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    Judges and Psychiatrists Decriminalizing Mental Illness Together

    Feb 10 2022

    On this episode, we are joined by Dr. Michael Champion and Judge Steven Leifman to talk about how judges and psychiatrists can work together to combat the over-incarceration of community members with mental illness.

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    Transcript of Audio

    Christopher Chun-Seeley: Hello. Welcome to Mentally Healthy Nation, a podcast of The American Psychiatric Association Foundation. I'm today's host, Christopher Chun-Seeley.

    Christopher Chun-Seeley: When community members with serious mental illness find themselves in contact with the criminal justice system, which happens two million times each year, they will often find their way in front of a judge. If this community member can be recognized by a judge as having a serious mental illness, the judge can use their discretionary power to divert them to the appropriate services. Even better, they can use their convening power to address the systemic issues further up, even before contact with the criminal justice system begins. This recognition of need and use of convening power is accomplished through training judges through a national model developed by the APA Foundation and the Council of State Government's Justice Center, Judges and Psychiatrists Leadership Initiative. At the heart of this model is simple, partnership. Partnership between judges and psychiatrists as experts in their respective areas to improve judicial, community and systemic responses to community members with serious mental illness.

    Christopher Chun-Seeley: Today, we bring to you two of those experts, Dr. Michael Champion, medical director for the Hawaii Department of Health, adult mental health division, and one of the two psychiatrists that serve as co-chairs for the JLPI for over eight years. And Judge Steven Leifman of Miami-Dade's 11th Circuit Court, one of the two judges that serves as co-chairs for JPLI for over 10 years now, to have a candid conversation around the importance of addressing the over-incarceration of community members with mental illness through partnerships between judges and psychiatrists.

    Christopher Chun-Seeley: Judge Leifman, Dr. Champion, thank you so much for being with us here today. People listening in might not know the scope of the problem and how a judge and psychiatrists got started working together. Can you tell me about why you each got started working at this intersection of mental health and justice system? Dr. Champion, how about you start us off?

    Dr. Michael Champion: Thank you, Chris. Good to be here today. And good to be with you, Judge Leifman, to have a discussion about this important and pressing topic. So, first let me give you a short answer, and then give you a little bit of a longer answer, because the question is both the scope of the challenge that is before us, but also on a personal level, how I became involved at this particular intersection. That may be relevant to those listeners who are considering working in this field or are working in the field now.

    Dr. Michael Champion: So, the short answer is that in our community, and in our state mental health systems around the country, after there was a shift from people being served in state hospitals and a shift into the community, back in the 1960s, 1970s, unfortunately many people who were in the community were not receiving services. And over time we've seen that they've become more and more involved with contact with the criminal justice system. So, those folks who struggle with mental illness and behavioral health conditions are more likely than not unfortunately, to become in contact with law enforcement and the criminal justice system. So, I'm also going to be very interested to hear Judge Leifman's perspective and experience on this as well.

    Dr. Michael Champion: But in brief, folks these days who have a mental illness are struggling with having limited access to healthcare and have a disproportionately higher rate of arrest compared to folks who don't have a mental illness, and end up staying in jails and prisons for a longer period of time when they arrive there.

    Dr. Michael Champion: Now, maybe for a little bit more of longer answer, personal answer. For me personally, when I finished college, I wasn't really sure about what I wanted to do, and whether I wanted to pursue clinical training or legal training, or what have you. And so after, well, I started working at a local prison as a bachelor level mental health worker. And one place was in a general population of medium security prison. And the other was in the maximum security prison, 150 bed psychiatric hospital. And during those years, I really got a clear picture that there's a huge amount of need for individuals who are at this criminal justice, mental health interface.

    Dr. Michael Champion: And so, I decided to go to medical school, ultimately to pursue training and start working at this interface. Later, trained in forensic psychiatry and focused my professional and personal efforts since then on working to decriminalize mental illness and try to divert people when appropriate out of the criminal justice system into treatment.

    Dr. Michael Champion: So, I'll just end with my experience over the years has allowed me to work with law enforcement, work in jails and prisons, work in courtrooms with judges and probation staff, and also in public mental health systems to try to transform the way that we approach people who are at this intersection. So, that's the short and long answer.

    Christopher Chun-Seeley: Judge, do you want to jump in and tell us a little bit about your story?

    Judge Steven Leifman: Thank you, Chris. And thank you so much for you and the foundation for putting this together. It's really interesting, but when I began as a judge, I knew nothing about mental health issues. And what I soon learned is that I probably as a judge in the criminal division was seeing more people with mental illnesses in a day than most psychiatrists were seeing in a month. And you also come to learn, after several years on the bench, that in many ways the criminal justice system is the repository of many failed public policies. And there is no greater failed public policy in America, in my opinion, than our treatment towards people with serious mental illnesses.

    Judge Steven Leifman: And so, my journey into the mental health world began one morning when I was getting ready to go on the bench. I was approached by the assistant public defender and the assistant state attorney. And they asked me if I would speak to a couple whose son was in jail on a case I was about to hear. They brought this lovely couple into my chambers. They were terribly distraught. The mom was crying. The dad was shaking. And they literally began to beg me to get their son help. At the time I was handling what we call a misdemeanor jail division. So, these are people that are charged with low level offenses, misdemeanors, that are still in custody. And there's three kinds of people 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 cannot afford to bond out of custody. But mostly this division was full of people with serious mental illnesses that just didn't know how to get out of custody.

    Judge Steven Leifman: So, this couple came in and they started to tell me about their son. They told me that he was brilliant. He had gone to Harvard. He had a late onset of schizophrenia. And he was now homeless. And he was recycling through the criminal system. And they just didn't know what to do. This is in the year 2000. I was relatively new at the time. I knew nothing about these issues or the system. And I made one of those rookie mistakes, promising them that I would get their son help, because I was under this false impression that if you got arrested and you had a serious mental illness, there must be treatment for you because we work in logic. And if you got arrested and had a heart attack, we would have a treatment system for you.

    Judge Steven Leifman: So, I promised them, I'd get their son help. And they were all excited. And they started to leave my chambers to go back to court, and the mom stopped me and she said, "Judge, there's one more thing you need to know about my son." And I said, "Yes." And she said, "Well, you see, my son probably knows more about the mental health system than you do." And I looked at her, I was unclear what she was trying to tell me. And I said, "Excuse me." And she said, "Oh, you see, my son is the former head of psychiatry at Jackson Memorial Hospital. That's our largest public hospital. And he just didn't show up one day and he disappeared. And we had no idea what happened."

    Judge Steven Leifman: And as it turned out, he had cashed in his life insurance policy, jumped on an airplane to fly to Israel because he wanted to be closer to God. And within three weeks, the Israelis had deported him back to Miami, and he was now homeless and recycling. And I was pretty taken back. I went to court. I called his case. We started to talk. He was thoughtful. He was coherent. As I like to say, he was more respectful than the lawyers. And except for looking like a homeless man, he didn't act or sound like someone who was particularly sick.

    Judge Steven Leifman: And at one point I asked him, because he kept insisting that he had no type of mental health disorder, and I asked him a question that I should not have. And it clearly triggered a psychotic episode. And he started screaming and ranting and raving in court that his real parents had died in the Holocaust. And the couple that were in court pretending to be his parents were imposters. And they had come from the CIA, and they had come to kill him. And it was really a horrifying situation. It was a horrifying case. And it turned out to be a window for me to everything that was wrong with our mental health system.

    Judge Steven Leifman: And as a result of this case, although I was not able to get him any help because we had no system in place on what to do with him, we have made significant changes moving forward. And it was quite a lesson into the mental health world. And it points why it's so critically important for us to team up with psychiatry, to be able to learn about these issues, to understand these illnesses, and equally important to learn how to talk to people with these illnesses, so we don't trigger situations, and also learn how to make sure that we get people access to treatment.

    Christopher Chun-Seeley: Yeah. Thank you so much both, Judge Leifman and Dr. Champion, for sharing a little bit about how you got started at this. And I think, the point being is judge, when you walked into that courtroom, you didn't know what you were walking into. And I think over the next 22 years, what you really have dedicated yourself to is learning.

    Christopher Chun-Seeley: And I think Dr. Champion, when we think about the role of a judge in addressing the complex issues behind keeping someone connected to mental health care, what can their role be and how can psychiatrists be a part of that role in this true idea of partnership?

    Dr. Michael Champion: That's an excellent question, Chris. There's a very important comment Judge Leifman made regarding seeing more people with mental illness and substance use disorder in front of the bench each day than most psychiatrists see in their day, in their clinic or their practice settings. So, that's the key issue. We have a real challenge in our country regarding having an adequate system of care available in the community from the crisis care continuum when people are experiencing an acute crisis and getting their needs met, or even beyond the crisis, when things have been stabilized and getting routine and regular care to help people actualize their potential in life.

    Dr. Michael Champion: And so, given those access issues and those service deficits that we have, many people are being channeled into the criminal justice system when they come in contact with law enforcement. And so, therefore judges are on the front lines in a way that clinicians are not. And so, it's extremely important for judges and staff in the judiciary to be knowledgeable and aware of what mental illness and its symptoms, and the kind of issues that people who are experiencing these kind of symptom are facing when they're going to be in front of the bench, so that they can be recognized. So, one thing is just having contact and recognition, and being able to have a potential point of action at that point.

    Dr. Michael Champion: Now, as Judge Leifman can explain, there are many points in the criminal justice pathway where judges will have face time with individuals who have behavioral health conditions. And so, at each point, the judge is in a unique position to be able to convene people, get stakeholders' attention, and develop some action points that are going to address the needs of the individual, and also the community as well.

    Dr. Michael Champion: So, a take home point is that judges are extremely well connected with many players or actors in the criminal justice system, but also stakeholders in the community as well. And they have the power to convene people, which they do every day, which Judge Leifman can speak more about. The mention of this is that there's the opportunity for the judge to exert influence on making those connections or channeling individuals to get services at any point in the pathway. In the courtroom or the judicial process, a person can be ordered to have an evaluation, to see what their needs are, what they're experiencing, what services will help stabilize them.

    Dr. Michael Champion: There's an opportunity to divert individuals into services out of the criminal justice pathway. There's also the opportunity to set conditions of release for an individual into the community. And those conditions can include ordering treatment, and reviews by the court and the judge to monitor adherence to that treatment as well. So, I think that's a treetop level view of how judges can be very integral in identifying individuals with needs, and also channeling them and connecting to that care.

    Christopher Chun-Seeley: Judge, I really want you to connect something that you said. And Dr. Champion, you kind of connected that already here is that, you were seeing more people coming through your courtroom. And you have this great convening power and ability to bring people together. And I know through our conversations in the past, you've talked about your secret sauce, if you will, being peer support, right? And actually integrating individuals with lived experience into the actual process of your court and how individuals are reintegrated back into our communities. And I'm just wondering if you could touch a little bit on that success and using your information and what you've learned, and bringing those individuals to the table.

    Judge Steven Leifman: Sure. So, thank you for that. And Dr. Champion made a few really important points that I want to come back to and expand upon a little bit. But we have a pretty large staff in our jail diversion system in Miami. We don't really have a mental health court per se, but we have a jail diversion system.

    Judge Steven Leifman: So, one of the most important things that we did is hire peer specialists. Those are people with serious mental illnesses, who are in recovery and act as navigators, peers to individuals who are coming into our system. We have a staff of about 25 people. Eight of them are peer specialists. And four of them actually graduated from our program. And they all have very serious mental illnesses, everything from schizophrenia to bipolar disorder, to PTSD. And they're all in recovery. And what people don't appreciate is that it's not like, "Hey, I have a mental illness. You have a mental illness. Let's bond." It's that they've been through this system and they know how difficult it can be to navigate, and how people just give up. So many people by the time they get arrested with these illnesses, not only have their serious mental illness, but often they have clinical depression on top of their serious mental illness, because the system has just beaten them up so badly.

    Judge Steven Leifman: And a lot of people, I call us civilians that don't have mental health issues. The civilians are saying, "Hey, if they just take their medication, they're going to be fine." Well, they're not ready at that point by the time they've gotten us because they just don't care. And what the peers help do is reestablish relationships with people that helps incentivize them to want to start to get better. And it's at that point, we're often able to start to get people to take their medication and stick with it. And the peers also help them navigate these very complex systems of care.

    Judge Steven Leifman: And little things that we have done that are very inexpensive that make a huge difference in the outcomes and the success of this population is our county gave us a car. And our peers have access to the car. And they drive the individual from court to where they're going to be staying, to their appointments. Help them get around town. Help them get benefits, so they have some money in their pockets, and they feel like human beings again. We make sure that they get housing. And the peers help them navigate all those different systems, so that they can get on their feet. And so, they are a critical, critical part of what we do.

    Judge Steven Leifman: But just to put some of this in context, what Dr. Champion was talking about a little bit, people don't realize this, but 70% of all the people in the criminal justice system, either have a serious mental illness, a substance use disorder, or both. In the United States, we spend over a trillion dollars a year in direct and indirect cost as a result of that. And so, we joke, but almost what we need to do is have specialty courts for the 30% that don't have one of these disorders. And we almost need to have a therapeutic jurisprudence system and a system that diverts people into other courts, civil courts to help manage their illnesses.

    Judge Steven Leifman: And what happens is for judges, and the reason doctors and psychiatrists play such an important role for us is that we need to be educated, because what often happens is the judge misinterprets, misunderstands or gets offended by an individual's behavior in court, not realizing that the person is just sick. And I used to teach a class called, Do No Harm, because sometimes my colleagues would make matters worse.

    Judge Steven Leifman: We know, for instance, that 92% of all the women in jails in the United States, with serious mental illnesses have horrific histories of trauma, mostly sexual abuse. We know that 75% of men who are in jails and prisons in the United States have horrific histories of trauma, sometimes sexual abuse, more often, more likely to be victims of domestic violence or witnesses to violent crimes. And just coming into the criminal justice system, it's easy to retraumatize this population. And there's so much data now that shows us just a day in jail for someone with a history of trauma, significantly increases recidivism rates. And so, most judges don't know that. They think they're going to fix this by punishing the person or trying to address the behavior as opposed to addressing their illness.

    Judge Steven Leifman: And so, it makes it so important that we team up with psychiatry to learn about these issues, to learn about these illnesses and learn how to address them. And so, it just is so important that we get it right. And if we want to reduce recidivism, if we want to save critical tax dollars, if we want to improve public safety, it's incumbent upon us to be educated. And the only way we can do that is to work with psychiatry.

    Christopher Chun-Seeley: I think you're so right. There's such a big gap across, I think the entire justice system on knowledge around mental health, and also around accessing care and those barriers to care. So, I think even what you mentioned about out your peer support program, having access to a car and thinking about just what transportation to services can be as a barrier is so huge.

    Christopher Chun-Seeley: And Dr. Champion, I'd love for you to jump into this conversation here. And as we're looking at about all this reform, that's happening. 988 is launching in a few short months come July. And there's a bunch of knowledge that has to happen around mental health and access to care. What role can judges and psychiatrists play to make sure that we are addressing that big gap that exists currently?

    Dr. Michael Champion: Well, let me build on a previous comment about judges and their role, but also the importance of psychiatrists collaborating with judges and other players in the judicial system, law enforcement systems, to build solutions. It's extremely important that psychiatrists and mental health professionals are at the table in identifying the need and identifying innovative solutions that work right for that community that they live and work in. And it's important to say that they work in terms of providing services, but that they live in as well. Of course, we know that behavioral health conditions do not discriminate in who experiences them. So, it affects us across the board. So, of course, we're invested on many different levels in finding innovative solutions.

    Dr. Michael Champion: So, it's extremely important to find a way to work in an innovative way to address the gaps that we see across the community spectrum. And that's particularly the case in the crisis space. When people are experiencing acute event and they need services, how are they going to get to it? How are they going to access the service? Is it going to be family members making phone calls for them? Is it going to be going to the emergency department? Is it going to be some concerned community member calling the police and the police responding into the community and interfacing with somebody who's in crisis?

    Dr. Michael Champion: 988 is a very, very important development in terms of developing a national unified way to access crisis services and supports when people are in a behavioral health crisis or suicidal and need attention and need it quickly. So, as that is being developed and rolled out, what's extremely important is not only how do you call and get connected to somebody who can channel you somewhere, you also have to build the services in the community that they can be channeled to, that's going to bring people into care and services in a timely way, and avoid start going down the criminal justice pathways through contact with law enforcement.

    Dr. Michael Champion: And so, this is particularly pertinent now that we're in the midst of a pandemic, because COVID has increased the stress on all of us. And the incidents of behavioral health conditions has really exponentially increased, and more and more of us in the community need these kind of services. And so, psychiatrists, mental health clinicians collaborating with judges and other stakeholders in the build out of 988 and it's implementation is absolutely key.

    Judge Steven Leifman: Dr. Champion talks a little bit about COVID, and it's not just the increased stress for some people. And there's studies that show maybe up to 20% of people that actually get COVID are experiencing some serious mental health related issues. Pregnant women, first trimester, maybe an increase in the child offspring at some point, having serious mental health related issues. I mean, this is going to be with us for a very long time. And we already don't have enough psychiatrists. And the demand for services is now greater than it has ever been. And as a result, people are again being pushed into the criminal justice system.

    Judge Steven Leifman: And so, while we saw a significant reduction in arrests during COVID, the number of people with mental illnesses seems to have stayed steady. And so, there's even more stress on our systems. And remember, not only is there an over-representation of people of color in the criminal justice system, there's even a larger over-representation of people of color with mental illnesses in the criminal justice system. And so, not only do we lack the number of psychiatrists, we even lack in greater numbers, cultural sensitivity, and cultural appropriateness, to be able to get people of color and different minorities access to doctors that are more representative.

    Judge Steven Leifman: So, the system is really stretched right now. And I think all of us have to figure out how we're going to continue to work together to try to improve access and care. And there's been this sense over the last 20 years since I've been doing this, that we need to improve the criminal justice response to people with mental illness. And I agree with that a thousand percent, but I also think there is a need to improve the justice systems response, not just the criminal justice response to people with mental illnesses.

    Judge Steven Leifman: And one of the things that Dr champion and I have been working on, on a related project, is developing new pathways, so that if people do penetrate the criminal justice system, and they don't have a serious risk of offending again, that we move that case into the civil system. We don't have to criminalize. And as you talked in your introduction, this is about reducing the criminalization of mental illness. And one way to do that, and I'm going to get back to 988 in a minute, but it's also to structurally change how we do things, and maybe pass laws that change the pathways, so that if you do get arrested and it's a low level offense, there's no violence involved, you don't have a high risk of reoffending, we move you into the civil system and let the civil court handle you. Why are we putting you behind bars? Why are we threatening you with jail? I mean, that is not always the best way to help people get treated.

    Judge Steven Leifman: Now, yes, the criminal justice system does have its leverage. And for some people, particularly people that are lacking a lot of insight to their illness, it may be the only way to help them get services, but still leaving us with a record makes everything so much more difficult. It makes it harder to get housing. It makes it harder to get employment. It makes it more likely you're going to make new bad friends, people that like to commit crimes, that take advantage of you in the criminal justice system when you get out.

    Judge Steven Leifman: So, we're not doing society or the individual many favors by using the criminal justice system as the defacto mental health system. And so, we need to start to rethink it. And that brings me to 988. I think there's a lot of potential. I think it's been oversold. I think it's going to take decades to get it where we want it to be. People don't know, 911 took almost 50 years. After 20 years, less than I think 40% of communities had 911. It took a long time to get it up and running. And there were more resources than there are with 988.

    Judge Steven Leifman: And so, I think we have to be careful. And I think also, people are communicating differently today. It's not just the phone. It's Zoom. And in 20, 30 years, when this is fully operational, I think we should have greater access, so people can just turn on their computer or their smartphone and see a therapist or a psychiatrist, and not worry about someone coming to their house.

    Judge Steven Leifman: And so, I think there's a lot that can be done there, but as a premise, it's wonderful. And we should limit when we can law enforcement's response. And we should have a medical response.

    Judge Steven Leifman: And I remember when I was actually out in Hawaii, I think it was before I was there with Dr. Champion. I was doing a lecture and I had done some research. And I found this article that was written in 1939. And it was written for Hawaii by this brilliant psychiatrist about restructuring our system. And the problem was right after he wrote it, Pearl Harbor happened. And people forgot about making those structural changes. But one of the things he talked about, and he says in this 1939 article, how wrong it is that police have to be the first responders to people in a mental health crisis. And that we should have medical personnel, transferring people from hospital to hospital or home to hospital, or wherever they need to go, and not the police.

    Judge Steven Leifman: And so, we've had the answers for many years. We just, unfortunately haven't implemented it. And in many ways, things have gotten much worse than they were before. The closure of the hospitals, sentencing guidelines, the war on drugs, the war on crime, massive cuts to housing, all created this perfect storm that pushed a lot of these individuals from hospitals to the street, and then to the criminal justice system. And now we've got to go back and try to figure out a way to restructure it.

    Judge Steven Leifman: And I'll turn it back to Dr. Champion. But one of the other projects that JPLI is working on is with the Conference of Chief Justices and the Conference of State Court Administrators, which I think is taking what we've done in JPLI to an entirely new level. And Dr. Champion, you want to talk about that a little bit, because I think that's going to be an amazing opportunity.

    Dr. Michael Champion: Yes. Thank you. I totally agree that the national judicial task force that we're participating in is a good example of, in the micro, judges and psychiatrists working together for solutions, but on the national judicial task force, a number of other stakeholders and actors in this broader system related to the judicial system, scaling up examples from local jurisdictions and states, and identifying best practices and disseminating them broadly across the country in a uniform way of communication, which includes giving examples of those best practices, or example of model laws or model procedures that can be implemented on a local level.

    Dr. Michael Champion: And in addition to that, making available trainings for members of the judiciary, where psychiatrists are collaborating with judges to give those kind of educational opportunities and training, but also technical assistance as the states are rolling out these changes across the board.

    Judge Steven Leifman: Yeah. And what's cool about this initiative is the structural changes I believe that are needed, do not necessarily require legislation. A lot of it can be done with the stroke of a pen by a chief judge or chief justice to structurally change how we're responding to cases, because it falls within what we call the administration of justice.

    Judge Steven Leifman: And so, this initiative, which has the support of all 50 chief justices plus the territories is one of the most significant changes that we've seen since I've started in this field. And I think it really in many ways is attribute to the JPLI because we helped bring it to them. And they have come to recognize that this is an incredibly important initiative.

    Judge Steven Leifman: The CCJ and COSCA, which is the Conference of Chief Justices and the Conference of State Court Administrators, they've been around a long time. And this is only the third time in their history that they've ever developed a task force on anything. And this one is particularly on mental health. And the idea is to take some of the best practices in Miami, Hawaii, and other locations, Arizona, Illinois, and put it into a coherent new system where the chief justices can then deliver it to their states.

    Judge Steven Leifman: And so, I'm actually as piffy as I am about COVID and all the crap we're dealing with surrounding it, this too shall pass, I hope. And at some point we'll turn to some normalcy. And when we do, I think we're going to be ready to implement an entire new structure on how we access care. And I think it's going to be not only exciting, but incredibly important. And we're going to see outcomes change significantly. And I've been in this space for almost, as you said, 22 years now.

    Judge Steven Leifman: And as a result of the work that my staff has been able to do in Miami, we've reduced the number of arrests from 118,000 a year to 53,000 before COVID. The number of people in our jail went from 7,300 to about 4,300. We closed one of our three main jails, say at a 12 million a year savings. Now, for eight years, that's at 86 million bucks or something. Do I have that wrong? No, I think it's $96 million. And it's a lot of money. And our recidivism has come way down. And our police shootings have almost stopped as a result of training police and teaching them how to handle these cases as well.

    Judge Steven Leifman: And so, if you do this right, you can really address some of the biggest issues facing our country and our communities today, and really get to some of the underlying problems that face us. And so, I'm very cautiously optimistic that we're going to see that sea change. And we couldn't do it without the psychiatrist at our side.

    Christopher Chun-Seeley: Psychiatrists and judges, each have such an important role to play. And they can't do this important work alone, as I think you've both really highlighted throughout our conversation today. As you both know Dr. Champion and Judge Leifman, last year, the Judges and Psychiatrists Leadership Initiative honored the life and legacy of Judge Stephen S. Goss, through unnamed award, honoring a judge and a psychiatrist for their work at the intersection of mental health and justice. And one of those key criteria for the award is showing true partnership. And I'd love to get your perspective on this award and why partnership is so important to show in this case.

    Dr. Michael Champion: Judge Goss was a shining example of a human being that worked as a professional in the judicial system that cared, wanted to make an impact, did make an impact, thought creatively about innovative ways to approach the needs of the people that come before the bench, and was a true paragon of collaborative partnerships. And that's how he worked and what he developed during his entire career. And it was remarkable what he was able to develop as a model for the country moving forward.

    Dr. Michael Champion: I'm going to let Judge Leifman riff off of that and provide some of the details. But I would say before wrapping up my comments on that is that Judge Leifman was just speaking about the fact that you don't need a big law change or a policy change to make a difference, and to bring folks together for solutions. Oftentimes, it's getting collaborative agreements and mutual commitments, and getting on the same page about what the challenge is and how to solve it.

    Dr. Michael Champion: And again, I would go back to the benefit of psychiatrists collaborating with judges because judges do have that convening power. And when they do say, "Let's get together." People listen. And oftentimes, they come to a meeting with their eyes and ears open. Psychiatrists, also are very influential in the medical community and have good standing in the community as well, but don't have that convening power. So, this is a very mutually beneficial relationship between psychiatrists and judges. And recognizing judges and psychiatrists who are shining examples of how to do it and do it well is extremely important, so that we can tell their story, illuminate their story and encourage other people to get a better sense and feel of what that looks like.

    Dr. Michael Champion: So, Judge Leifman would appreciate the hearing a little bit more, particularly about what Judge Goss accomplished during his career.

    Judge Steven Leifman: Steve was one of those gentle giants. He was from rural Georgia. He was not in an urban area. He was in an area where there was very little access to treatment. And as a percentage, they still got the same amount of cases coming into rural criminal justice as they do in urban. And in some ways, it's harder because there's less treatment in those communities. And through his abilities and kindness, and compassion, he did what judges do best is bring people together, even if they don't want to be together. And he set up some of the first diversion systems and mental health courts in rural Georgia, which then went on to help us address a lot of these rural issues around the country.

    Judge Steven Leifman: And he was one of these people who was quiet and didn't say a lot, but when he spoke, everybody listened, because whenever he spoke, he had something important to say. And he was just a true gentleman. His death was horrifyingly tragic. It was related to mental health, which made it in some ways that much more confounding and tragic, because many of us who were his friends didn't know. And awkward, terrible way, just highlighted that this is a silent illness. And people suffer in silence so often without us knowing. And that's why we need probably to be a little kinder and gentler to each other and look out for each other. But he had a huge impact.

    Judge Steven Leifman: There's a wonderful chapter in Rosalynn Carter's book on mental health about his work. And he was one of the early pioneers of the JPLI and helped us get where we are today. And we miss dearly. And I think it's a wonderful tribute to have an award named after him, so that we can recognize people for doing the kind of work that he did, so we can continue it and grow and expand upon what we're trying to get done.

    Christopher Chun-Seeley: Thank you both for sharing a little bit about what Judge Goss meant to the work that we're doing, and then also, I think just the importance of partnerships, and that they are so key and they can be accomplished wherever you are, whether you are in rural Georgia to Miami-Dade County. And I think our two award winners last year, one looked at Ohio and stepping up and the state approach, and that was Retired Justice Evelyn Stratton, who's a current Foundation board member. And then, Dr. Kristen Ochoa, out of LA County and her work in competency restoration in the community, which is a huge issue that, which if you're listening to Mentally Healthy Nation throughout 2022, you can expect a full conversation just on competency restoration, as well with some of our experts through the JPLI. So, I think that's so key and so important.

    New Speaker: And yeah, I just wanted to mention, we also recognize Dr. Mark Munetz, who is one of the co-authors of the Sequential Intercept Model, also from Ohio, and has made a huge contribution to the field through the sequential intercept model and the other work that he's done in Ohio and around the country. So, it's just important to recognize people that are champions and that are doing this kind of work and moving these issues forward.

    Christopher Chun-Seeley: And so, for our final question, before I give the two of you, last words to end the podcast. We started this conversation talking about the start at this intersection of mental health and criminal justice. And what we really hope to do is inspire both judges and psychiatrists, or any mental health professional, or any individual in the justice system, or any community member who is interested in this to get started sooner, right? Not having to experience a tragedy like Judge Leifman, or looking at Dr. Champion in your experience of looking at that penitent. And now, I know we've talked and how you haven't seen that happen anywhere else. And how do we get to these individuals sooner? So, Dr. Champion, Judge Leifman, if there is a psychiatrist, a mental health professional, someone in the justice system, listening to the podcast today, where should they get started in this kind of journey at the intersection of criminal justice and mental health?

    Dr. Michael Champion: Well, I can speak about psychiatrists. I have to say just, I appreciate the opportunity to share my own personal journey, or at least the highlights of it that enabled me to be working in this space today. I feel very privileged and I have a lot of gratitude for being able to walk through a life path that has me working in a robust way with partners on something that is very near and dear to me, that I identified very early on in my life, that was an important piece of what I wanted to accomplish while I was on this planet.

    Dr. Michael Champion: And so, in thinking about how other people can get started and making these connections, no matter where they're at in their career, one place that we've already talked about is the Judges and Psychiatrists Leadership Initiative. The JPLI has a website and a newsletter that people can sign up for, that will give resources and information, and notifications about work at this interface. Once you become part of that community, it also is a channel into identify who in your local jurisdiction is doing some work in this area, but also opens the door for partnership for psychiatrists to become part of this initiative and join us on our broader team and rolling out this trainings and initiative around the country.

    Dr. Michael Champion: The other place is for psychiatrists, the State Psychiatric Association, because that can help connect you with others who are working in this space on the mental health side. It'll also give the opportunity for thinking about and getting involved in policy development on the state or local level. And the reason why I say policy development is because in the process of policy development, it brings together oftentimes many stakeholders who are thinking about a particular issue and trying to solve the problem, and gives you face time with those folks.

    Dr. Michael Champion: The other thing is by connecting with some national organizations that have local branches like the National Alliance on Mental Illness, NAMI or Mental Health America, MHA, there are many individuals in both of those organizations who are working at this criminal justice, mental health interface, who are good to connect with, who can help point you in the right direction.

    Dr. Michael Champion: Wearing my public mental health system hat, I would say you could contact your county or state department of health or department of mental health to ask the question about who in the department is working at this interface and how you might learn more about it.

    Dr. Michael Champion: And then the last thing I would say, which was a way of maybe handing the baton over to Judge Leifman is contacting the county or state judiciary, and asking about how to get connected with people who are working on this interface. And I think the nuances and the details of something like that, Judge Leifman could answer with more fidelity.

    Judge Steven Leifman: Thank you, Dr. Champion. And Chris, thank you so much again for putting this together. I will tell you I've been on the bench for 24 years, almost 25 at this point. And I think the greatest gift that I get as a judge is watching people recover. I mean, it's hard every day to watch this chain of misery come through the criminal justice system. And when you see people get help, get their lives back and get hope and some happiness again, I don't think there's any greater reward as a judge. And this has just been one of the most fulfilling professional aspects of my life. And I don't think I would've stayed a judge, particularly in the criminal system this long, if I wasn't able to be part of this, because you just can't adjudicate to put people in jail every day. It's just not something that's healthy, but to watch people recover is really tremendous.

    Judge Steven Leifman: And if you're a judge listening or a psychiatrist and you want to get involved at a greater level, we are recruiting right now. We are looking for judges and psychiatrists to get involved. We are going to be doing a lot more train the trainer programs aside with the National Center of State Courts. And this initiative I discussed, we discussed about the chief justices. And so, you can go to the, Michael mentioned, we have a website for the Judges Psychiatrists Leadership Initiative. And you can get into that either through the American Psychiatric Association Foundation website, or you can get into it through the Council of State Governments Justice Center website. And you could learn more about the Chief Justices Initiative by going to the National Center for State Courts and looking up the mental health task force. And you'll get a link to that as well.

    Judge Steven Leifman: We would love you to sign up on our listserv. We do not inundate. We're not an advertising mechanism. But once a quarter, you will get the best in most up-to-date information about what we're doing and about what's going on in the field. Also, you should speak to your chief judge, if you're a judge and you're interested, your mental health court judge, but also you want to reach out to your provider community and find out what they're doing, and seeing how you can strengthen ties and relationships. And that's how you can meet the local psychiatrists that are working in this field. And if it's not going on, pretty much most communities and Dr. Champion can talk a little bit more about this, have a psychiatric society and are usually more than willing... Or there's a strong community psychiatry in your community, that's very interested in this field.

    Judge Steven Leifman: And so, we're looking for psychiatrists and judges now to join us, to become part of this movement. And I want to be able to look back in 20 years and say, "God, how did we ever treat people that way? And now look at this amazing system of care we have that we're making sure that people who are just sick, get what they need." And we significantly reduce the reliance on the criminal justice system and provide the kinds of treatment that people need and they deserve. I mean, we wouldn't treat people with cancer or heart attack, or heart disease this way. So, I don't know why we treat people with mental illnesses this way.

    Judge Steven Leifman: And I guess, the one thing that I've taken away it's been the most frustrating is that if we did treat people with primary health issues, the way we treated people with mental illnesses, not only would be a plethora of civil lawsuits, it would probably be indictments for gross negligence. But for some reason, we've made it acceptable to discharge people in the middle of the night, not give them the access to care that they need, allow them to maintain homelessness. It's absurd. And we need to get a little angrier about it. And we need to do more about it. And the only way that's going to happen is if we join hands through initiatives like this to improve our society. And God knows right now after COVID, we need it more than ever.

    Christopher Chun-Seeley: Yes. Yes. Well, main takeaways that I've pulled from this conversation today are psychiatrists and judges definitely have a very important role to play, to address the judicial, community and systemic responses to community members with serious mental illness. And they can't do this work alone. They have to work together. They must work together to address the unique issues that their local and state levels all have. And I think coming to the table together and understanding the unique roles is super important, and that partnerships can happen and they do happen. And it doesn't matter size. It really depends on bringing the right people to the table.

    Christopher Chun-Seeley: And so, thank you both so much for the conversation today. I do want to make sure that I give you our experts, the final words. So, Judge Leifman, I'm going to start with you, and then pass it to Dr. Champion for just final words or takeaways for this evening.

    Judge Steven Leifman: As I mentioned already, I just think this is an amazing opportunity. It's the one area in civil rights we've gone backwards on, and it's time to fix it. And we know what works. Now, we have to make sure that we provide access to treatment for people, so that they can live a life of recovery. And we have to build a system where the criminal justice system becomes the last resort for people with serious mental illnesses, not the entry point. And I think through initiatives like this, the JPLI and others, we can really make that happen. We're laying the groundwork now. And I am really optimistic that in 10 years, we'll look back and we'll see a really different system than we see today, but we need everybody to join us.

    Judge Steven Leifman: And so, thank you for the opportunity. And I want to particularly thank the American Psychiatric Association Foundation for all the support that they've given us with this initiative.

    Dr. Michael Champion: So, thank you, Chris. And thank you, Judge Leifman. Thank you to the American Psychiatric Association Foundation for this opportunity and other collaborators that we've mentioned during this call, and this opportunity to speak about the many stakeholders and examples of partnership that we've outlined.

    Dr. Michael Champion: I'd like to say in closing that sometimes when people talk with me and learn about and understand the kind of work that I'm involved in, we are involved in, they just shake their head. And it just seems like a huge daunting task to try to tackle, to make any progress whatsoever.

    Dr. Michael Champion: And I think a main takeaway for me and my life experience, but also from what's been discussed on this call is, oftentimes the solutions are not complicated. Treating folks equally, having parity in the way that we address both physical and mental and emotional conditions, substance use disorders, extremely important. Opening up our eyes and seeing the inequities that are present in the current way that we do things, whether there's disproportionate impact on people with mental illness, people who are financially or socially disadvantaged, people of color. This is a space to work in where you can take a small amount of movement and have a huge amount of impact on many, many different people.

    Dr. Michael Champion: And so, I would say as a psychiatrist, this has given me an opportunity to take my toolkit, my doctor's toolkit and bring it into a larger sandbox and work on a broader change with individuals who have standing to an influence to make those kind of changes. We're at, from my perspective, in my 30 years of working at the interface, beyond a tipping point where things are moving and changing at a fairly rapid pace. And I think it's a good time to get involved and be effective and make a difference.

    Dr. Michael Champion: The last thing that I would say is on a personal level that this does give me hope as we move forward, because it really is about the potential of the human spirit and human spirits, and coming together, developing a vision and making a change, that's going to make a huge pact on many vulnerable people who live in our community or in our families in a very, very broad way. I think when we're operating at this interface together in a collaborative way, it's really an example of our best selves showing up for addressing very important needs around us. So, the bottom line take home point is hope.

    Speaker 4: The views and opinions expressed in this podcast are those of the individual speakers in their personal capacity only, and do not necessarily represent the views of the American Psychiatric Association Foundation, or the views, official policy, or position of the institutions and organizations with which the speakers are affiliated. The content of this podcast is provided for general informational purposes only, and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.