On October 6, 2020, hundreds of stakeholders in the mental health area reconvened for the second of five virtual sessions aimed at “Improving the Court and Community Response to Persons with Mental Illness and Co-Occurring Disorders Through Compassion and Hope." The title of this presentation was Mental Health Diversions from the Justice System through Leadership, Collaboration, Building Momentum, and Moving Forward with Lessons Learned from the Pandemic. These sessions are free and available at www.ncsc.org/mentalhealth.

Justice Kathryn Zenoff of the Illinois Appellate Court, Second District, welcomed attendees. In her opening remarks, she noted that: “We are in a pandemic, but also in the midst of the 'silent epidemic'—mental illness.” Justice Zenoff emphasized the importance of raising awareness of those who live with mental health issues and co-occurring disorders and the need of providing help through the coordinated action of various agencies in the community. She stated that compassion and hope were essential and encouraged participants to “see the person, not the disease.”

Next, Kimberly McCullough, deputy director of community outreach, from the Department of Healthcare and Family Services welcomed the participants and highlighted the agency’s continuing efforts to provide service for the public during the COVID-19 crisis, especially expanding the Medicaid program.

Judge Steven Leifman, associate administrative judge, in the Eleventh Judicial Circuit of Florida (Miami-Dade County) was the keynote speaker. Judge Leifman currently chairs the Steering Committee on Problem Solving Courts for the Supreme Court of Florida and the Mental Health Committee for the Eleventh Judicial Circuit of Florida.
The theme of the presentation was his "journey into the mental health system, the legal and medical history that led to America's mental health crisis and the essential elements necessary to create an effective system of care that ultimately would transform the mental health and criminal justice systems and would make jail the last option for people with serious mental illnesses, not the first."

Judge Leifman pointed out that it would be “failed public policy” if we applied the traditional criminal justice model to people with mental health disorder rather than population health model or disease model. However, he emphasized that it is not just a “criminal system problem but a systemic problem with the mental health system. Systemic changes are needed to improve the appropriate response to people with mental illness.”

Various source of data supported the strong correlation between multiple involuntary civil examinations and arrests of people with mental health issues. A disproportionate number of people with Serious Mental Illness (SMI) were arrested and incarcerated rather than hospitalized. The criminal justice system was becoming a de facto mental health system and it caused great fiscal impact, as well as human cost. Due to the pandemic, the jail population was decreased, providing a unique opportunity to reassess the approach to the arrestees who were having a mental health crisis.

Judge Leifman presented the Miami-Dade approach as an example of effective ways to address the “high users of the system without overhauling the entire system.” He highlighted the critical aspects of collaboration of court, community, and law enforcement to serve the people with SMI. The Miami-Dade two-tier approach was the following: 1) Pre-Arrest Diversion-Crisis Intervention Team (CIT); 2) Post-Arrest Diversion. He would add a third tier: School-based/Pediatric Program to identify and help children who show signs and symptoms of trauma or SMI (sexual assault or domestic violence).

In addition to the two-tier approach, three other measures were used in Miami/Dade County under Judge Leifman; Competency Restoration Alternative Program, Assisted Outpatient Treatment (AOT) Program in County Court Criminal Division, and Jail In-Reach Program.

The Miami/Dade Court approach effectively help individuals with mental illness who are in crisis. It routes them to appropriate mental health care facilities rather than jail. The approach has resulted in a decrease in the number of arrests and incarceration and lowered recidivism, all at a significant cost reduction. There was an added benefit of providing treatment of the PTSD of law enforcement.

Judge Leifman showed a clip of the documentary, The Definition of Insanity, which aired on PBS on April 14, 2020. The Definition of Insanity shows how Judge Leifman’s novel approach to solving the mental health crisis could be the model to tackle the much larger epidemic throughout America. https://www.pbs.org/video/the-definition-of-insanity-7egjih/

The last part of the session was a panel discussion, moderated by the Judge Sharon Sullivan, Presiding Judge of the County Division of the Circuit Court of Cook County. Members of diverse areas of expertise in the mental health arena each discussed the services they provide to people with mental health issues, the impact of the pandemic and their responses.

• Representing treatment providers, Dr. Rashad Saafir, president and CEO, Bobby E. Wright Center Comprehensive Behavioral Health Center and co-founder and director of the Westside Community Triage and Wellness Center, discussed how his organization helped the people with mental illness or substance abuse disorder in his community by crisis intervention, assistance with housing, food, and job search and working with law enforcement.
• Representing Medicaid, Kim McCullough, deputy director of community outreach, Department of Healthcare and Family Service stated the agency expanded during the pandemic and changed the emergency rule of Medicaid to reimburse “telehealth” services so treatments are more accessible to those in need.
• Representing the courts, Judge Janet Holmgren, of the Juvenile and Problem-Solving Court Division, 17th Judicial Circuit Court and President of the Illinois Association of Problem-Solving Courts, detailed problem-solving courts (drug court or mental health court) and their function, roles and procedures. Judge Holmgren further talked about the challenge posed during the pandemic and the implementation of creative methods, such as telehealth, to help the participants.
• Representing probation, Hanna Ewing, MSW, Tazewell County specialty court officer, who also has a clinical social work background, expressed the concerns of different effects of the pandemic on her clients, such as treatment access, probation appointments, or other daily routines such as grocery shopping. Her probation department tried to utilize a new method to contact the clients such as downloading a free meeting app or using on-line NA/AA.
• Representing prisons, Dr. Melvin Hinton, chief of mental health services, Illinois Department of Corrections (IDOC), stated the pandemic also affected prison population in the IDOC. Out of 31,000 offenders, 12,000 (39 percent) are in mental health caseload. The IDOC faced the challenge of providing the inmates' mental health services while they were in the facility. The IDOC also tried to help prisoners by giving information and education so they could continue to seek treatment after their release and return to the community.
• Representing the legislature, Rep. Deb Conroy, Illinois state representative, 46th District, chair of Mental Health Committee expressed the importance of educating other legislators and the public about mental health and substance abuse issues and the committee's efforts of expanding telehealth, mental health and addiction issues and creating new laws and budgets.

The second session of the Illinois Mental Health Task Force Virtual Summit afforded participants an opportunity to learn valuable information from a variety of different government agencies and community organizations, focusing on the new challenge during the pandemic and creative responses to continue to help the most vulnerable population. The Miami/Dade County approach demonstrated how a creative and well-coordinated system with the collaboration of various resources could accomplish helping people with mental health disorders effectively.

Eun K. Yoon is an assistant public defender in Kane County, Illinois.