Tony Mantor: Why Not Me the World
Judge Liefman: Breaking the Cycle of Autism and Mental Illness in Criminal Justice
Mon, 28 Apr 2025
Send us a text Judge Steven Leifman shares his remarkable journey from witnessing horrific conditions in a state psychiatric hospital as a teenager to becoming a leading judicial advocate for mental health reform. His work in Miami-Dade County has transformed how the criminal justice system handles people with mental illness, saving millions of dollars while giving thousands a path to recovery. • Began his advocacy at 17 when investigating abuse at a state psychiatric hospital where he found an autistic young man being improperly treated as psychotic • Discovered as a judge that our system has transferred responsibility for the mentally ill from inadequate state hospitals to equally inadequate jails • Found that just 97 people with severe mental illness were arrested 2,200 times over five years, costing Miami taxpayers tens of millions • Created a comprehensive diversion program that reduced Miami arrests from 118,000 to 53,000 annually and closed one jail, saving $168 million • Building a first-of-its-kind mental health facility with crisis stabilization, housing, employment support, primary healthcare, and court services • Working with Chief Justices nationwide to replicate Miami's successful model in communities across America • Emphasizes that people with mental illness are more likely to be victims than perpetrators of crime • Advocates for early trauma intervention since 92% of incarcerated women and 75% of men with mental illness have histories of severe trauma If you know anyone who would like to share their story on our show, please send them to TonyMantor.com/Contact. https://tonymantor.com https://Facebook.com/tonymantor https://instagram.com/tonymantor https://twitter.com/tonymantor https://youtube.com/tonymantormusic intro/outro music bed written by T. Wild Why Not Me the World music published by Mantor Music (BMI)
Chapter 1: Who is Judge Steven Leifman and what is his background?
Hopefully you gain more awareness, acceptance, and a better understanding for autism around the world. Hi, I'm Tony Mantor. Welcome to Why Not Me? The World, Humanity Over Handcuffs, The Silent Crisis special event. Joining us today is Judge Stephen Leifman. He was first elected to the 11th Judicial Circuit Court of Florida in 1995.
In 2007, he served as a special advisor on criminal justice and mental health for the Supreme Court of Florida. He has received several awards, including one from the Pope. It is truly an honor to have his honor with us today. Thanks for coming on. Sure. Thanks for having me. Oh, it's my pleasure. You've been doing this for a very long time.
What led you to become an advocate for people with mental health and autism?
Chapter 2: What inspired Judge Leifman to become an advocate for mental health and autism?
Yeah, I have two stories. And the first one starts when I was 17 years old. I was an intern for a state legislator here in Miami, and he had received a letter from the then editor of the Miami Herald newspaper. about a young man who was in our local state psychiatric hospital. This is 48 years ago.
This is the height of institutionalization, and it's the height of the abuses that went on at state hospitals. So I guess being the low guy in the totem pole, I got asked to go to the state hospital to investigate. The editor of the Miami Herald, who wrote the letter to the legislator, raised concerns that there was abuse going on at this facility and that this young man was being abused as well.
Chapter 3: What were the conditions like in state psychiatric hospitals 48 years ago?
So I walked through the front doors of a state psychiatric hospital 48 years ago. And it was a scene out of One Flew Over the Cuckoo's Nest. Funny in a way, I'm a 21-year-old son. I would never allow him to go. I can't believe they sent a 17-year-old kid. Anyway, I found Jonathan, the young man I was looking for. He was in all four-point restraints.
He was being injected with probably Thorazine, which was the only antipsychotic at the time. He was screaming and moaning and crying. And it was a scene out of a horror movie. So I started to look at his records. This is well before HIPAA. I started to talk to the staff, although I will candidly tell you I had no idea what I was looking at. I was 17 and knew nothing.
But what I did find that shocked me, and when I spoke to the staff, it turns out that he was not psychotic at all. He was autistic.
Wow, that's amazing.
Here they were injecting him with antipsychotic medications.
What was the next step when this came to your attention?
While I was there, there was a group of advocates touring the facility, and they found out that there was a representative from a legislator's office, albeit a 17-year-old who had no knowledge and no power. But they insisted I take a tour of the facility. They brought me downstairs to what looked like a dungeon. It was like a jail cell. And I found these seven men.
lying in their own feces while a guard, they were naked, and a guard stood there with a hose and washed them down like they were animals in a zoo. It was pretty traumatizing and pretty horrific. And while I did not have much authority to help them, I was able, with the help of the senator, to get the young man out of the hospital.
And we got him placed in a really wonderful, amazing adult living facility for other young men with autism. And he was very well cared for after that.
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Chapter 4: How did Judge Leifman's early experiences shape his judicial career?
That's really good that you could help him. How did that affect you?
It left a pretty indelible mark on me. About 17 years later, I got appointed to the bench. And ironically, that hospital that I had been at 17 years earlier was closed. The jail across the street from me started to become the psychiatric facility for our community. So those same folks or type of folks that had been in the state hospital, they got released to the streets without services.
And many of them ended up in the criminal justice system. In 1955, there were about, maybe we estimate 5,000 people with serious mental illnesses in state hospitals. There were about, excuse me, in jail, there were about 550,000 at that time in state hospitals. Today, there's less than 30,000 civil psychiatric beds in this country.
And last year, we had about 1.5 million people with serious mental illnesses arrested and about 2 million incidents. And so we never deinstitutionalized. What we really did is we transferred responsibility from these really terrible, crappy, horrible state hospitals to these really terrible, crappy jails.
And the problem is in some ways it's worse because now you end up with a criminal record and it's harder to get housing and it's harder to get employment.
Did you have any single case that stands out in your mind? You now look back on it and it was the beginning of your journey of helping those with autism and mental health?
When I got assigned to the criminal division, I ended up having a case. This is the second part of my story. I was getting ready to go on the bench one morning, and the assistant public defender and the assistant state attorney came to see me. And they said that there was a case that was really mind-boggling on my docket.
If I wouldn't mind, would I please speak to the defendant's parents who were in court? At the time, I was handling what we call a jail misdemeanor division. These are people on very low-level charges who are still in custody. There's kind of three types of folks in that division. There are those with attached felonies who are not allowed out of custody.
There are those that are too poor and they can't afford to bond out of custody. But mostly, it's really people with serious mental illnesses that don't know how to get out of custody.
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Chapter 5: What challenges exist in the criminal justice system for people with serious mental illness?
And she said, my son is the former head of psychiatry at Jackson Memorial Hospital. That is our largest public hospital in Florida. And she said he didn't show up to work one day, and he was having religious ideations. So he cashed in his life insurance policy. He flew to Israel to be closer to God.
And within a few weeks, he was deported back because he was running around naked in the Orthodox sections of Jerusalem and they were afraid for his safety. So they sent him back to Miami where he became homeless and started cycling through our system.
What happened from there?
I called this case. We had a great conversation. He ended up having a full-blown psychotic episode in court, screaming at the top of his lungs that his real parents had died in the Holocaust and this couple sitting in the back were from the CIA and they'd come to kill him.
And after ordering a battery of evaluations and adjudicating him incompetent to proceed, it turned out in Florida that because it was only a misdemeanor, I literally had no authority to get him help and I had to release him back to the street. Well, that was the beginning of my journey. And between those two incidents, I think I became the Forrest Gump of mental health.
I just started going through and trying to fix things the best I could, given the wonderful moral authority I had. To my great, pleasant surprise, it has far exceeded all of our expectations. We've been able to do some miracles because I have an amazing staff and an amazing community that has allowed me to make these structural changes that were so necessary.
That's great that you have such supportive people around you. Now, I understand you are starting a crisis unit or a facility along that line.
I'm already working on that. It's not a crisis unit, but I appreciate you asking about it because it's fascinating. It is the first of its kind in the United States, possibly in the world. It is a one-stop shop for the most acutely ill that continuously cycle between the most acute systems of care, such as homelessness, jail, and hospitalization, both primary and psychiatric.
It's the old competency restoration facility. It's 181,000 square feet. And it's going to be a mental health diversion facility for that population. Just back up a little bit so your listeners understand the problem. When community mental health was designed in the United States, the most acutely ill were still in psychiatric hospitals.
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Chapter 6: What is the new mental health diversion facility Judge Leifman is building?
And understand that there's a smaller subset of this population that are so sick, but they're using up all the resources. We did one study with one of our universities in Florida that looked at who the highest users of criminal justice and mental health services were.
We sent them the names of 3,300 people who had come through our system, and they had access to all the arrests in Florida and all of the civil commitments in Florida, all the Medicaid and Medicare records.
That's very interesting. When you got the numbers back, what did they tell you?
It narrowed it down to basically 97 people, primarily men, primarily diagnosed with a severe psychotic disorder, primarily homeless, primarily co-occurring, who over a five-year period, these 97 people were arrested 2,200 times. They spent 27,000 days in the Dade County Jail, 13,000 days at a psychiatric facility, cost taxpayers tens of millions of dollars, and we got nothing for it.
And so this building is really for that subpopulation. In fact, we've had this diversion program going on for 24 years, and I'll describe it a little bit more in a minute, but we get a list every day from my county of who is eligible to be diverted into the community. And because of the lack of capacity, we can't get to them all.
Over the last five years, we just looked at the data because we're trying to figure out who's going to go into this building first. We identified 16,000 people who over five years, they were arrested 32,000 times. They spent 1.2 million days in the Dade County Jail. That's 3,400 years. $414 million in taxpayer dollars wasted, and we got nothing for it.
Those are just totally amazing numbers. What's this facility going to look like when it's up and going?
So it's that type of population that this new facility is for. And so the building will have a receiving facility, a crisis stabilization unit, a short-term residential facility, a deactivity program that'll teach individuals self-sufficiency, how to manage their illness, a culinary supportive employment, vocational supportive employment programs like computer labs.
It will have a primary health clinic, a dental clinic, an eye clinic, and a podiatry clinic. They'll have tattoo removal because people do silly things when they're psychotic and stunned. It has a courtroom in the facility so we can manage both criminal and civil cases.
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Chapter 7: How will the new facility help reduce recidivism and improve outcomes for the mentally ill?
Now, as a judge, you have certain things that you can do. Of course, you have certain limitations that you have to adhere to. How do we get the empathy from the DA side working with the defense lawyer so they can help these people rather than being focused on the number of convictions that they're able to get?
Yeah, and that's a wonderful question. And I'm actually quite optimistic because it's changing. And part of the reason it's changing is I've been working very closely over the last several years with something called the Conference of Chief Justices and the Conference of State Court Administrators.
All the chief justices of all the state Supreme Courts in the United States and all their court administrators. And they have made mental illness their primary issue for the last four or five years. They are having summits now. We have tours to Miami quite regularly. They come here. They learn about how to restructure their community.
They're going back and starting to put together plans on how to do what we've done because we've been able to reduce the arrests in Miami as a result of our project from 118,000 a year to 53,000. Our jail audit went from 7,400 to 4,400. We closed one of our three main jails at an actual savings, not cost shift, of about $168 million so far.
And one of the things that we hadn't anticipated, our police shootings have almost stopped here. And while it's possible that race certainly can play a role in a police shooting, it turns out that the reality may be that many of the police shootings have as much to do with PTSD among law enforcement as anything. They overreact because they get scared.
I've been talking with several different people. They actually go into precincts, work and train with the police. So I'm hoping that's going to help out a lot as well.
The woman that runs my training program for law enforcement, we call it CIT, Crisis Intervention Team Policing, she gets between 150 and 250 calls a month from police officers for their own personal mental health issues. It's tragic, but last year, more officers died from suicide than in the line of duty. We set up a program to help get them treated when they're having issues.
And it has helped amazing, and they've become incredibly empathetic. And then as for the prosecutors, our own prosecutor has become a huge advocate because she's learned that if you want to really improve public safety, we have two choices. We can release this population without treatment or we can release them with treatment. You know what happens when we release them without.
We might as well do it the right way, get people what they need. Recovery is real. Many mental illnesses have better recovery rates than heart disease and diabetes. It's really just about making sure there's access, competent and quality care for this population.
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Chapter 8: How is collaboration between judges, defense lawyers, and prosecutors evolving for mental health cases?
I was sponsored by the Hilton Foundation and they wanted to see if it was a program that could be replicated or scaled in the U.S. And the reason they picked Trieste is because the World Health Organization has determined that Trieste has the best mental health system in the world. And after visiting it for a week, I can unequivocally tell you it does. They basically had no homeless.
They had few, if any, people in jail with mental illnesses, few, if any, people in their state psychiatric system, and few, if any, in their forensic system. It was really remarkable. And they did it not through anything that should shock anybody. They intervened early. If there was a break, the doctor went to the house. They wrap around services. They get you housing.
They have a really great day activity program. They don't define you by your illness. They put you on a long-term injectable medication. And they make sure that you're incredibly well case managed. And you're working during the day. So you have a life and you have goals and hopes. Nothing that we all don't know works.
We're so quick to try to incarcerate before we treat that it's absurd and it's expensive. The United States spent almost a trillion, with a T, dollars last year on costs related to incarceration. Could you imagine what we could do with that kind of money for mental health and autism?
You've had a tremendous amount of success in your area. You're working on the new facility, trying to work with the legal system across the country. What are some of the hurdles that has been presented to you that you see that you've got to either go around or jump over so that you can make a difference, not just in Miami, but across the country as well?
It's a couple of things. The message is very important, but I'm finding equally important is who delivers the message. And I think one of the great things that's going on in the U.S. right now is the level of judges that have gotten involved. Reality is that we're seen as Switzerland. We don't have an axe to grind. We don't have an interest or a financial interest.
By having judges become involved in this issue has really opened a lot of doors. It gets the right people to the table. I tell people the best part of my job is that when I invite people to a meeting, they come. And so we need to use that moral authority, get people to the table, and explain to them what we're doing and why it works.
And look, as cynical as I could be on days, I do believe when you get a chance to meet people one-on-one and you really get to talk about these issues rationally instead of In the world we live on where everything is argued, most people get this. They don't want to see people with mental illnesses in jail. They have loved ones. They know people.
They want to make sure that this population is cared for, treated, housed. And they know that if you do that, we're going to get better outcomes. And they're pining for it. They really want a system that works as opposed to trying to navigate one that doesn't.
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