Ohio 

DANIEL E. LUNGREN, California

BOBBY VASSAR, Chief Counsel 

MICHAEL VOLKOV, Minority Counsel 

(III)

C O N T E N T S 

MARCH 27, 2007

OPENING STATEMENT 

Page 

The Honorable Robert C. Scott, a Representative in Congress from the State 

of Virginia, and Chairman, Subcommittee on Crime, Terrorism, and Homeland Security ........................................................................................................ 1

The Honorable J. Randy Forbes, a Representative in Congress from the 

State of Virginia, and Ranking Member, Subcommittee on Crime, Terrorism, and Homeland Security .......................................................................... 3

WITNESSES 

The Honorable Steven Leifman, Judge, Criminal Division of Miami-Dade 

County Court, 11th Judicial District, Miami, FL 

Oral Testimony ..................................................................................................... 5

Prepared Statement ............................................................................................. 8

Mr. Phillip Jay Perry, Court Participant, Bonneville Mental Health Court, 

Boise, ID 

Oral Testimony ..................................................................................................... 12

Prepared Statement ............................................................................................. 13

Sheriff David G. Gutierrez, Lubbock County Sheriff’s Office, Lubbock, TX 

Oral Testimony ..................................................................................................... 14

Prepared Statement ............................................................................................. 15

Lieutenant Richard Wall, Los Angeles Police Department, Los Angeles, CA 

Oral Testimony ..................................................................................................... 18

Prepared Statement ............................................................................................. 20

Mr. Leon Evans, Executive Director, Jail Diversion Program, San Antonio, 

TX 

Oral Testimony ..................................................................................................... 24

Prepared Statement ............................................................................................. 26

(1)

CRIMINAL JUSTICE RESPONSES TO 

OFFENDERS WITH MENTAL ILLNESS 

TUESDAY, MARCH 27, 2007

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON CRIME, TERRORISM,

AND HOMELAND SECURITY

COMMITTEE ON THE JUDICIARY, 

Washington, DC.

The Subcommittee met, pursuant to notice, at 1:06 p.m., in Room 

2141, Rayburn House Office Building, the Honorable Robert Scott 

(Chairman of the Subcommittee) presiding. 

Present: Representatives Scott, Conyers, Johnson, Jackson Lee, 

Davis, Forbes, Sensenbrenner, Coble, and Chabot. 

Staff present: Veronica Eligan, Professional Staff Member; 

Ameer Gopalani, Majority Counsel; Bobby Vassar, Majority Chief 

Counsel; and Michael Volkov, Minority Counsel. 

Mr. SCOTT. The Subcommittee will now come to order. 

And I am pleased to welcome you to today’s hearing before the 

Subcommittee on Crime, Terrorism, and Homeland Security, on 

criminal justice responses to offenders with mental illness. 

We are at a crossroads with regard to treatment of people with 

mental disorders who are brought in to the criminal justice system. 

People with mental illnesses are overrepresented compared to their 

percentage in the general population in all parts of the criminal 

justice system; in their contact with law enforcement and the 

courts and jails and in prison. 

A recent Department of Justice study found that while approximately 5 percent of the U.S. population has a serious mental illness, 16 percent of the prison or jail population has such illnesses. 

This large proportion of mentally ill persons in our jails and prisons is part of a growing trend to transfer individuals who used to 

be tracked for mental health treatment straight to jail. 

One problem contributing to this trend is the lack of programs 

which train law enforcement to identify and properly handle offenders with mental illness. Mentally ill offenders create enormous 

problems for both arresting officers and holding facilities, even for 

temporary periods. Traditional law enforcement strategies can confuse and threaten people with mental illnesses, which can lead to 

behavior that sometimes results in severe injury to these individuals and to the officers. 

This is why many communities have created crisis intervention 

teams, one form of collaboration between law enforcement and the 

mental health system. There are somewhere between 150 to 200 

2

law enforcement agencies in this country with crisis intervention 

teams. 

These teams have proven to work. Through them, officers not 

only spend less time admitting individuals with mental illness as 

compared to arresting them, but there is also a decreased number 

of injuries resulting from and to police. 

Another problem contributing to the high incidence of offenders 

with mental illness in jail is simply the lack of mental health treatment, particularly for non-violent offenders. Once incarcerated, people with mental illness have difficulty obtaining adequate treatment. They are at high risk of suicide, and they may be preyed 

upon by other inmates. 

Unfortunately, reports in the media tend to focus on sensational, 

violent crimes committed by people with mental illness. Even 

though there are offenders with mental illness who commit serious 

crimes for which arrest, adjudication and incarceration are entirely 

appropriate, the majority of those with mental illnesses are those 

who are incarcerated at low-level, non-violent offenses and they require a more comprehensive approach than simple incarceration. 

And one approach to this problem that we will be exploring in 

this hearing is the establishment of mental health courts. They are 

modeled after drug courts, and mental health courts divert select 

defendants with mental illnesses into judicially supervised community-based treatment. 

All mental health courts are voluntary. In the 1990’s, only a few 

court-based programs identifying themselves as mental health 

courts were accepting cases. By 2006, 113 mental health courts 

were operational. 

These courts have demonstrated success. For example, a study of 

defendants of the mental health court in Broward County, Florida, 

found that they were twice as likely to receive services for their 

mental illnesses, they were no more likely to commit new crimes, 

and they spent 75 percent fewer days in jail compared to defendants with similar mental illnesses and criminal charges who did 

not participate in the mental health court. 

Finally, in this hearing, we hope to explore the need for additional funding under the Mentally Ill Offender Treatment Crime 

Reduction Act. This act provides funding for a wide range of programs, including mental health courts and crisis intervention 

teams. Five million dollars was appropriated for fiscal year 2006 

and 2007, well short of the $50 million authorized by the act. This 

hearing will hopefully bring to light how inadequate this current 

funding level is. 

Repeated arrests and incarceration of low-level, non-violent offenders whose mental health needs are not adequately addressed 

perpetuates a cycle of criminal justice involvement, diverts attention from more serious crimes and does not necessarily respond to 

the underlying cause of the offense. Having trained law enforcement officials and alternative mental health facilities not only 

saves injuries, money and frustration for all involved, and even 

lives, but it also gets an offender the proper treatment and puts 

them on the path toward productive, fulfilling lives. 

3

And it is my pleasure, at this point, to recognize our esteemed 

Ranking Member, my colleague from Virginia, Congressman 

Forbes, for his opening statement. 

Mr. FORBES. Thank you, Congressman Scott, and I appreciate 

your holding this oversight hearing on criminal justice responses to 

offenders with mental illness. 

As always, we appreciate our witnesses being here. And thank 

you, gentlemen, for taking your time and effort to be here today. 

The problem of mentally ill offenders is growing. Unfortunately, 

mentally ill offenders who are unable to obtain adequate services 

have been swept up into the wheels of the criminal justice system. 

This has had a dramatic impact on State and local criminal justice 

systems, which were not designed to handle the large number of 

mentally ill offenders. 

Approximately 5 percent of the U.S. population has a serious 

mental illness. Sixteen percent of the prisoner jail population, or 

over 1 million prisoners, have a serious mental illness. The Los Angeles County jail and the New York Rikers Island jail hold more 

people with mental illnesses than the largest psychiatric in-patient 

facilities in the United States. 

At the same time, according to a National Institute of Justice 

survey, 64 percent of jail administrators and 82 percent of probation and parole agency directors indicated the need for improved 

medical services for offenders with mental illnesses. More than 

one-fifth of jails have no access to any mental health services at all. 

Many criminal justice agencies are unprepared to meet the comprehensive treatment and needs of individuals with mental illness. 

Poorly trained law enforcement officers can be put in danger when 

interacting with individuals in crisis and may spend crucial labor 

hours trying, often unsuccessfully, to connect these individuals to 

treatment. Jails and prisons require extra staffing and treatment 

resources for inmates with mental illnesses. 

In addition, mentally ill offenders can be affected by incarceration in many different ways from the general population offenders. 

There is no question that public safety is critical and that innocent people must be protected from mentally ill offenders. The public safety can be served by a more strategic approach when dealing 

with mentally ill offenders. And, fortunately, there are effective 

models for the Subcommittee to examine and support. 

The Justice and Mental Health Collaboration Program was created by the Mentally Ill Offender Treatment and Crime Reduction 

Act of 2004. The act needs to be reauthorized, and I look forward 

to working with Chairman Scott in reauthorizing this act and adding new and effective tools to the existing act. 

The Mental Health Collaboration Program increases public safety by facilitating collaboration among the criminal justice, juvenile 

justice and mental health treatment and substance abuse systems 

to increase access to treatment for this unique group of offenders. 

A mere $5 million, as Chairman Scott mentioned, has been appropriated for the program in 2006 and this current fiscal year. 

The importance of collaboration among stakeholders involved in 

mental health services and criminal justice agencies is critical to 

improving the treatment of mentally ill offenders. 

4

Such collaboration efforts should include working with the mental health community to provide training, direct assistance and 

treatment, working with emergency hospitals to which police may 

take people in crisis, appointing police liaison officers to the mental 

health community, training police officers on responses to incidents 

involving offenders with mental illness, initiating assisted outpatient treatment to encourage adherence to prescribed treatment, 

establishing crisis response sites where police can transport people 

in mental health crisis as an alternative to hospital emergency 

rooms or jails and establishing jail-based diversion programs before 

or after booking to remove detainees with mental illness from jails 

to treatment settings and establishing mental health courts to 

make adjudication and sentencing decisions tailored to the needs of 

each defendant. 

Mr. Chairman, I look forward to hearing from today’s witnesses, 

and, once again, thank you for holding this hearing. And I yield 

back. 

Mr. SCOTT. Thank you. 

If there are no other opening statements, without objection, we 

will ask others to introduce their statements for the record. 

Our witnesses today, comprise a distinguished panel. 

Our first witness will be the Honorable Steven Leifman, who 

serves as associate administrative judge of the Miami-Dade County 

Courts Criminal Division, and is currently on special assignment to 

the Florida Supreme Court as special counsel on criminal justice 

and mental health. In addition to these posts, he also chairs the 

Florida Supreme Court Mental Health Subcommittee, as well as 

the Mental Health Committee for the 11th Judicial Circuit of Florida. 

In recognition of his efforts, he has received numerous awards, 

including the 2003 president’s award from the National Alliance for 

the Mentally Ill and the 2003 distinguished service award from the 

National Association of Counties. 

He received his bachelor’s degree from American University and 

law degree from Florida State University. 

Our next witness, Phillip Jay Perry, is a participant in the Bonneville Mental Health Court of the Idaho Supreme Court. The 

court was established in August of 2002, is located in Idaho Falls, 

ID, and serves up to 30 individuals who come before the court with 

felony or serious misdemeanor offenses and who are diagnosed as 

seriously or persistently mentally ill. He is a graduate of South 

Fremont High School in Saint Anthony, Idaho. 

The next witness will be Sheriff David G. Gutierrez, who was the 

sheriff of Lubbock County in Texas. He has 30 years of law enforcement experience in the sheriff’s office and is currently serving his 

second full term as county sheriff. 

In addition to his current position, he was appointed by Texas 

Governor Rick Perry as presiding officer of the Texas Commission 

on Jail Standards. He is on the Board of Mental Health America 

of Texas, an affiliate of the National Mental Health Association 

and is a member of the Texas Task Force on Mental Health. 

He holds a bachelor’s degree in occupational education, specializing in criminal justice and human services, from Wayland Baptist 

University in Plainview, TX. 

5

Our next witness will be Lieutenant Richard Wall, a police lieutenant with the Los Angeles Police Department. He has served the 

Los Angeles Police Department since his appointment as a police 

officer in 1981 and serves as the department’s mental illness 

project coordinator. 

He received his bachelor’s degree from California State University at Long Beach, a Fulbright fellowship from the National Police 

Staff College in Bramshill, England and is currently a candidate 

for a master’s degree in history from California State University at 

Long Beach. 

Our final witness will be Mr. Leon Evans, executive director of 

the Center for Health Care Services in San Antonio, Texas. Prior 

to holding this position, he served as the director of the Community 

Services Division of the Texas Department of Mental Health and 

Mental Retardation in Austin and is chief executive officer of the 

Dallas County Medical Health Mental Retardation Center in Dallas, Texas, and was executive director of the Tri-County Mental 

Health and Mental Retardation Services in Conroe, Texas. 

He holds both a bachelor’s and master’s degree in special education from the University of Oklahoma. 

Each of our witnesses has already submitted written statements 

to be made part of the record, and I would ask each witness to 

summarize your testimony in 5 minutes or less. And to help you 

stay within the time, there will be little color-coded lights that will 

start off green, will go to yellow, and when your time is up, they 

will turn red. 

I recognize the gentleman from North Carolina, Mr. Coble, and 

the Chairman of the full Committee, Mr. Conyers, with us today. 

And before we start with our witnesses, we will start with a 

video, and we will play that at this time. 

[Video presentation.] 

Mr. SCOTT. Thank you. 

Judge? I think we have seen you before. 

TESTIMONY OF THE HONORABLE STEVEN LEIFMAN, JUDGE, 

CRIMINAL DIVISION OF MIAMI-DADE COUNTY COURT, 11TH 

JUDICIAL DISTRICT, MIAMI, FL 

Judge LEIFMAN. I think so. 

I want to thank the reporter, Michele Gillen, from CBS in Miami, 

who really helped expose just a horrible, horrible issue. As you see, 

it is a pretty sobering thing to watch. 

Mr. Chairman and Members of the Subcommittee, we want to 

thank you very, very much for holding a hearing on this very difficult and critical issue that really for so long has just not see the 

light of day. 

When I became a judge, I had no idea I was becoming the gatekeeper for the largest psychiatric facility in Florida that was our 

jail. 

In 2005, the Miami-Dade County grand jury actually issued a report that was entitled, ‘‘The Criminalization of Mental Illness: A 

Recipe for Disaster, a Prescription for Improvement.’’ After a year 

of investigation, the grand jury disclosed what most of us have 

known in the criminal justice system for many, many years: We 

6

have a mental health crisis in our communities, in our States and 

in this country. 

As surgeon general, Dr. David Satcher once called mental illness 

the ‘‘silent epidemic of our times,’’ unless, of course, you are a judge 

in the criminal justice system, where every single day you see a parade of misery brought on by the consequences of untreated mental 

illness. 

When our country was first founded until the early 1800’s, we 

took people who had serious mental illnesses and put them in jail, 

because, frankly, we just did not know better. In the late 1800’s, 

a nun was visiting a Massachusetts jail and she came across several men who were literally freezing to death in the jail. They had 

no charges pending, but they were there because they had mental 

illness and the community didn’t know what else to do with them. 

She was so horrified by this scene that she actually began a national movement to take people from jail and send them to hospitals. And by 1900, every State had a psychiatric facility in our 

country. However, because there was no real treatment, there was 

no psychiatry, there was no medication, these hospitals grew at a 

ridiculous rate and they became, frankly, houses of horror. 

The normal medication became insulin, electric shock therapy, 

people were getting hurt, and people were dying. In the 1950’s, the 

first psychotropic medication was developed. That was Thorazine, 

and, unfortunately, while it has certain positive uses, it is certainly 

no cure. 

In what would have been his last public bill signing, in 1963, President Kennedy signed a $3 billion authorization that would 

have created a national network of community mental health facilities for the whole country. The idea was that they would take people in these houses of horrors, release them to the communities and 

make sure they had Thorazine. 

Well, unfortunately, and tragically, following the president’s assassination and the escalation of the Vietnam war, not one penny 

of the $3 billion was ever appropriated. However, during that same 

period of time, a whole slew of Federal lawsuits were filed against 

the States for operating these horrible facilities. 

And in 1972, the first major case reached the Federal court. In 

what was really, and still remains, a phenomenal opinion, the Federal court issued an opinion with two parts. The first part of the 

opinion basically orders the deinstitutionalization of the State hospitals. But the second part, which is probably the more important 

and interesting part, tells the States that if you are going to order 

the deinstitutionalization, that you shall, you are required to provide community-based treatment for the people you are releasing. 

Unfortunately, my State, like the rest of the States, only read the 

first half of the opinion, and because no money was ever appropriated to President Kennedy’s national network of community 

mental health facilities, there was absolutely nowhere to absorb 

this population that was now getting released. 

The impact has been staggering. In 1955, there were some 

560,000 people in State hospitals around the country. Today, there 

are between 40,000 and 50,000 people in those same hospitals. 

However, last year, more than 1 million people with serious mental 

illnesses were arrested, we have between 300,000 and 400,000 in 

7

jail and prisons today and another half a million people with serious mental illnesses on probation. Jails and prisons have become 

the asylums of the new millennium. 

And there are two sad and horrible ironies to this. Number one 

is, we never deinstitutionalized. What we in fact did is we created 

the trans-institutionalization. We transferred people from these 

really horrible hell holes of State facilities to these really horrible 

jails that you have seen today. And although this is a horrible facility in Miami-Dade, it is nothing unique to most facilities around 

our country. 

The second, and sadder cruel irony, is that 200 years have now 

passed and jails are once again the primary facilities for people 

with mental illnesses in this country. It is the one area in civil 

rights we have actually gone backwards. 

As a consequence of this situation, we have seen homelessness 

increase, we have seen police injuries increase, we have seen police 

shootings increase, we have wasted tax dollars, and, in effect, we 

have made mental illness a crime in this country. 

In Florida, the police actually initiate more voluntary examinations than the total number of arrests for robbery, burglary and 

grand theft auto combined. In my own community, we have more 

than 20 percent of the people in our jail with serious mental illness. We have over 1,000 people on psychotropic medications every 

day. We are spending $100,000 daily to warehouse this population. 

Three of our nine floors of our main jail are now mental health. 

The conditions are not conducive for treatment. People with mental 

illnesses stay in jail eight times longer than someone without mental illness for the exact same charge, at a cost of seven times higher. 

We have also had 19 people die during an encounter with the police, who have serious mental illness, just since 1999. 

And while more and more judges are becoming involved in this 

issue, the reality is that none of us can fix the problem alone. It 

is going to take a collaborative effort between members of the judiciary and all the non-traditional stakeholders, such as the public 

defenders, the State attorneys, our local, State and Federal Government, which is exactly what the Mentally Ill Offender Treatment 

and Crime Reduction Act sets out to do. 

We were very fortunate in my community that we were able to 

receive a Substance Abuse and Mental Health Administration 

grant to do something similar. 

The results of our collaborative effort have absolutely been astonishing. We have been able to reduce our misdemeanor recidivism 

rate from over 70 percent to just about 20 percent. We are improving our public safety, we are reducing police injuries, our officers 

are getting back to patrol in about half the time it took to make 

an arrest, we are saving our county about $2.5 million annually, 

it is saving lives and in effect decriminalizing mental illness. 

We are hopeful with the legislation that you are looking at we 

will see similar successes nationally, and we will begin to accomplish what the Federal court set out to do 35 years ago. 

Thank you very, very much. 

[The prepared statement of Judge Leifman follows:]

8

PREPARED STATEMENT OF JUDGE STEVE LEIFMAN

Mr. Chairman, Ranking Member Forbes, and Members of the Subcommittee: 

Thank you for the opportunity to testify before you today on the topic of ‘‘Criminal 

Justice Responses to Offenders with Mental Illnesses,’’ and the importance of continued funding of the Mentally Ill Offender Treatment and Crime Reduction Act of 

2004 (MIOTCRA). My name is Steve Leifman, and I serve as Associate Administrative Judge for the County Court Criminal Division of the Eleventh Judicial Circuit 

located in Miami-Dade County, Florida.

The Problem:

As a member of the judiciary, I have seen, first hand, the rampant effects of untreated mental illnesses on both our citizens and our communities. A former Surgeon General once called mental illness the silent epidemic of our times; however, 

for those who work in the criminal justice system nothing could be further from the 

truth. Everyday our courts, jails, and law enforcement agencies are witness to a parade of misery brought on by untreated mental illnesses. Because of lack of access 

to community-based care, our police, correctional officers, and courts have increasingly become the lone responders to people in crisis due to mental illnesses. In fact, 

jails and prisons in the United States now function as the largest psychiatric hospitals in the country. 

According to the National Alliance on Mental Illness, roughly 40% of adults who 

suffer from serious mental illnesses (SMI) will come into contact with the criminal 

justice system at some point in their lives. Unfortunately, these contacts result in 

the arrest and incarceration of people with SMI at a rate vastly disproportionate 

to that of people without mental illnesses. 

Often times, when arrests are made it is for relatively minor offenses or nuisance 

behaviors such as disorderly conduct or simple trespassing. Unfortunately, the result of incarceration tends to be a worsening of illness symptoms due to a lack of 

appropriate treatment and increased stress. Not only does this contribute to extended periods of incarceration resulting from disciplinary problems and the need 

to undergo extensive psychiatric competency evaluations, but it makes it all the 

more difficult for the individual to successfully re-enter the community upon release 

from custody. 

Over time, individuals may become entangled in a cycle of despair between periods of incarceration and jail-based crisis services, followed by periods of disenfranchisement in the community and inevitable psychiatric-decompensation. In addition 

to placing inappropriate and undue burdens on our public safety and criminal justice systems, this maladaptive cycle contributes to the further marginalization and 

stigmatization of some of our society’s most vulnerable, disadvantaged, and underserved residents. 

With a prevalence rate 2 to 3 times greater than the national average, MiamiDade County has been described as home to the largest percentage of people with 

serious mental illnesses of any urban community in the United States. It is estimated that at least 210,000 people, or 9.1% of the general population, experience 

serious mental illnesses; yet fewer than 13% of these individuals receive any care 

at all in the public mental health system. The reason for this is that Miami-Dade 

County, like most communities across the United States, lacks adequate crisis, 

acute and long-term care capacity for people with serious mental illnesses. 

On any given day, the Miami-Dade County Jail houses between 800 and 1200 defendants with serious mental illnesses. This represents approximately 20% of the 

total inmate population, and costs taxpayers millions of dollars annually. In 1985, 

inmates with mental illnesses occupied two out of three wings on one floor of the 

Pre-Trial Detention Center. Today, individuals with mental illnesses occupy 3 out 

of 9 floors at the Pre-Trial Detention Center, as well as beds in 4 other detention 

facilities across the county. The Miami-Dade County Jail now serves as the largest 

psychiatric facility in the state of Florida. People with mental illnesses remain incarcerated 8 times longer than people without mental illnesses for the exact same 

offense, and at a cost 7 times higher. With little treatment available, many individuals cycle through this system for the majority of their adult lives; however, for 

some the outcome has been far more tragic. Since 1999, 19 people experiencing 

acute episodes of serious mental illness have died as the result of altercations with 

law enforcement officers. The most recent event occurred less than two weeks ago. 

Unfortunately, the situation in Miami-Dade County is not unique to South Florida, nor is it the result of deliberate indifference on the part of the criminal justice 

system. Our law enforcement personnel were never intended to be primary mental 

health providers and our corrections facilities are ill-equipped to function as psychiatric hospitals for the indigent. The fact is we have a mental health crisis in our 

9

communities, in our states, and in this country; and our jails and prisons have become the unfortunate and undeserving ‘‘safety nets’’ for an impoverished system of 

community mental health care. 

In the State of Florida alone, approximately 70,000 people with serious mental illnesses requiring immediate treatment are arrested and booked into jails annually. 

In 2004 and 2005, the number of examinations under the Baker Act (Florida’s involuntary mental health civil commitment laws) initiated by law enforcement officers 

exceeded the total number of arrests for robbery, burglary, and motor vehicle theft 

combined. Moreover, during these same years, judges and law enforcement officers 

accounted for slightly more than half of all involuntary examinations initiated. A 

2006 report published by the National Association of State Mental Health Program 

Directors Research Institute found that Florida continues to rank 48th nationally 

in per capita spending for public mental health treatment. As a result, fewer than 

25% of the estimated 610,000 adults in Florida who experience serious mental illnesses receive any care at all in the public mental health system. 

The National GAINS Center estimates that nationwide over one million people 

with acute mental illnesses are arrested and booked into jails annually. Roughly 

72% of these individuals also meet criteria for co-occurring substance use disorders. 

On any given day, between 300,000 and 400,000 people with mental illnesses are 

incarcerated in jails and prisons across the United States and another 500,000 people with mental illnesses are on probation in the community. 

The consequences of the lack of an adequately funded, systemic approach to these 

issues have included increased homelessness, increased police injuries, and increased police shootings of people with mental illnesses. With little treatment available, many individuals cycle through the system for the majority of their adult lives. 

In addition, the increased number of people with serious mental illnesses involved 

in the criminal justice system has had significant negative consequences for the administration of the judicial system, as well as public safety, and government spending generally. The cost to Miami-Dade County alone to provide largely custodial care 

to people with mental illnesses in correctional settings is roughly $100,000 a day, 

or more than $36 million per year. 

Unfortunately, the public mental health system in the United States is often 

funded and organized in such a way as to ensure that we provide the most expensive services, in the least effective manner, to fewest number of individuals (i.e, 

those in acute crisis). As a result, the system is arguably set up to fail. In many 

communities, for example, people who experience serious mental illnesses, but lack 

resources to access routine care in the community can only receive treatment after 

they have become profoundly ill and have crossed the unreasonable and catastrophic 

threshold of ‘‘imminent risk of harm to self or others.’’ At this point, the individual 

is typically eligible for crisis stabilization services, but nothing more. Once they are 

stabilized and no longer present as a ‘‘risk of harm,’’ they are often discharged back 

to the same community where they were unable to receive services to begin with, 

only to get sick again and require another episode of crisis stabilization services. 

The result is that instead of investing in prevention and wellness services, public 

mental health funds are disproportionately allocated to costly crises services and inpatient hospital care.

Historical Perspective:

The current problems and weaknesses of the community mental health system 

can be traced to historical events that have shaped public policy and attitudes toward people with mental illnesses over the past 200 hundred years. From the time 

the United States was founded until the early 1800’s, people with mental illnesses 

who could not be cared for by their families were often confined under cruel and 

inhumane conditions in jails and almshouses. During the 19th century, a movement, 

known as moral treatment emerged which sought to hospitalize rather than incarcerate people with mental illnesses. Unfortunately, this well-intentioned effort failed 

miserably. 

The first public mental health hospital in the United States was opened in Massachusetts in 1833. The institution contained 120 beds, which was considered by experts at the time to be the maximum number of patients that could be effectively 

treated at the facility. By 1848, the average daily census had grown to approximately 400 patients, and the state was forced to open additional public mental 

health facilities. A similar pattern was seen across the country as more and more 

states began to open public psychiatric hospitals. By the mid-1900’s, nearly 350 

state psychiatric hospitals were in operation in the United States; however overcrowding, inadequate staff, and lack of effective programs resulted in facilities providing little more than custodial care. Physical and mental abuses were common 

10

and the widespread use of physical restraints such as straight-jackets and chains 

deprived patients of their dignity and freedom. 

Around this same time, advances in psychopharmacology lead to the idea that 

people with mental illnesses could be treated more effectively and humanely in community-based settings. In 1963, legislation was signed which was intended to create 

a network of community-based mental health providers that would replace failing 

and costly state hospitals, and integrate people with mental illnesses back into their 

home communities with comprehensive treatment and services. In what would be 

his last public bill singing, President Kennedy signed a $3 billion authorization to 

support this movement from institutional to community-based treatment. Tragically, 

following President Kennedy’s assassination and the escalation of the Vietnam War, 

not one penny of this authorization was ever appropriated. 

As more light was shed on the horrific treatment of people with mental illnesses 

at state psychiatric hospitals, along with the hope offered by advances in psychotropic medications, a flurry of federal lawsuits were filed which ultimately resulted 

in the deinstitutionalization of public mental health care by the Courts. Unfortunately, there was no organized or adequate network of community mental health 

centers to receive and absorb these newly displaced individuals. The result is that 

today there are more than five times as many people with mental illnesses in jails 

and prisons in the United States than in all state psychiatric hospitals combined. 

In 1955, some 560,000 people were confined in state psychiatric hospitals across 

the United States. Today fewer than 50,000 remain in such facilities. Over this 

same period of time, the number of psychiatric hospital beds nationwide has decreased by more than 90 percent, while the number of people with mental illnesses 

incarcerated in our jails and prison has grown by roughly 400 percent. Over the last 

ten years, we have closed more than twice as many hospitals as we did in the previous twenty and, if this weren’t bad enough, some of the hospitals that were closed 

were actually converted into correctional facilities which now house a disproportionate number of inmates with mental illnesses. 

The sad irony is that we did not deinstitutionalize mental health care. We allowed 

for the trans-institutionalization of people with mental illnesses from state psychiatric facilities to our correctional institutions, and in the process, made our jails 

and prisons the asylums of the new millennium. In many cases, the conditions that 

exist in these correctional settings are far worse than those that existed in state 

hospitals. The consequences of this system have been increased homelessness, increased police injuries, increased police shootings of people with mental illnesses, 

critical tax dollars wasted, and the reality that we have made mental illness a 

crime; or at the very least a significant risk factor for criminal justice system involvement. In 200 years, we have come full circle, and today our jails are once again 

psychiatric warehouses. To be fair, it’s not honest to call them psychiatric institutions because we do not provide treatment very well in these settings. 

What is clear from this history is that the current short-comings of the community 

mental health and criminal justice systems did not arise recently, nor did they arise 

as the result of any one stakeholder’s actions or inactions. None of us created these 

problems alone and none of us will be able to solve these problems alone. As a society, we all must be a part of the solution.

The Solution:

Just as I have been witness to the tragic effects of untreated mental illnesses, I 

have also had the privilege of observing and working with many dedicated and tireless individuals who are committed to bringing about transformation of the public 

mental health system and helping to ensure that a diagnosis of a mental illness is 

no longer a risk factor for arrest, incarceration, or worse. 

Across the United States, effective collaborations have been forged, involving diverse arrays of traditional and nontraditional stakeholders, such as providers, consumers, and family members within the mental health care, substance abuse treatment, and social services fields; law enforcement and corrections professionals; representatives from State and local governments and agencies; and members of the 

judiciary and legal community. These partnerships have established many successful, innovative initiatives serving people with mental illnesses involved in the justice 

system or at risk of involvement in the justice system, such as mental health courts, 

pre-trial diversion programs, jail re-entry programs, and specialized crisis response 

programs for law enforcement officers. In addition, the identification and implementation of promising programs and evidence-based practices such as assertive community treatment, intensive case management, integrated dual-diagnosis treatment, 

and supportive housing have resulted in more successful and adaptive integration 

for people with serious mental illnesses in the community. 

11

The Mentally Ill Offender Treatment and Crime Reduction Act of 2004 

(MIOTCRA), which authorized the Justice and Mental Health Collaboration Program, administered through the Bureau of Justice Assistance, U.S. Department of 

Justice, has been crucial to facilitating collaborative community-wide solutions to 

people with mental illnesses in the criminal justice system. Local communities 

across the United States that have received funding have been able to design and 

implement highly successful, collaborative initiatives between criminal justice and 

mental health systems. This funding has helped to reverse the criminalization of 

mental illnesses, improve public safety, reduce recidivism to jails and hospitals, 

minimize wasteful acute care spending, and allowed those with mental illnesses to 

live a life of recovery in the community. It is imperative that Federal funding of 

such criminal justice/mental health initiatives be continued. 

I’m proud to report that Miami-Dade County has been the recipient of Federal 

support that has helped place my community at the forefront in the nation in working to de-criminalize mental illnesses and resolve this problem of untreated mental 

illnesses. Six years ago, the Eleventh Judicial Circuit Criminal Mental Health 

Project (CMHP) was formed following a two-day summit meeting of traditional and 

non-traditional stakeholders who gathered to review how the Miami-Dade community dealt with individuals involved in the criminal justice system due to untreated 

mental illnesses. The stakeholders were comprised of law enforcement agencies, the 

courts, public defenders, state attorneys, social services providers, mental health 

professionals, consumers, and families. The outcome of the summit was both informative and alarming. Many participants were surprised to find that a single person 

with mental illness was accessing the services of almost every agency and professional in the room; not just once, but again and again. Participants began to realize 

that people with untreated mental illnesses may be among the most expensive population in our society not because of their conditions, but because of the way they 

are treated. 

The result of this summit was the establishment of the CMHP, which was designed and implemented to divert people with serious mental illnesses who commit 

minor, misdemeanor offenses away from the criminal justice system and into community-based care. The program operates both pre-booking and post-booking jail diversion programs; and brings together the resources and services of healthcare providers, social-service agencies, law enforcement personnel, and the courts. 

In 2003, the CMHP in collaboration with the Florida Department of Children and 

Families received a Federal Targeted Capacity Expansion grant from the Substance 

Abuse and Mental Health Services Administration’s Center for Mental Health Services. With technical assistance provided by The National GAINS Center’s TAPA 

Center for Jail Diversion, this funding enabled significant growth within the CMHP 

which has enabled more effective and efficient response to people with mental illnesses involved in the criminal justice system or at risk of involvement in the criminal justice system. 

As a result of the services and training provided by the CMHP, individuals in 

acute psychiatric distress in Miami-Dade County are more likely to be assisted by 

law enforcement officers in accessing crisis services in the community without being 

arrested. Individuals who are arrested and booked into the jail are evaluated, and 

if appropriate, transferred to a crisis stabilization unit within 24–48 hours. Upon 

stabilization, legal charges are typically dismissed, and individuals are assisted at 

discharge with accessing treatment services, housing, and other entitlements in the 

community. 

The CMHP has resulted in substantial gains in the effort to reverse the criminalization of people with mental illnesses, and serves as a testament to the value and 

potential of true cross-systems collaboration. Key outcomes include reductions in recidivism among misdemeanant offenders in acute psychiatric distress from over 70% 

prior to program implementation to 22% last year, improved public safety, reduced 

police injuries, millions in tax dollars saved, and lives saved. To date, more than 

1,100 law enforcement officers in the county from 25 of the 32 agencies in operation, 

have been trained to more effectively identify and respond to mental health emergencies. The idea was not to create new services, but to merge and blend existing 

services in a way that was more efficient, pragmatic, and continuous across the system. The Project works by eliminating gaps in services, and by forging productive 

and innovative relationships among all stakeholders who have an interest in the 

welfare and safety of one of our community’s most vulnerable populations. 

It is imperative that communities be given the resources to work collaborative to 

identify and implement promising programs and evidence based practices that will 

improve the response of the public mental health system and the criminal justice 

system to people with mental illnesses and/or co-occurring substance use disorders 

12

involved in the criminal justice system or at risk of involvement in the criminal justice system. 

The health and well-being of our communities across the United States are inextricably linked to the health and well-being of our residents. To the extent that we 

continue to allow people with mental illnesses to revolve in cycles of disenfranchisement and despair, our communities will suffer. To the extent that the interventions 

and services offered are fragmented and do not embrace the concepts of recovery 

and hope, our communities will suffer. There is a need for a coordinated effort to 

replicate and expand promising programs and strategies targeting people with mental illnesses involved in the criminal justice system or at risk of involvement in the 

criminal justice system throughout the United States.

PLEASE SUPPORT CONTINUED FUNDING OF THE MENTALLY ILL OFFENDER TREATMENT AND CRIME REDUCTION ACT OF 2004.

Mr. SCOTT. Thank you. We apologize that we didn’t give you the 

1-minute notice. I think we have it figured out now. 

Judge LEIFMAN. Thank you. Did I make my time? [Laughter.] 

Mr. SCOTT. We are going to continue with the—we have a series 

of votes coming up, so we will hear from one more witness, then 

we will have to break for a few minutes. 

Mr. Perry? 

TESTIMONY OF PHILLIP JAY PERRY, COURT PARTICIPANT, 

BONNEVILLE MENTAL HEALTH COURT, BOISE, ID 

Mr. PERRY. I would like to express my appreciation for being invited to speak here today. 

I have had urges to hurt people since I was in high school. It 

wasn’t until I dropped out of college and tried to jump off a grain 

elevator to kill myself did I begin to realize that I had a problem. 

My parents, who have always been very supportive of me and my 

illness, coaxed me into going and talking to someone about my 

problems after that first incident. 

That was the first of many times to come that I was institutionalized in a mental health facility. It was there that I found out 

that everyone doesn’t hear voices to tell them to do things like I 

do. I was diagnosed with a mental illness, and that diagnosis was 

labeled Schizoaffective Disorder, which essentially means that 

when not properly medicated, I am delusional with a mood disorder 

and that disorder being clinical depression. 

This was also the first of four times that I have been court committed to the State psychiatric hospital. There, they put me on a 

lot of medications with side effects that I wasn’t too fond of. So 

when I got out of the hospital, I stopped taking my medications because I found that marijuana helped ease my voices just as good 

as the medications did, without the side effects that no one would 

want to live with for the rest of their lives. 

There was, however, one bad aspect of the marijuana use: It was 

illegal, which means I could get in trouble with the law for using 

it. And that is exactly what I did. I have counted it up and, including the incarcerations in correctional facilities, I have been institutionalized 26 times in my adult life. That would be approximately 

14 years. 

Since the stays in the correctional facilities were always a result 

of my drug use, which, in turn, was a factor in trying to help selfmedicate my voices, all these institutionalizations were a direct result of my illness. 

13

Every time I have been put in one of the places, they have put 

me in a drug and alcohol program because I have a drug and alcohol problem. Even in jail they had the AA program, but it seemed 

no matter how hard I tried, every time I got out I would revert 

back to my old habits and relapse and end up using again no matter how much sober time I had under my belt. 

Fortunately, for me, though, I was introduced to the Mental 

Health Court Program this last time that I was in jail. This program has changed my life for the best. I feel I can live a sober and 

relatively mentally stable life because of the tools and skills that 

the program has taught me. I do feel the program is a great program in itself. 

I can’t speak for any of the other mental health programs around 

the United States, but they wouldn’t be as good as ours is if it 

weren’t for the people like Judge Moss, Eric Olson and Randy Rodriquez. What I am trying to say is that it wouldn’t be as successful 

if it weren’t for the people who run it like the ones I mentioned, 

who are caring, compassionate people. 

[The prepared statement of Mr. Perry follows:]

PREPARED STATEMENT OF PHILLIP JAY PERRY

I’ve had ‘‘urges’’ to hurt people since I was in high school. It wasn’t until I 

dropped out of college and tried to jump off a grain elevator to kill myself did I 

begin to realize that I had a problem. My parents who have always been very supportive of me and my illness coaxed me into going and ‘‘talking’’ to someone about 

my problems after that first incident. 

That was the first of many times to come that I was to be institutionalized in a 

mental health facility. It was there that I found out that everyone doesn’t hear 

voices to tell them to do things like I do. I was diagnosed with a mental illness and 

that diagnosis was labeled Schizoaffective Disorder which essentially means that 

when not properly medicated I am delusional with a mood disorder. That disorder 

being clinical depression. 

This was also the first of four times that I’ve been court committed to the state 

psychiatric hospital. There, they put me on a lot of medications with side-effects 

that I wasn’t too fond of. So when I got out of the hospital, I stopped taking my 

medications because I found that marijuana helped ease my ‘‘voices’’ just as good 

as the medications did without the side effects that no one would want to have to 

live with for the rest of their lives. 

There was, however, one bad aspect of the marijuana use. It was illegal. Which 

means I could get in trouble with the law for using it. And that is exactly what I 

did. I’ve counted it up and including the incarcerations in correctional facilities, I’ve 

been institutionalized 26 times in my adult life. Since the stays in the correctional 

facilities were always a result of my drug use which in turn was a factor in trying 

to help self-medicate my ‘‘voices,’’ all these institutionalizations were a direct result 

of my illness. 

Every time I’ve been put in one of the places they have put me in a drug and 

alcohol program because I have a drug and alcohol problem. Even in jail they had 

the AA program, but it seemed no matter how hard I tried, every time I got out 

I would revert back to my old habits and relapse and end up using again no matter 

how much sober time I had under my belt. 

Fortunately for me though, I was introduced to the Mental Health Court Program 

the last time I was in jail. This program has changed my life for the best. I feel 

I can live a sober and relatively mentally stable life because of the tools and skills 

that the program has taught me. I do feel the program is a great program in itself. 

I can’t speak for any of the other mental health court programs, but they wouldn’t 

be as good as ours is if it weren’t for the people like Judge Brent Moss, Eric Olson, 

and Randy Rodriquez. What I’m trying to say is that it wouldn’t be as successful 

if it weren’t for the people who run it like the ones I mentioned, who are caring, 

compassionate people.

Mr. SCOTT. Well, thank you very much. Thank you. 

14

And, Sheriff, we will be back in about—I think we have one 15-

minute—we have four votes, so it will probably be close to half an 

hour. 

[Recess.] 

Mr. SCOTT. The Committee will come to order, and I appreciate 

your patience. 

Sheriff Gutierrez? 

TESTIMONY OF SHERIFF DAVID G. GUTIERREZ,

LUBBOCK COUNTY SHERIFF’S OFFICE, LUBBOCK, TX 

Sheriff GUTIERREZ. Mr. Chairman, Vice Chairman, distinguished 

Members of the Subcommittee, my name is David Gutierrez, sheriff 

of Lubbock County. I appreciate the opportunity to speak on the 

mental health issues in the criminal justice system. 

As sheriff, I deal with the frontline issues; as Texas sheriff, with 

254 counties in the State of Texas. In my lengthy law enforcement 

experience, I have recognized and understood the initial impact on 

the frontline system. As sheriff and the keeper of the jail, we also, 

I also understand, as well as many sheriffs across the country, the 

enormous responsibility, the costly responsibility of maintaining 

the mental health issues in detention facilities. 

In Lubbock County, law enforcement on the front end, the peace 

officer is trained to take care of the situation, the problem. What 

we have found is, as sheriff, looking at the facility and the number 

of assaults, arrests, the number of suicide attempts and actual suicides in a detention facility concern me greatly. 

We pulled in our local mental health provider to look at a memorandum of understanding when I became sheriff, and what we did 

at that time was coordinate from the front end level with the local 

mental health providers to form a memorandum of understanding 

and we dealt with to provide on-call, on-site assistance by their crisis intervention counselors to come to the scene when a law enforcement officer is dealing with a situation which he may believe 

may be the result of unusual behavior. 

Number two is, if the individual is arrested and brought into the 

county jail, that that crisis team, once it is recognized by the detention officer, that the crisis team is called and arrive within 4 hours 

at the county jail to assist us in the continuum of care, to help us 

evaluate that individual. We also treat all individuals as indigents 

so that care services can be provided for them. 

Now, while this MOU was just the beginning step locally, it is 

not the end. As sheriff and chairman of the Texas Commission on 

Jail Standards, we are looking at the whole State of Texas. The 

legislature has directed the Texas Commission on Jail Standards 

to look at the frontline issues across the State when it comes to 

mental health issues. 

Early in the introduction, you have stated all the true concerns 

that we are facing as law enforcement officers across the country, 

and as a result of that, we are looking statewide at the front end. 

And the legislature directed the Texas Commission on Jail 

Standards to look at the issues. What we have found is that in the 

institutional division, the prison system in Texas, there is a chart 

here that out of 151,000 individuals incarcerated in the State of 

Texas, 45,000 were actually in fact consumers of the mental health 

15

system. They were actually patients at one time of the State mental health system—45,000, 30 percent. This was the result of a 

2005 report that the legislature performed on the prison system. 

The Texas county State system, the county system, there are over 

70,000 individuals. 

When looking at the 45,000, those individuals come in from the 

frontline, on the street, from local cities and counties and sent to 

the State institution. What we need to identify, and what we are 

identifying this time, as the chairman of the Subcommittee that 

oversaw the 254 counties and the recommendations to the legislature, is that we oversee the county jails and develop a medical assessment, suicidal mental health evaluation at the intake, when an 

individual is arrested, also to cross-reference the statewide care 

system, which is a statewide database for all individuals who have 

received treatment in the State mental health system, to identify 

cross-reference with that database to determine if in fact they are 

mental health consumers when they arrive into the beginning of 

the criminal justice system. So in that place, we may possibly divert these individuals. 

We are also requiring every county jail to have a diversion plan 

and a memorandum of understanding with their local mental 

health provider. That means to get them to communicate, to talk, 

to assist them in the continuum of care and medical protocol for 

their medical issue so that we can continue that care throughout 

the criminal justice system and possibly divert them from the 

criminal justice system. 

My concern is, when individual justice must be done, individuals 

that violate the law must be incarcerated. The problem is, did the 

individual intentionally and knowingly violate the law or was it a 

result of a mental health disability? If that in fact is the case, we 

must deal with the mental health issue prior to dealing with the 

violation of the law. 

I want to thank you for allowing me to be here today, and thank 

you for your commitment to this issue. There are millions of individuals, particularly families, who have been impacted by the lack 

of appropriate care in facilities for the men and women with mental health impairments. 

Too often an individual with mental health impairments become 

the responsibility of the criminal justice system, because it is easier 

and safer to have them behind bars rather than in society. And 

with your help today, we can work together to create some State 

and national guidelines to divert these individuals and to assist 

them with proper care. 

Thank you. 

[The prepared statement of Sheriff Gutierrez follows:]

PREPARED STATEMENT OF DAVID G. GUTIERREZ

Mr. Chairman, Vice-Chair, and distinguished Members, my name is David Gutierrez, Sheriff of Lubbock County, Texas. I want to thank you for the opportunity to 

speak to you about some serious issues we are facing in the criminal justice system 

today. As a Sheriff and a 30-year veteran of law enforcement, I have seen our criminal justice system evolve and have faced the tremendous challenges in the growth 

of not only our law enforcement on the front line—the first responders—but in the 

growth of our detention and institutional systems. 

In Texas, as in many states, the Sheriff is the keeper of the jail. While we continue to provide law enforcement services and maintain peace in the county, the 

16

Sheriff receives all individuals arrested by every peace officer, including city police 

officers, county deputies, state police, and federal agencies. Law enforcement officers 

are trained to maintain the peace and arrest individuals when laws are violated. 

During initial contact by law enforcement officers, many individuals interviewed 

may be disoriented and become combative and result in additional charges, such as 

Aggravated Assault on a Peace Officer or Attempted Capital Murder on a Peace Officer, being added to further compound the original breach of the peace. These 

charges, while valid, may be the result of a mental health or special needs issue. 

Most peace officers across the country are not trained on recognizing these symptoms. 

Once arrested, the individual is transported to the local county jail, where they 

are processed and the uncooperative individual is then treated accordingly. Additional charges may be added there if a detention officer is assaulted. 

The reality is that the jails and prisons of criminal justice systems nationwide 

have become the institutions at which individuals with mental impairments/special 

needs are placed. There are no standardized methods used to identify them prior 

to or during the incarceration process. When mentally impaired offenders arrive at 

correctional facilities the jail staff, in most cases, does not have the professional 

training or understanding to address their needs or the circumstances surrounding 

their incarceration. As a result, attempted and achieved suicides, inmate-to-inmate 

assaults and inmate-to-officer assaults have dramatically increased in our jail and 

prison facilities. 

In 1998, in Lubbock County, Texas, a ‘‘Memorandum of Understanding’’ (MOU), 

was developed with the Regional Mental Health and Mental Retardation unit to:

• Provide on-call Crisis Intervention Counselors to come to the scene when law 

enforcement officers believe the suspect being detained may have a mental 

disorder to indicate a need for diversion prior to arrest.

• Utilize an on-site mental health assessment at the correctional facility to determine if a suspect has a possible mental health issue, and if that assessment indicates a mental health issue, diversion to a local mental health facility could be an option in lieu of incarceration.

• If jail officials, during the booking process, have reason to believe an individual may have a mental health issue, the Crisis Intervention team will arrive within 4 hours at the jail facility and interview the individual for mental 

health services

• All individuals arrested are treated as indigents while incarcerated and receive treatment and medication for continuum of care.

The MOU in Lubbock was a major step in assisting individuals entering the 

criminal justice system with mental health/special needs issues; this was just the 

beginning of a front line attempt to an enormous problem. One of the most pressing 

problems is that even though we have diversion plans in effect there are no diversion facilities statewide to place these individuals. In my opinion, this is one of the 

crucial areas that we are deficient in. 

While we, as Sheriffs’, dealt with these issues, the State of Texas was not naı ̈ve 

to these issues. In 1996, the Texas State Legislature statutorily allowed medical information, in accordance with the federal Health Insurance Portability and Accountability Act, to be disseminated between the medical profession and the criminal justice system. This allowed for a continuum of care for individuals which are incarcerated. 

In 2006, the Texas Department of Criminal Justice and the Department of State 

Health Services cross-referenced each other’s offender/client databases to establish 

a prevalence rate of offenders who were former or current clients of the public mental health system. The following is the result of the state’s cross referencing:

17

In addition, a 2005 report prepared by the Texas Commission on Jail Standards, 

found that 29% of inmates sentenced to prison had been identified as being a former 

mental health client, but had not been identified as an individual with mental 

health issues while at the county jail when processed. 

Following those findings, a committee directed by the Texas Legislature was 

formed to determine what can be done to appropriately handle the prevalence of offenders with mental health impairments and the lapses in identification, along with 

other issues. The committee recommended the following:

• All 254 Counties and their respective Sheriffs’ Offices in Texas develop and 

have a MOU and Diversion Plan for individuals with mental impairments 

with the 41 Regional Mental Health and Mental Retardation units;

• That the Texas Commission on Jail Standards oversee as part of annual jail 

inspections:

• A medical screening form is part of the initial intake;

• A cross reference with the state’s C.A.R.E. system is performed on all individuals arrested to determine if an individual is a client of the public mental health system. This will assist law enforcement, jail officials, the public 

defender and the county/district attorney’s offices in the adjudication of 

their cases.

• That the C.A.R.E. system be made available by computer to be accessed by 

any Texas law enforcement officers. This information should be available immediately while the officer is making contact with the individual/suspect to 

help determine an appropriate course of action by the officer for possible diversion and;

• That all 80,000 Texas Peace officers have Crisis Intervention Training as part 

of their 40 hours of state-mandated continuing education. This would assist 

with early-assessment during the initial contact with an offender and possible 

diversion to the criminal justice system.

The impact to the families of mentally impaired offenders can be, and too frequently is, catastrophic. Many families with a mentally impaired family member 

turn to the law enforcement community as a last result, no longer being able to deal 

with the individual’s violent tendencies. This cry for help usually comes at a point 

of calamity with their mentally impaired family member. Due to their extreme or 

erratic behavior, many offenders with mental impairments are injured or killed 

while in contact with law enforcement during this time of crisis. Law enforcement 

and detention administrators across the United States are greatly concerned that 

they do not have the proper tools, training, and information at their disposal to ensure that offenders with mental impairments are dealt with in a safe and suitable 

manner, which would provide positive outcomes for everyone involved in these situations. 


DG.eps
18

The bottom line is that we need to hold those who intentionally violate the law 

accountable, and help those whose condition makes them incapable of intentionally 

violating the law. 

In conclusion, I want to thank you for your commitment to this issue. There are 

millions of families impacted by the lack of appropriate facilities for men and 

women with mental health impairments. Too often an individual with mental health 

impairments becomes the responsibility of the criminal justice system because it is 

easier and safer to have them behind bars rather than in society. With your help 

we can work together to create state and national guidelines that will divert these 

individuals to more appropriate facilities.

Mr. SCOTT. Thank you. 

Mr. Wall? 

LIEUTENANT RICHARD WALL, LOS ANGELES

POLICE DEPARTMENT, LOS ANGELES, CA 

Mr. WALL. Thank you, Mr. Chairman. 

Distinguished Members, a man I will call Mike lives in south Los 

Angeles. He is a 31-year-old African-American male with his first 

documented contact with the Los Angeles Police Department was 

January 21, 1993, when, at the age of 17, he attempted to take his 

life to stop the voices in his head. 

Over the next 12 years, he was placed on a number of mental 

health holds, as his delusions became more severe, his actions more 

desperate. During the 17-month period between July of 2004 and 

November of 2005, Mike was repeatedly refusing to take his medications and fell into a pattern. On the 15th, 16th, 17th of every 

month, he would begin acting out; on the 18th, 19th and 20th, he 

would become violent; on the 21st, 22nd and 23rd, he would attempt suicide by cop. 

During this 17-month period, his actions generated 48 calls for 

police services, resulting in 22 mental health holds. On the three 

occasions he attempted suicide by cop, I asked him, I talked to him 

about it, I said, ‘‘Why did you want to kill yourself? Why did you 

want the police to kill you?’’ And his response is very simple: ‘‘To 

stop the voices in my head.’’

While Mike’s story is remarkable, unfortunately it is repeated in 

cities and towns across this Nation on an hourly basis, if not more 

frequently. 

Laws identifying who can place a patient on a mental health 

hold vary, but one option is available to everyone. At 3 a.m., when 

there is a mental health crisis call, there is one agency that will 

respond, and that is law enforcement. You dial 911 and you will 

get police officers who will use the best training that they have to 

get this patient to the appropriate mental health facility. 

An interesting thing to note, in 2004, I conducted a review of Los 

Angeles Police Department calls for service involving the mentally 

ill. Ninety-two percent of those calls came from family members 

and caregivers. This is contrary to the stereotype of the almost 

mentally ill person who assaults somebody walking down the 

street. While that does happen on occasion, it is more frequently 

that the victim of the assault is a family member and then the police are called to respond. 

There are three basic models to respond for law enforcement: 

One is the CIT Program, which we have talked about; the second 

is a co-response model, which partners the Department of Mental 

19

Health clinician or specialist with a police officer, and the last is 

one that is handled by most county departments of mental health. 

In Los Angeles, we have a combination where we have all three. 

We have CIT, we have a co-response model, and we have a very 

active county department of mental health who has its psychiatric 

mobile response teams, or PMRTs. 

We respond to a number of crisis calls. They include suicide in 

progresses, barricaded suspect scenarios, and I will point out that 

on barricaded suspect scenarios in Los Angeles, 37 percent of those 

calls, over one-third, resulted in no criminal charges being filed. 

The subject was placed on a mental health hold. 

We also respond, unfortunately, to a number of calls within the 

Los Angeles County school district, within the Los Angeles Unified 

School District, in which case twice a week our teams are responding to crisis calls involving children under the age of 10 who are 

actively attempting suicide. Think about that for a second: Children under the age of 10, twice a week, in Los Angeles, are attempting suicide, and we are responding to those calls. 

This is clearly an issue that has been forced on law enforcement, 

and, in essence, law enforcement has become the de facto mental 

health triage system for the Nation. 

The important thing here is to remember that our goal is to provide training for these officers. The goal of training is to reduce violent encounters of the mentally ill, that is it. And we need your 

support through the Bureau of Justice grants and other funding to 

help fund this type of training. 

Again, we have a very unique situation within the city and county of Los Angeles, within the city, specifically. We have a program 

that is unrivaled anywhere, and it is truly as a result of the leadership at the top. This can’t be done without the buy-in at the top 

of the ladder. 

Dr. Marvin Southard, the director of the Department of Mental 

Health for the County of Los Angeles, and Chief William Bratton, 

the chief of police of Los Angeles, have committed to expand these 

programs and work on these programs. 

In 2003, we had 13 officers assigned to my unit. Today, we have 

about 45 officers and 25 clinicians, for a total of 70 people, and our 

next budget for next fiscal year has even more of an increase. The 

old saying that actions speak louder than words, well, I have to say 

that the actions of Chief Bratton and Dr. Southard are truly deafening. 

Our motto in my office is very simple, and I truly believe in this, 

our motto is, ‘‘Every day you go to work you save a life.’’ And I 

truly believe that. We have encountered people in severe crisis who 

are at high risk for suicide, high risk for death at the hands of another, high risk for suicide by cop. 

And every time we respond to a call, it is not the sexy stuff of 

running into the burning building and rescuing the children, but 

every time we encounter a 90-year-old woman who can’t meet the 

basic needs for food, shelter and clothing as a result of her mental 

illness, she will die in that situation if it wasn’t for the officers’ actions that we take every day. 

And, again, we appreciate your continued support in this area. 

Thank you. 

20

[The prepared statement of Mr. Wall follows:]

PREPARED STATEMENT OF RICHARD WALL

Overview 

A man I will call ‘‘Mike’’ lives in South Los Angeles. He is a 31 year old, African 

American male, who suffers from mental illness. He suffers from schizophrenia, depression, and bi-polar disorder. His first documented contact with the Los Angeles 

Police Department was on January 21, 1993, when at the age of 17, he attempted 

to commit suicide to stop the voices in his head. Over the next 12 years, he was 

placed on a number of mental health holds as his delusions became more severe and 

his actions became more desperate. During the 17-month period between July 2004 

to November 2005, ‘‘Mike’’ was repeatedly refusing to take his medications and fell 

into a pattern of suicidal behavior. The pattern being:

• On the 15, 16, 17th of the month, he would begin acting out;

• On the 18th, 19th, and 20th, he became violent, assaulting either a neighbor 

or family member; and

• On the 21st, 22nd, and 23rd he would become suicidal.

During this 17-month period, his actions generated 48 calls for police services resulting in 22 mental health holds. On three occasions he attempted to commit Suicide by Cop (SbC) and was the subject of a Barricaded Suspect scenario necessitating a response by the SWAT team and an evacuation of the surrounding neighborhood, displacing approximately 50 residents. On the occasions that he tried SbC, 

he called the police, advised them that he had a gun and would ‘‘kill the police.’’ 

When the police responded, he would place an object inside his jacket and feign 

drawing a weapon, hoping to draw police gunfire. When I asked him why he wanted 

to have the police kill him, he replied, ‘‘To stop the voices in my head.’’

While ‘‘Mike’s’’ story is remarkable, unfortunately it is repeated in cities and 

towns throughout this nation on a daily, if not hourly basis. Clients suffering from 

serious mental illnesses that either refuse or have no access to treatment, or their 

treatment is ineffective, generate calls for service for their mental health crises. 

Laws identifying who can place a client suffering from severe mental illness on a 

mental health hold vary from state to state; however, one option is consistent 

throughout the nation. At 3:00 AM, when a client is suffering from a serious episode 

of mental illness, there is one place that family members and caregivers can call 

to help. That number is 911. And in every jurisdiction in the nation, law enforcement officers will respond to help get the client to the appropriate mental health 

facility. In fact, in some jurisdictions, like those in Los Angeles County, a doctor 

with 30 years experience in a medical emergency room or a paramedic with 20 years 

of experience cannot, by law, place a suicidal client on a mental health hold. However, a police officer, the day he or she graduates from the police academy can. As 

a result, the onus of evaluating and obtaining appropriate mental health treatment 

falls to law enforcement who have become have become the de facto mental health 

triage service providers. 

In 2004, I conducted a review of calls that were identified as involving an episode 

of mental illness in the City of Los Angeles during the previous year. That review 

revealed that 92 percent of the calls for service that involved persons suffering from 

mental illness, the reporting person was either a family member or a caregiver. 

Contrary to the stereotypical image of the mentally ill being homeless and assaulting innocent passersby, the reality is that many times the victims of assaults by the 

mentally ill are actually their family members; the ones who care for them on a 

daily basis with love and understanding. Unfortunately, when these clients begin 

to act violently, these family members call the police. 

There are three basic models for law enforcement responders handling calls for 

service involving the mentally ill. These are the Crisis Intervention Team (CIT) 

model where specially trained officers respond to the calls; the co-response models 

that partner a law enforcement officer and mental health professional; and the mental health model that sends mental health professionals to address the needs of the 

client after the client has been taken into custody. These models are deployed 

throughout the nation in many jurisdictions. Of these models, there is no ‘‘best’’ 

model. Smaller jurisdictions may not have the resources to deploy CIT personnel or 

field co-response units. Others will use the model that best fits their needs. For example, Memphis, Tennessee has an outstanding CIT program that few can rival; 

San Diego, California, utilizes co-response Psychiatric Emergency Response Teams 

(PERT Teams) as this model works best for them. 

21

PROGRAMS IN THE CITY OF LOS ANGELES

In Los Angeles, California, the Los Angeles Police Department has a truly unique 

program. The Los Angeles Police Department utilizes an approach that involves 

each of these programs and more. I oversee the Department’s Crisis Response Support Section that currently has 45 officers and detectives from the Los Angeles Police Department and 25 doctors, nurses, and clinical social workers assigned to the 

Los Angeles Department of Mental Health. 

The first link in this process is the Mental Evaluation Unit’s Triage Desk. These 

are specially trained officers who handle inquiries from patrol and dispatch personnel to help to identify incidents involving the mentally ill and provide information, direction, and advice to the field personnel. The Mental Evaluation Unit maintains a database of all law enforcement contacts in the City of Los Angeles. This 

confidential database provides our personnel in the field with information regarding 

prior law enforcement contacts to assist them in addressing the needs of the client 

in the field. Those cases that require additional follow-up in the field are referred 

to our SMART teams. 

In partnership with the Los Angeles County Department of Mental Health, Los 

Angeles Police Department currently has 18 Systemwide Mental Assessment Response Teams (SMART Teams) that provide citywide coverage. These teams respond 

to mental health crisis calls that include but are not limited to:

• Suicide in progress calls (jumpers, overdoses, etc),

• Barricaded suspect scenarios, hostage situations, and other situations that involve the Crisis Negotiation Team,

• Crisis Response calls such as major disasters (MetroLink Train crash in January 2005) or incidents involving children (e.g. One situation where an individual committed an act of murder/suicide that was witnessed by several of 

the victim’s children), and

• Crisis Response calls to Los Angeles Unified School District involving suicidal 

children (SMART personnel respond to an average of two calls each week involving suicide attempts by children under the age of ten.).

A recent addition to the SMART teams is the Homeless Outreach/Mental Evaluation (HOME) Teams operating in the ‘‘Skid Row’’ area of downtown Los Angeles. 

These teams, made up of a police officer and a registered nurse or licensed social 

worker, work to assist patrol officers who encounter those clients who are also 

homeless. This program has been extremely successful in providing linkage with 

mental health services and working to reduce the victimization of the homeless 

mentally ill. 

Additionally, the Los Angeles Police Department holds quarterly CIT training 

courses and currently has 307 CIT certified officers assigned to field operations. 

These officers are deployed throughout the City’s 19 Geographic Divisions and serve 

as first responders to mental health crisis calls. 

The Los Angeles Department of Mental Health also maintains Psychiatric Mobile 

Response Teams (PMRT Teams) that are deployed throughout the City of Los Angeles to provide early intervention and assessments prior to the client generating an 

emergency call. Family members and/or the client’s assigned doctor notify these 

teams of potential problems. 

However, one of the most innovative programs in Los Angeles is the Case Assessment and Management Program (CAMP). The goal of the CAMP investigator is to 

identify those clients who:

• As a result of their mental illness, are at high risk for death by their hands 

(suicide) or the hands of another (Suicide by Cop); or at high risk to injure 

another,

• As a result of their mental illness, are the subject of repeated criminal investigations where the nature of the crime is directly related to the client’s mental illness, and

• As a result of their mental illness, generate a high number of calls for service 

that involve emergency services (police, fire, and paramedics).

Cases that are assigned to CAMP are managed by the Los Angeles Department 

of Mental Health staff and the focus is to get those clients who, as a result of their 

mental illnesses, commit minor offenses into the mental health system where they 

can receive appropriate treatment, thus keeping them out of the criminal justice 

system. To date, CAMP has been extremely effective in this endeavor 

The biggest problem facing these programs in Los Angeles County is that there 

is no effective Mental Health Court or court diversion process. Instead, the CAMP 

22

detectives must work with the prosecutors and public defenders on a case by case 

basis to achieve, what we believe to be, positive outcomes involving placement and 

treatment options. This requires our detectives to travel to different courts throughout the County of Los Angeles and spend time educating the respective prosecutors, 

defense attorneys, and judges on available options. I will let Judge Leifman’s testimony address the importance of your support of Mental Health Courts in further 

detail. 

Our CAMP investigators provide regular follow-ups on the subjects of barricaded 

suspect scenarios. In 2006, 37 percent of all barricaded suspect scenarios resulted 

in the client being placed on a mental health hold with no criminal charges being 

filed. These were clients, who were, in most cases, suicidal and armed with weapons, including firearms. In each case, after the client has surrendered, CAMP personnel accompany the client to the hospital and complete the mental health holds. 

Then, our partners from the Los Angeles Department of Mental Health work with 

the client and his/her family to obtain treatment and conduct regular follow-ups to 

ensure that we don’t have a repeat occurrence. To date, we have not had any repeat 

incidents with a client in which CAMP was involved in a subsequent violent incident. 

During 2006, our CAMP has successfully placed seven clients on conservatorships; 

seven clients are in locked psychiatric facilities; two are in State prison, and four 

homeless mentally ill clients were reunited with their families and linked to services 

in their home counties. It is important to note that while we work very closely with 

our partners at Los Angeles Department of Mental Health, we maintain separate 

databases. Our criminal databases are protected and the information is confidential. 

Similarly, the databases maintained by Los Angeles Department of Mental Health 

are also confidential. While limited information can be shared between partners 

working on a case, that information is kept confidential. For example, as the officerin-charge, I know the names of some of the clients that we have criminal cases 

pending on but I don’t know their diagnoses. 

As I mentioned earlier, police officers and the criminal justice system have become 

the de facto mental health triage service providers. The largest ‘‘treatment facility’’ 

west of the Mississippi River is the Twin Towers jail facility maintained by the Los 

Angeles County Sheriff. That facility has approximately 1,000 beds for mentally ill 

clients, all of which are full. I won’t elaborate on the needs of the county jails in 

this area as Sheriff Gutierrez is better equipped to address this issue. However, one 

issue remains constant. That issue is the need for adequate training to provide law 

enforcement personnel with the best and most appropriate training available. 

The goal in training law enforcement in handling calls for service that involve the 

mentally ill is to reduce violent encounters with this population. That being said, 

I must add the following caveat: Despite the level of training that law enforcement 

personnel have, there will always be those situations where the client’s mental illness is so severe and their state is so deteriorated, that they will engage officers 

in violent confrontations. Unfortunately, there will always be those situations where 

the client’s condition is so severe and they have a weapon, that officers will be 

forced to use deadly force. There is no ‘‘magic wand’’ that can assure that once an 

officer is trained, they will never have a violent encounter with a mentally ill client. 

This is evidenced by the fact that, as I mentioned earlier, the client’s family members and caregivers generate over 90 percent of calls for service. In most cases, these 

are people who know and love the client and have many years of history with him 

or her. These are people who know the client’s moods and behaviors intimately, as 

in many cases, they have been living with the mental illness for many years. However, many times, the family is forced to call the police because the client has assaulted a family member. Why then, should we place an expectation on an officer 

that because he/she has taken a 40-hour course on Crisis Intervention Techniques, 

that he/she will never be forced into a violent confrontation with a client? I would 

also cite the fact that each year, doctors and nurses who work in our nation’s mental health hospitals are violently assaulted by clients with whom they have daily 

contact and interactions. They recognize that the client’s mental illness is the precipitating factor in the aggressive actions and their actions, like those of law enforcement officers, are in response to those actions. 

It is clear, however, that by providing training to law enforcement personnel on 

how to recognize and respond to clients who are suffering from mental illnesses, 

that violent encounters can be reduced. It is important to identify and fund relevant 

training in this area. Within the Los Angeles Police Department, we have worked 

to accomplish this. For example, in the 40-hour CIT course, there is an 8-hour segment on ‘‘Psycho-pharmacology.’’ The reality was that most officers, who don’t work 

in the mental health field, could not recall all of the drugs or their use, two weeks 

after they completed the course. We realized that it was important to provide trainVerDate 0ct 09 2002 16:49 Sep 06, 2007 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6621 H:\WORK\CRIME\032707\34359.000 HJUD1 PsN: 34359
23

ing that field personnel can use to identify clients who are experiencing episodes of 

mental illness and adjust their approach accordingly. 

One of the more innovative training modes that the Los Angeles Police Department has developed is the CIT e-learning course. We have taken our 24-hour course 

and have broken it down into 12 two-hour blocks. As we develop each block of instruction, they are placed on our Department Web. We have found that this delivery 

system is an effective means to provide this program to all Department employees 

and is extremely cost effective. Traditionally, when courses are offered, police departments must send officers to a central location for training and, in many cases, 

backfill their positions in order to ensure that the public safety needs of their respective communities are met. 

By utilizing the e-learning modules, field personnel can break the class into digestible segments and take the courses during their regular shifts at their respective stations, while remaining available to respond to emergencies. The effectiveness 

of this program is truly impressive. 9,100 Department personnel have completed the 

Los Angeles Police Department’s first four-hour block of instruction. A two-hour segment titled, ‘‘Introduction to Mental Illness’’ was completed by 6,727 field and investigative personnel over a four-month period. The next course titled ‘‘Mood Disorders’’ 

is in the final review and will be released next month. 

The goal of the Los Angeles Police Department is to present all 24 hours of elearning instruction on mental illness to all field personnel, thus raising the basic 

level of understanding of mental illness to all employees who are likely to encounter 

clients who are in crisis. Those personnel who wish to become CIT certified can then 

take an additional 16 hours of interactive instruction and role-playing exercises to 

improve their expertise. Currently, there are over 400 patrol officers who have expressed an interest in becoming CIT certified. 

By all accounts, the programs implemented by the Los Angeles Police Department 

have been extremely successful. As the program manager, I can truly say that in 

my 26 years as a Los Angeles Police Department officer, this has been my most rewarding assignment. However, we could not be as effective as we have been without 

our partners at the Los Angeles Department of Mental Health. As I have looked at 

programs across the nation, I have noted one particular trend. Law enforcement and 

the mental health system, whether state, county, or municipal, private or public, 

have the same objective. That is to get the client into an appropriate setting where 

he/she can receive the proper help. However, I have also noted that these entities 

are heading toward the same destination, with the same objectives, but are on separate tracks. As a result, there is a disconnect between these entities, allowing clients 

to fall through the cracks. 

The partnership between Los Angeles Police Department Los Angeles and the Department of Mental Health is truly unique. In our office, a supervisor from the Los 

Angeles Department of Mental Health occupies the desk across from mine. We are 

a true partnership and have equal standing in common decisions. Our facility is not 

in a police station, but an office building in downtown Los Angeles. Our SMART 

teams drive unmarked police cars with emergency equipment (lights and sirens). 

Our officers are in plain clothes, which we have found reduces the anxiety of the 

clients we serve. No where in the nation have I found such a positive relationship 

between a county and municipal agency. 

The reason for the effectiveness of this relationship rests at the top of our organizations. Chief William Bratton and Dr. Marvin Southard have provided absolute 

support for this program from the beginning. In 2003, we had six SMART teams 

comprised of 13 Los Angeles Police Department personnel and nine Los Angeles Department of Mental Health personnel. Today, we have 70 total personnel. Both the 

Los Angeles Police Department and the Los Angeles Department of Mental Health 

have submitted budgets for the new fiscal year that will increase the unit even 

more. The old saying that ‘‘Actions speak louder than words’’ holds true. And the 

actions of Chief Bratton and Dr. Southard are deafening. 

You may recall that I opened this testimony with the story of ‘‘Mike,’’ the client 

who was placed on 22 mental health holds in a 17-month period. Well, ‘‘Mike’’ was 

our first client that was placed in our CAMP Program. In 2006, due to the intensive 

efforts of our personnel, ‘‘Mike’’ generated one call for service. He has been successfully linked with services and while our CAMP personnel have monthly contact with 

him and his family. He has not been the subject of a radio call in over a year. 

We have a motto in our office. It is a motto that I truly believe in. Our motto 

is ‘‘Every day you save a life.’’ Each time we respond to a call for service, it involves 

a client that is suicidal, a danger to others, or cannot meet their basic needs for 

food, shelter, or clothing. Your continued support of these programs is essential. The 

grants funded by the Bureau of Justice Administration and future funding initiatives are critical to helping us save lives. Thank you.

24

Mr. SCOTT. Mr. Evans? 

TESTIMONY OF LEON EVANS, EXECUTIVE DIRECTOR,

JAIL DIVERSION PROGRAM, SAN ANTONIO, TX 

Mr. EVANS. Mr. Chairman and all the Members, I am Leon 

Evans from the Center for Health Care Services in Bexar County, 

Texas, that is San Antonio. I am also the chairman-elect of the National Association of County Behavior Health Care Directors, an affiliate of the National Association of Counties. 

The National Association of Counties has a committee that mirrors your Committee, the Justice and Public Safety Steering Committee, and that committee has passed a resolution asking this 

body and Attorney General Gonzales to look into the criminalization of the mentally ill by creating some kind of oversight committee. 

I have some slides I would like to put up, and the second slide 

shows our community partnerships, our collaboration. Now, we 

have had visitors just 2 weeks ago from Canada, the Ministry of 

Health in Ontario province in Canada, we have had people visit 

our program from all over the United States. And the thing they 

marvel at, just like most of the things you have heard today, is the 

community collaboration, the partnership. They can’t get over how 

the sheriff, the police chief, the judges, everybody involved have 

come together to work out these problems. 

Now, we all know that we are so underfunded, and there is a 

natural aversion for law enforcement and mental health to work together in the first place. So who is going to make us do it? We need 

to get community leadership at the Federal, State and local level 

to come together and develop strategies to overcome these barriers. 

We need to integrate our Federal, State and local funding because 

there is not enough. 

Now, we have conducted a cost-benefit analysis, we had Dr. Michael Johnsrud, a medical economist at the University of Texas, to 

do an initial one when we first started. We showed the first year 

a $3.8 million to $5 million savings in our efforts. 

Now, even though we have, like, 46 points where we identified 

people with severe mental illness who were inappropriately incarcerated into the criminal justice system, we focused on the fact that 

if you have a mental illness, you shouldn’t go to jail in the first 

place. 

So we have a collaboration—if you will go a couple slides—the 

next slide just kind of shows the entry points. The next slide shows 

the number of people that are being screened. 

Historically, law enforcement officers did not know how to access 

mental health services. Let me share a story. When we did our first 

Crisis Intervention Training (CIT), I was visiting with an officer 

and he was telling how bad he felt when he picked up a person who 

was delusional. And the example he gave me was he got called to 

McDonald’s because this guy was saying the Lord’s prayer and upsetting everybody in the restaurant, and he was saying the Lord’s 

prayer because he was having hallucinations, auditory hallucinations, and he would say the Lord’s prayer to drive these voices 

out of his head. 

25

And the law enforcement officer said, ‘‘I didn’t know about you 

guys. I didn’t know about the mental health system. I just knew 

I couldn’t leave this guy in McDonald’s. I didn’t know what to do 

with him.’’ I said, ‘‘Well, what do you usually do with a person like 

that?’’ He said, ‘‘I take them to the emergency room, if I am close 

to the ER, or I take them to jail.’’

And so what we have done is we have a collaboration now where 

we do minor medical clearance and psychiatric evaluations in a 

central place. We are diverting people from emergency rooms who 

used to average 8 to 14 hours in an emergency room waiting for 

a minor medical clearance or psychiatric evaluation. So you are 

shackled to a law enforcement office, you are not having a heart 

attack, you weren’t in a car wreck, so you get triaged to the back 

of the line. 

Our Police Chief Albert Ortiz, before we implemented this pro- gram, was spending $600,000 a year in overtime pay, plus taking 

law enforcement officers off the street 8 to 14 hours. Now, with this 

new crisis center, he can get a medical clearance and psychiatric 

evaluation in 45 minutes. And he is putting $100,000 of his drug 

asset and seizure money—that is what most police chiefs buy body 

armor and weapons with—into this mental health program, because it makes so much sense. 

Diversion from our county jail, if you haven’t committed a major 

crime, you are brought to us. Law enforcement officers basically 

drop them off. We are the mental health authority, we do the disposition. We have all kinds of step-downs. About 20 percent of the 

people need to be hospitalized. 

Other people need observation, short-term crisis services, some 

people might be urinating in public, sleeping on doorsteps, digging 

in trash cans or dumpsters. They are brought to us, evaluated by 

psychiatrists, and not to be found blatantly psychotic or a danger 

to themselves or others and refusing treatment. So we contract 

with a shelter. In a lot of these cases, people had been in a shelter 

before. So we have, kind of, a mental health unit in this public 

shelter and we try to endear ourselves and get people into treatment. 

So that is just one venue that we have. 

And I want to make another point real quick, because my time 

is about out. The Texas Department of Criminal Justice started 

identifying all these non-violent, mentally ill people in the prison 

system. So they developed this Texas Correctional Office on Offenders of Medical and Mental Illness Impairments, and they put them 

on parole and they contract with my organization. 

And a condition of their parole is they see the psychiatrist, take 

their medication, do their alcohol or drug screening, as so ordered, 

and generally be in compliance with their mental health treatment. 

Do you know what our revocation rate is? It is less than 3 percent. 

And, Sheriff Gutierrez, I think statewide it is less than 5 percent, 

right? 

And that just goes to show you if these people had been treated 

in the first place, they wouldn’t have gotten involved with the 

criminal justice system. It was their mental illness and those 

strange behaviors associated with mental illness that brought them 

in contact with law enforcement. 

26

So I appreciate this Committee’s leadership and interest in this. 

It is a huge subject. It is very costly to society, and it is devastating 

to the individuals who get jailed because of their mental illness. We 

don’t put people in jail that have heart disease or diabetes, and 

people with major mental illness shouldn’t have to go there either. 

Thank you so much. You are very kind. 

[The prepared statement of Mr. Evans follows:]

PREPARED STATEMENT OF LEON EVANS

Honorable Chairman and Members of the Subcommittee of the House Judiciary 

Committee: 

My name is Leon Evans, President/Chief Executive Officer of The Center for 

Health Care Services (Center), a state community mental health center which is the 

Mental Health Authority for Bexar County/City of San Antonio Texas. 

I am Chairman-elect of the National Association of County Behavioral Healthcare 

and Developmental Disabilities Directors. The organizational mission of this association is to provide county based mental health and substance abuse services across 

22 States. 

I am also a proud member of the National Council for Community Behavioral 

Healthcare with a membership of 1,300 mental health centers providing services 

across our nation. 

Additionally, I am a member of the Justice Committee of the National Association 

of Counties (NACO) that has been active through their membership representing 

2,075 member counties and their county judges, commissioners, sheriffs and county 

jail administrators, in advocating for a new system of response to alleviate the inappropriate incarceration of persons with mental illness and the cost associated with 

it. 

It is an honor to come before this subcommittee on Crime, Terrorism, and Homeland Security of the Committee for the Judiciary of the U.S. House of Representatives regarding ‘‘Criminal Justice Responses to Offenders with Mental Illness.’’

It is an honor to come before you to tell you about our community collaboration 

in Bexar County. This collaboration created a very successful community initiative 

known as ‘‘The Bexar County Jail Diversion Program.’’ In the last two years, our 

collaboration has been nationally recognized for its excellence in service, focusing on 

first line contact within the jail diversion continuum. 

In 2006, The American Psychiatric Association recognized the Bexar County Jail 

Diversion Collaborative with its national ‘‘Gold Award’’ for the development of an 

innovative system of jail diversion involving community partnerships and collaborations. This award recognized the collaborative innovation of improved services, enhanced access to and continuity of care for persons with mental illness, which resulted in financial savings to the community. 

The Bexar County Jail Diversion Program (BCJDP) was also the recipient of the 

2006 ‘‘Excellence in Service Delivery Award’’ provided by the National Council for 

Community Behavioral Healthcare. 

The Bexar County Jail Diversion Model has been highlighted in the Substance 

Abuse and Mental Health Services Administration (SAMHSA) journal for its innovations and creativity. Visitors from all over the United States, including Canada, 

have come to study this model program in the hope of developing similar models 

in their communities. 

We are in the process of completing our second cost benefit analysis that identifies 

the costs associated with mentally ill non-violent offenders and the use of public resources such as hospital emergency rooms, jails and prisons. Without proper identification and access to service and treatment, many of these individuals are caught 

in a never ending revolving door resulting in harm to the individual and the draining of public dollars. 

In Fiscal Year 2004, our first economic study reviled that in Bexar County, with 

the diversion of over 1,700 people an estimated $3.8 million to $5.0 million dollars 

in avoided costs was actualized within the Bexar County Criminal Justice System. 

Economically, it makes sense to divert from incarceration and treat non-violent 

persons with serious mental illness in different venues and make available crisis 

services and other treatment modalities outside the criminal justice system. This 

protects the dignity of persons with a severe mental illness while making sure our 

county, state and federal dollars are spent in the most effective and efficient way 

possible. By not providing the appropriate intervention and treatment we are findVerDate 0ct 09 2002 16:49 Sep 06, 2007 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6621 H:\WORK\CRIME\032707\34359.000 HJUD1 PsN: 34359
27

ing that people with mental illness are being incarcerated. This in-appropriate system of incarceration could be considered cruel and unusual punishment.

The Problem:

It is a national tragedy that in today’s society, persons with severe mental illnesses, for who the most part are not violent, find themselves caught up in the 

criminal justice system. Many persons with mental illness are over represented in 

in-appropriate settings such as emergency rooms, jails and prisons. For sometime, 

it was thought that about 16% of persons in our jails and prisons had a severe mental illness. More recent studies would suggest that the number could be at least 

twice as high. This is not only wasteful and inappropriate but delegates’ people with 

an illness to be housed in our jails and prisons rather than treated in the least restrictive most appropriate therapeutic setting. 

The reason for this problem is multi faceted. First, in the 60’s when psychotropic 

medicines were being developed and President Kennedy, through the Community 

Mental Health and Mental Retardation Facilities Act of 1963, initiated the delivery 

of community based services, states started closing our state hospitals. It was understood that necessary funding would follow these persons back to the community 

to pay for the treatment and medication. In reality, that did not happen. Today, we 

find ourselves not only ‘‘under-funded,’’ but the funding that has been dedicated to 

serve persons with mental illness in the community tends to be directed towards 

outpatient services instead of necessary funding for intensive crisis services. There 

is little or no services associated with stabilizing persons and re-integrating them 

into their communities. 

Historically, law enforcement and Community Mental Health Authorities have not 

partnered nor communicated with each other to address these problems! Due to the 

lack of this poor communication and trust, to date there has been little training, 

little planning, and therefore poor to limited services. This break-down in communication results in duplicated efforts, inefficiencies and limits the impact of our tax 

dollars being spent in our communities. It is well known that the average length 

of stay for these non-violent offenders who end up in our jails is 3 to 4 times longer 

at 5 to 6 times the cost of their stay as compared to the cost of the stay of a violent 

offender. 

Why is this?

1) These persons lack the resources to advocate for themselves or have the 

knowledge or ability to access commercial or specialty bonds for release.

2) The nature of mental illness and the lack of public information force a judge 

to act conservatively in their decision process which extends their stay.

During their stay in the jails, most persons with mental illness usually receive 

poor treatment for their mental illness. After all, jail and prisons are not therapeutic environments. Many times people that end up in jail do not get referred to 

mental health services on discharge. Therefore, these individuals end up de-compensating and ultimately end up back in jail and in our state prisons. Inappropriate 

sentences in state prisons create episode costs that could range in hundreds of thousands of dollars per incarcerations. 

We have a failed public policy when it comes to the incarceration of non-violent 

mentally ill offenders. This does not make sense when it comes to public policy. A 

non-violent offender taking up space increases overcrowding and reduces bed availability for those individuals who do need confinement. 

History has shown us that the current system has caused the suffering, indignity 

and humiliation for thousands of persons with serious mental illness who have been 

inappropriately jailed due to the lack of availability of treatment and crisis services 

within the community. Tax payers, in the end, are paying the price for this failed 

system. 

Our County Judge Nelson Wolff brought together a group of community leaders 

who formed a collaborative, which has been functioning for several years focused on 

improved services and driving out waste associated with the criminalization of the 

mentally ill. 

The BCJDP has been designed and developed, through this expansive collaborative effort of community leaders and stakeholders, to ameliorate the practice of 

utilizing the jail system for the inappropriate ‘‘warehousing’’ of individuals with substantial mental health issues. The thrust of this effort was to also minimize the use 

of the arrest/booking process of adult offenders with mental illness who by their conduct, are subject to being charged with a minor non-violent criminal offense. 

Within four years, from 2003 to date, we have developed a new model of diversion, 

which focuses on both physical and mental disabilities working closely with law enforcement within forty-six intervention points along a jail diversion continuum. Our 

28

new Crisis Care Center has compressed the waiting time required of law enforcement officers to deliver an individual in crisis for psychiatric assessments and medical screenings. This compression of time has allowed law enforcement officers to be 

released back into the community within a 15 minute time frame and more appropriately provide service to the community and results in less inappropriate incarcerations and/or inappropriate use of our emergency rooms. It is estimated that in the 

first year alone, $3.8 to $5 million dollars was saved in the community through our 

diversion efforts resulting in the reduction of over crowding of the jail and increasing the capacity in our jails for the incarceration of violent offenders. It should also 

be noted that our emergency rooms are not packed with law enforcement officers 

waiting for medical clearance and psychiatric evaluations and keeping them from 

performing the law enforcement functions in the community. This has resulted in 

avoiding associated overtime costs for those officers who have to wait with the apprehended person needing medical clearance and psychiatric evaluations. We have 

implemented a number of innovative programs which work closely with the court 

system, the probation system, and local judiciary at large. We have incorporated 

probate judges in the development of civil commitment actions which ensure intensive outpatient case management for high utilizers resulting in significant savings 

as a result of a shortened State hospital stays.

Future:

Engaged efforts are currently in place to reach out to all community stakeholders 

such that local law enforcement, emergency medical services, hospital districts, the 

judicial system, local treatment agencies and others gain knowledge of working with 

persons suffering serious mental illness and the provision of cost effective, least restrictive, clinically effective treatment options within a community collaborative 

framework.

Conclusion:

We don’t put people with diabetes and heart attacks in jails so why do we allow 

this to happen to our sons and daughters, to our family members who have a serious mental illness. We must treat the illness and not the symptom. We need to improve the quality of life by providing them with more appropriate venues of treatment. The mentally ill do not belong in the emergency rooms and jails for minor 

criminal offenses committed as a result of their mental illness. The emergency 

rooms are needed for more serious injuries for those that need the appropriate use 

of the emergency room. The jails are overcrowded and the mentally ill do not belong 

there. 

Bringing them to an appropriate Crisis Center with an appropriate treatment program can alleviate the crowded situation faced at hospital emergency rooms as well 

as jails. We need to train law enforcement to become knowledgeable and have an 

awareness of the need to bring those individuals to us as opposed to jails. 

There is a failure in the public mental health system. A Crisis Center, working 

with judges, and providing services to the mentally ill with additional supports can 

be a solution to the communities needs. We have many challenges before us but I 

am pleased to offer an alternative which focuses on community ownership and community collaboration. 

Documents for the record include the following attachments:

1. APA Gold Award 

2. Jail Diversion Short Presentation 

3. National Weekly ‘‘Bexar County Story’’

4. CCC Dr. Hnatow Article 

5. Hollywood CIT Final Version 

6. JD Model Lite 

7. Written Testimony March 23, 2007

8. SAMHSA Newsletter 

9. 3 JOHNSRUD FINAL 

10. BCJD Economic Impact Study 

11. CCC Brochure 

12. Hnatow UHS 

13. Jail Diversion White Paper 

14. Out of Jail and Into Treatment

Mr. SCOTT. Thank you. Thank you, Mr. Evans. 

And I thank all of our witnesses for their testimony. 

29

We will now have questions from the Members under the 5-

minute rule, and I recognize myself for the first 5 minutes. 

Mr. Evans, you indicated you had a cost-benefit analysis? 

Mr. EVANS. Yes, sir. And it is part of your record, and we just 

contracted in a partnership with the Texas Department of Medicaid. They have a drug vendor program, and drug companies give 

the State either a reduction in drug costs or, if the drug company’s 

Medicaid division will allow it, can reinvest in the community program. 

So part of how we got this done was a partnership with 

AstraZeneca and the State Medicaid Program. Part of that initiative was to do an extensive cost-benefit analysis. The one that you 

have copies of just show the cost savings in jail. In reality, there 

should be savings in the prison system, in the hospital system. If 

people don’t get identified and treated as they come out of jail, and 

some people will be jailed because of their offense, there will be 

that revolving door, that recidivism rate. So all these costs are associated with people not getting treated. 

And the new cost-benefit analysis done by the Research Triangle 

in North Carolina should be finished in June or July, and we will 

have all those associated costs, and also inappropriate hospitalizations. 

Mr. SCOTT. Judge—is it ‘‘Leifman?’’

Judge LEIFMAN. Yes, sir. 

Mr. SCOTT. Judge Leifman, are there constitutional standards 

that we have to achieve to avoid constitutional violations? 

Judge LEIFMAN. There are constitutional standards, but I think 

what has happened is the local jails have become so overcrowded 

and overwhelmed with the issue they just don’t know what to do 

with the population. We tried to make sure that those constitutional protections are in place, but I think everyone is so overwhelmed with this issue that they are trying desperately to figure 

out a way to divert people from coming in or once they do come in 

to divert them out of our systems. 

Mr. SCOTT. The situation in the jail in your county, do you think 

you had crossed the line into a constitutional violation? If somebody filed suit, would we have been in jeopardy? 

Judge LEIFMAN. Most likely. But it is ironic because they had 

been under Federal court orders before. It just doesn’t work. And 

what I think works is when the community comes together to avoid 

that lawsuit, and you end up spending so much money on a Federal lawsuit to defend it that you waste what you need to do to fix 

it. 

We did a study. We took 31 people who were the highest utilizers in our jail who had serious mental illness. It cost us $540,000 to 

do nothing, because that is what it costs to keep them in jail when 

they have mental illness or get them acute care. If you do nothing, 

you end up spending the money. It is much cheaper and much 

more efficient to keep them from coming in, and when they do get 

in to get them out quickly. 

Mr. SCOTT. Thank you. 

Sheriff, did you have a comment on that? 

Sheriff GUTIERREZ. Yes. There are some constitutional issues. I 

will tell you that, unfortunately, Lubbock County came under a 

30

Federal lawsuit, and during my 30 years of experience our jail was 

declared unconstitutional by cruel and unusual punishment, and it 

set the standard for all the jails across Texas for the proper care, 

medical treatment and assistance. 

And the judge is correct, that the problem has become very overwhelming and we are trying to stay on top of those issues, and we 

are very concerned that we may, once again, return to that Federal 

guidance or oversight. 

Mr. SCOTT. Now, sheriff, you mentioned that 30 percent of the 

patients were already mental health patients, and I suspect that a 

lot of others should have been mental health patients. And you 

treat them all as indigents so there is not a financial barrier to 

them receiving services once they get to you? 

Sheriff GUTIERREZ. Yes. We treat them as indigents so that our 

local hospital locally can provide the services continuum of care. 

However, somebody has to pay for it and that is the citizens, the 

taxpayers, of those counties. 

Mr. SCOTT. But since they are treated as indigents and they are 

in the criminal justice system, the services get provided. 

Sheriff GUTIERREZ. We are trying to provide those services. The 

problem is there is not enough money to be able to fund those 

issues. That is where we need your assistance to provide that care. 

Mr. SCOTT. And if you have a drug court and you want to divert 

them somewhere, you have to have some services there——

Sheriff GUTIERREZ. To assist them, absolutely. We are looking locally at some mental health courts. The problem is, once again, the 

funding. We have put together locally——

Mr. SCOTT. And that is not funding for the court, that is funding 

for the services——

Sheriff GUTIERREZ. Services, absolutely. 

Mr. SCOTT [continuing]. That the court will have at its disposal. 

Sheriff GUTIERREZ. That is correct. 

Mr. SCOTT. Do you want to make a comment, Mr. Evans? 

Mr. EVANS. Yes, sir, Mr. Chairman. Most jails do not have this 

kind of psychiatric and therapeutical talent systems in place. It is 

not a therapeutic environment, it is a stressful environment, and 

it is absolutely the wrong place to treat people with mental illness. 

Now, if you go to jail because you have created a major offense, 

you need to be in jail, then you need to be treated, but having our 

jails and prisons be the substitute for mental health hospitals, that 

is wrong. 

Mr. SCOTT. Thank you. 

Mr. Forbes? 

Mr. FORBES. Thank you, Mr. Chairman. 

Let me once again thank all of you for taking time to come here. 

Mr. Perry, thank you for being here and for your testimony. 

Lieutenant, can you tell us, what proactive steps can be taken to 

prevent mentally ill offenders from actually offending? 

Mr. WALL. In Los Angeles, we have initiated a new program that 

focuses exactly on that. It is called our CAMP program, our Case 

Assessment Management Program. We are the only law enforcement agency in the Nation that maintains a database of law enforcement contacts with the mentally ill, and when these high utiVerDate 0ct 09 2002 16:49 Sep 06, 2007 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6601 H:\WORK\CRIME\032707\34359.000 HJUD1 PsN: 34359
31

lizers come up regularly and we identify people like Mike, the person I was talking about earlier, Mike was our first CAMP patient. 

We looked at him, and I said, ‘‘We are going to kill him. This person is truly going to die at the hands of law enforcement based on 

his behavior.’’ As a result, we became very intense in working with 

the Department of Mental Health. 

And I talked with my chief and I said very simply, ‘‘Chief, here 

is the deal: If I can tell you the day a crime is going to occur, where 

that crime is going to occur and who the suspect is going to be, will 

you allow me to deploy police resources to prevent that crime?’’ And 

the answer is always, ‘‘Yes.’’

Well, if it involves a patient who is suffering from mental illness 

and we know what his pattern is and we know that on the 15th 

of the month he is going to begin acting out, why can’t we go out 

on the 13th and talk to his family and see if he has taken his 

meds, and if he has not, provide linkage with the Department of 

Mental Health before we have an action or we have an incident? 

As a result of that intensive type of procedures with Mike, remember that 17-month period generated 22 holds and 45 calls for 

service. In 2006, he generated one radio call, and we have not had 

a radio call in over a year with that individual. Now, we contact 

him monthly, we still talk to the family every month to make sure 

everything is being done, but most of that is being driven by the 

Department of Mental Health because of our partnership with the 

Department of Mental Health. 

Mr. FORBES. Mr. Evans, are there any other effective programs 

that could be used for collaborative approaches, other than mental 

health courts, for pre-and post-arrest diversion? 

Mr. EVANS. Yes, sir. In fact, we have several. One of the programs is an intensive outpatient commitment, and a lot of people 

with severe mental illness, also have cognitive learning disabilities, 

they have a hard time staying compliant with their treatment. 

They can’t remember to take their medications because of their illness. A lot of them don’t have significant others or families to help 

support them. 

And so what we have done is we have given, on the civil side, 

the probate judge a case worker, and we look at people who have 

had multiple admissions to the State hospitals and they are kind 

of in and out of compliance of treatment, and we do outpatient 

commitments, and we do treatment plans around that and report 

back to her court to see if the person is compliant, similar to what 

Los Angeles does. 

We have had almost a 50 percent reduction in hospital bed-day 

usage and other public services just by having one case worker 

there and a judge stand up before this person and say, ‘‘I care 

about your health, you are not being compliant, I am ordering you 

to see your doctor, take your medication and stay in compliance 

with your treatment.’’ And it works. It is absolutely amazing, and 

it is not very costly. 

We also have some step-downs for first-time offenders. We have 

three projects, we have a 60-bed facility for those people who do get 

put in jail and some mental health step-downs where we actually 

have treatment and it is overseen by the parole division. 

32

We provide the therapeutic treatment in two 100-bed facilities 

for substance abusers. Most of these are young people, young family members, a lot of them have kids, and they don’t understand 

what the drugs and alcohol are doing to themselves. And it is a 

therapeutic environment, and we are starting to show good outcomes there. 

So I think there is a variety of other kinds of partnerships with 

law enforcement and the mental health and substance abuse community that could be provided. I know the National Council of Behavioral Health has 1,300 members in rural frontier and urban settings that stand ready to serve, but there needs to be some way 

to develop these specialized models, these best practices, these collaborations so we drive out waste and get the best return on our 

investment with these partnerships. 

Mr. FORBES. Thank you. 

Judge, thank you for your work on this and the program. Just 

a quick question, my time is almost out. On your program, does it 

require the judges participate in the training program as well? 

Judge LEIFMAN. We do have some training, and we are now actually looking to install a statewide training program for all the 

judges in Florida. 

Mr. FORBES. Good. 

Well, thank you all so much. Sorry I am out of time; I would love 

to talk with all of you more. 

Mr. Chairman, I yield back. 

Mr. SCOTT. Thank you. 

The gentleman from Georgia, do you have questions? 

Mr. JOHNSON. Yes, thank you. 

Mr. Wall, prior to the institution of your educational program for 

the officers, what percentage of the persons who were incarcerated 

in your jail were suffering from mental illness? 

Mr. WALL. I can’t give an accurate answer to that for two reasons: Number one, prior to 2004, we didn’t keep accurate number 

of contacts; and, secondly, our patients are not housed—Los Angeles city doesn’t have a jail. Ours are housed at the Twin Towers 

facility with the Los Angeles County sheriffs. 

I can tell you from my discussions with the sheriffs, though, that 

a significant percentage of those patients that are within Twin 

Towers come from the city of Los Angeles, and, currently, the sheriff maintains approximately 1,000 beds, which at any given time 

are full. 

Mr. JOHNSON. Does anybody else on the panel have any insight? 

Judge LEIFMAN. We do. I am with Miami-Dade County. We segregate the people who have mental illnesses in the jails, so we actually had a study done. And we have about 20 percent of the population on psychotropic medication. We are the largest psychiatric 

warehouse or facility in Florida. We spend $100,000 per day 

warehousing them in our jail. 

Mr. EVANS. In San Antonio, as Sheriff Gutierrez explained, we 

do a cross-match with the State mental health database, and even 

though we have this phenomenal diversion program, we still have 

16 to 20 percent of folks who go to book-in that have a history of 

treatment in the mental health system at one time or another. We 

are also stationed at book-ins so we can divert there also. 

33

And one of the problems is during the crisis intervention training 

you only can train so many officers at a time, and there are, like, 

5,000 law enforcement officers in Bexar County, and at 40 a class, 

we have only got several classes, so there is still a lot of training 

to do. 

We are starting to train dispatchers and 911 folks, so if somebody is called and its somebody that sounds like they are having 

mental health problems, one of these specially trained officers show 

up. 

Mr. JOHNSON. Judge Leifman, that is $100,000 per year? 

Judge LEIFMAN. Per day. 

Mr. JOHNSON. Per day. 

Judge LEIFMAN. Thirty-six million dollars a year. 

Mr. JOHNSON. Thirty-six million dollars a year. That includes 

petty criminals as well as——

Judge LEIFMAN. Yes. In fact, what was interesting in the study 

that we did, about 55 percent of the people that have been arrested 

were on third degree felony charges, which in Florida is the lowest 

level of a felony. But 65 percent of them, which was about 1,100 

people a year, were on what we would consider an avoidable arrest. 

It doesn’t mean it didn’t happen, but it was like battery on a law 

enforcement officer or resisting with violence. And so it probably 

occurred, it is just the officer may not have been trained on how 

to avoid it and the situation escalated as opposed to deescalated. 

That is a lot of people that should not have been in our jail to 

begin with that we could have avoided, put them into a mental 

health system, which would have been more effective and efficient 

and cost-effective. 

Mr. JOHNSON. Certainly cheaper, because it cost——

Judge LEIFMAN. No doubt. 

Mr. JOHNSON [continuing]. You how much per inmate, per day? 

Judge LEIFMAN. It is very expensive. I mean, it is a lot less expensive to get them treatment, and it is a lot more humane for 

them to make sure that they are in a system of wellness and recovery as opposed to one of criminalization. 

Mr. JOHNSON. Yet, sometimes, I suppose, when persons—let’s 

take, for instance, Mike. I wouldn’t call him a petty crime suspect, 

but let’s suppose that he was a petty crime suspect and he would 

act out every month according to that schedule that you gave and 

without proper training officers would come along and lock him up 

and he wouldn’t be able to make bond, and he would languish in 

the jailhouse for some number of weeks, or perhaps months, until 

he came to court. And I guess his condition would be stabilized 

while he was in the jail, perhaps, we would hope. 

Judge LEIFMAN. Perhaps. 

Mr. JOHNSON. And before he went through this cycle of going to 

jail, he may have had some Medicaid benefits, he or she. And once 

he or she was incarcerated, they would cease to be eligible for those 

Medicaid benefits and unable to pay for the medication that they 

were not taking. 

And so how difficult is it once that type of person gets out to reestablish the coverage so that they can have the medication that 

at least they can have the option to take? 

34

Judge LEIFMAN. If I may, it is one of the biggest problems we 

have. It usually takes at least 6 months to get someone their benefit. And when someone is leaving jail they need it the day they 

are leaving. They need housing, medication and case management 

the day they leave. 

So what we did in Miami-Dade is we are trying a novel approach. 

We were able to get our county government to give us a lump sum 

of money on a pilot basis, and what we are doing is signing an 

agreement with the consumer and Social Security in our county. 

We are fronting the benefit for them so we are making sure there 

is housing, medication and case management the day they get out. 

When their benefit kicks in, it is retroactive. Instead of it going 

back to the consumer, it is coming back to us, it replenishes our 

fund and we are leveraging the Federal dollar, and we will have 

more money to help the next person. 

And so far it’s been very, very successful, and it is the only way 

we can figure out to get around the 6 months, because, quite frankly, we might as well not offer the benefit if you don’t give it to them 

the day they leave, because they are going to go back to substance 

abuse issues, they are going to get rearrested and they are going 

to continue to recycle. 

Mr. JOHNSON. Yes. Thank you. 

Mr. SCOTT. Gentleman from North Carolina, Mr. Coble? 

Mr. COBLE. Thank you, Mr. Chairman. 

Mr. Chairman, as you know, I think prison overcrowding is one 

of the most severe problems facing society today, and when you 

have prison overcrowding involving mentally ill offenders, the problem becomes severely compounded. 

I appreciate you all being here. 

Judge, does the criminal mental health project coordinate with 

other jurisdictions interested in focusing on mental illness? And if 

so, are there distinctions from programs and procedures implemented by other jurisdictions? 

Judge LEIFMAN. Yes. We do work with other jurisdictions, and 

what we have decided is each jurisdiction is a little unique and 

novel, so we try to work with them to set up a system but to operate it in a fashion that works best for them. 

I mean, in Dade County, we have six public crisis stabilization 

units, so we have a written understanding with them that when 

someone gets arrested on a low-level misdemeanor offense, within 

24 to 48 hours we divert them to one of these crisis units, we try 

to put a case management system into place and follow them. 

Another community may have private hospitals, not a crisis stabilization system, and they will try to work out a similar situation. 

Mr. COBLE. I got you. Thank you. 

Mr. Perry, at what point did the court take your illness into account when you were having difficulty with the law enforcement 

people? 

Mr. PERRY. The last time I was in jail, my public defender suggested that I try to get accepted to mental health court. 

Mr. COBLE. And had you been incarcerated prior to that time——

Mr. PERRY. Yes. 

Mr. COBLE [continuing]. Several times? 

Mr. PERRY. I have been incarcerated eight times in my adult life. 

35

Mr. COBLE. Mr. Perry, was marijuana the only illegal drug you 

used that got you into difficulty? 

Mr. PERRY. No. I used more than that. Marijuana was the drug 

that was the one that I was charged for, though. 

Mr. COBLE. I got you. Thank you, sir. 

Sheriff, how can the Federal Government assess local and State 

officials dealing with mental health issues, and are certain incentives more effective than others? 

Sheriff GUTIERREZ. Sir, I believe that the problem that we are 

facing is in the continuum of care, and once they are released, it 

is providing the proper facilities and services for these individuals 

so that they could possibly not be rearrested. Integration back into 

the community is paramount, and the lack of resources seems to 

be the problem that we are facing today. 

Mr. COBLE. Thank you, sir. 

Lieutenant, how does L.A. review its mental health programs to 

ensure that they are effective in being well and prudently managed? 

Mr. WALL. We have a multilayered approach. One of the first, in 

fact, is happening tonight in Los Angeles. We have quarterly stakeholders meetings with members of the community where the community can come in and talk on an open forum about issues involving law enforcement and mental illness, their perceptions of what 

needs to be fixed, and then we actively work on that. 

I also report, through my chain of command, semiannually to the 

Board of Police Commissioners, which in Los Angeles is appointed 

by the mayor to oversee police operations and set policies and procedures for the department. And so I report to them on a semiannual basis. 

And then on top of that, we also are currently under the Federal 

consent decree. So we are being looked at by the independent monitor and the Federal court, all of which have given our program 

very high remarks. 

Mr. COBLE. I thank you for that. 

Mr. Evans, what role do prosecutors and the courts play in your 

program that you oversee? 

Mr. EVANS. We, Congressman, are working with prosecutors in 

getting peace bonds and mental health bonds for people that get incarcerated, actually get put in jail that have committed a major 

crime. We also have established a mental health court where we 

are working with judges on book-in, the original book-in and dockets there for early diversion. 

So almost every place in the criminal justice system there is a 

contact for the mentally ill person. We are working with that 

branch of government in the judicial system to make sure that justice is served but also that these people get the needed treatment 

so they don’t decompensate and end up getting back involved with 

law enforcement. 

Mr. COBLE. Thank you, sir. 

Mr. EVANS. Thank you. 

Mr. COBLE. My time is about to expire, Mr. Chairman. I yield 

back. 

Mr. SCOTT. Thank you very much. 

36

And I thank the witnesses for your testimony. This has been very 

helpful, and, to a large extent, our efforts will be in the Appropriations Committee, but this hearing record will be extremely important. I have talked to at least one appropriator so far who is going 

to be very supportive of trying to get some additional funding for 

you. 

So thank you very much for your testimony. 

And I would ask unanimous consent that a letter from the Justice Center, from the Council of State Governments, be entered into 

the record. Without objection. 

[The information referred to follows:]


JC-1.eps
37


JC-2.eps
38

Mr. SCOTT. Members may have additional written questions for 

our witnesses, and we will forward them to you and ask you, if 

there are any, to answer them as quickly as possible so they can 

be made part of the record. 

And, without objection, the hearing record will remain open for 

1 week for submission of additional materials. 

Without objection, the hearing now stands adjourned. Thank you. 

We will now be going into a Subcommittee markup on the Second 

Chance Act, and it will take us a few minutes to get reconfigured. 

[Whereupon, at 3:12 p.m., the Subcommittee was adjourned.]

Æ