posted 08-17-2001 07:23            

The Post's article "Families' Pleas for Help End in Gunfire" [July 3] detailed the failure of Prince George's County police to adopt nonlethal options for handling encounters with mentally ill people. But the problem is not confined to Prince George's or Maryland, and dealing with it is not entirely a matter of reforming police practices.

In the past 18 months, four persons with mental illness have died in altercations with police in Miami-Dade County, Fla., nearly as many as were reportedly killed in Prince George's County over a 10-year period. Nationally, conservative estimates show that people with mental illness are killed by police at a rate four times greater than the general population.

Police shootings are just one symptom of a much larger epidemic involving people with mental illness in our criminal justice system. Thirty years ago, laws governing treatment of the mentally ill were radically reformed so that people who refuse treatment for a mental illness must become dangerous before they can be treated. When that happens, it is the police who are called to respond. Additionally, states have continued to close psychiatric hospitals at alarming rates, without providing the laws and services necessary to provide effective community-based treatment. There are nearly five times more mentally ill people in the nation's jails and prisons (nearly 300,000) than there are in all of the state psychiatric hospitals combined (fewer than 60,000).

There are currently twice as many people in the Miami-Dade County Jail who have mental illness as at the South Florida Evaluation and Treatment Center. At any given time, this jail houses between 800 and 1,200 inmates with serious mental illness -- many for low-level offenses that result from untreated symptoms of their illness. In reality, our jail has become the public psychiatric hospital for our community.

We can reduce the risk of injury and rates of incarceration when the mentally ill encounter the criminal justice system. Miami Beach Police implemented Crisis Intervention Teams (CIT) of specially trained patrol officers who are dispatched to respond to calls involving the mentally ill in crisis. CIT policing has substantially reduced police injuries, enabled officers to return to patrols much more quickly, substantially reduced the arrest rate of individuals with mental illness and has reduced recidivism among individuals with mental illness. Miami-Dade County's mental health diversion program effectively routes misdemeanor defendants with a mental illness to community mental health facilities within 24 to 48 hours after arrest, thereby reducing unnecessary and harmful incarceration of individuals more in need of medical treatment than punishment.

But while there are many innovative programs being developed around the country to make police encounters with the mentally ill safer and divert them out of the criminal justice system, we need to place more emphasis on preventing these encounters in the first place by changing the laws that cultivate them.

As a criminal court judge, I have observed that the majority of mentally ill people who appear in my court have stopped taking their medication. One way to prevent encounters with the criminal justice system is to change restrictive state laws such as those in Florida and Maryland that prevent effective referrals for mental illness treatment until a person is dangerous to himself or others. This is crucial because, while the mentally ill who are treated are no more dangerous than the rest of the population, those who are not being treated are significantly more likely to become dangerous.

I could stop the revolving courtroom door for many of these individuals from the bench if I could order them to take the medication they need when they leave my court. It is frustrating that Florida law, like Maryland's, does not allow for court-ordered community treatment for individuals who don't recognize they need it and have a history of noncompliance.

In the 41 states that permit assisted outpatient treatment, there are opportunities to reduce the consequences of untreated mental illness: homelessness, suicide, incarceration, victimization and violence. The most comprehensive study demonstrated that long-term assisted outpatient treatment reduced the risk of arrest by 74 percent, the probability of violence by 50 percent and hospital admissions by up to 72 percent.

Mental illness treatment laws must be reformed to foster treatment so that we no longer use criminal law to battle the epidemic of untreated mental illness.

The writer is a county judge in Florida's 11th Judicial Circuit and co-chairman of that circuit's mental health committee.