English Podcast on Criminal Justice and Mental Health
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Hello, Welcome to mentally healthy nation, a podcast of the American psychiatric Association Foundation. I'm today's host Christopher Chancellor, 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 AP Foundation and the Council of State Governments 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. 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 JPL I for over eight years, and Judge Stephen Lightman of Miami Dade's 11th Circuit Court, one of the two judges that serves as co chairs for JPL I 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. Judge Weisman 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 in psychiatrist 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 to solve? Thank you chris Good to be here today and good to be with you, Judge Lightman to have a discussion about this important and pressing topic. So, first, uh, 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 the the 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. So, the short answer is that in our community, in our state, mental health systems around the country, after there was a shift from people being served in state hospitals In in a shift into the community back in the 1960s, unfortunately, many people who are 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, uh, and I'm also going to be very interested to hear judge life men's perspective and experience on this as well. But in brief folks these days who have a mentor on this are struggling with having limited access to health care and have a disproportionately higher rate of arrest. Um, compared to folks who don't have a mental on this and end up staying in jails and prisons for a longer period of time when they, when they arrived there. Now, maybe for a little bit more of a longer answer personal answer. Uh, for me personally, when I finished college, I wasn't really sure about what I wanted to do and you know, whether I want to pursue clinical training or legal training or what have you. And so after I started working at a local prison And as a, as a bachelor level mental health worker. And one place was in the general population, a medium security prison and the other was in a maximum security prison in 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. And so decided to go to medical school ultimately to pursue training and start working at this interface. Later trained in forensic psychiatry and have focused my professional and personal efforts since then on working to decriminalize mental on this and try to divert people inappropriate out of the criminal justice system and the treatment. So I'll just end with my experience of the year, says 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. Judge, Do you wanna jump in and tell us a little bit about your story? Thank you chris and thank you so much for you and the foundation for putting this together. Um you know, 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 we're seeing in a month. And you also come to learn after several years on the bench is that 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. 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 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 were 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. 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 re cycling 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 you know, we work in logic and if you got arrested and had a heart attack, we would have a treatment system for you. So I promised them I'd get there some 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, um there's one more thing you need to know about my son. I said yes and she said, well, you see, um my son, um 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. 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 recycle and I was pretty taken back, went to court, I called his case, we started to talk, he was thoughtful, he was coherent, 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 and at one point I asked him because he kept insisting, but 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 and as a result of this case, although I was not able to get him any help because we had no system in place and what to do with him. Um, we have made significant changes moving forward and um, it was quite a lesson into the mental health board 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. Yeah, I think thank you so much. Both Judge Lightman and dr champion for for sharing a little bit about how you, how you got started at this. And I think, you know, the the point being is, you know, 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 is learning. And I think Dr champion, you know, when we think about the role of a judge in kind of 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. That's an excellent question. Chris there's a very important comment Judge Life been made regarding seeing more people with mental illness and substance use disorders in front of the bench each day than most psychiatrists see in their day and their clinic or their practice settings. So that's the key issue. We have a real challenge uh 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 in getting routine and regular care to help people actualize their potential in life. 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 symptoms are facing when, when they're going to be in front of the bench so that they can be recognized. So, so one thing is just having contact and recognition and being able to have a potential point of action at that point. Now, as Judge Lightman can explain, there are many points in uh the criminal justice pathway where judges will have facetime with individuals who have behavioral health conditions and so at each point, the judges 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. So the 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 just like men can speak more about dimension of this is that there is 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 of 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. 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 in reviews by the court in the judge to monitor adherence to that treatment as well. So that's a, I think that's a treetop level view of how judges can be very integral and identifying individuals with needs and also channeling them and connecting to that care judge. I really want you to connect something that you said in in dr champion and kind of connected that already here is that, you know, you were seeing more people coming through your courtroom uh, and you know, 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 and how individuals are reintegrated back into our communities. And I'm just wondering if you could touch a little bit on um that success in in, in using kind of your information and what you've learned and bringing those individuals to the table. Sure, so, thank you for that. And and dR champion made a few really important points that I want to come back to and stand upon a little bit. Um, 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. 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. Um, we have a staff of about 25 people, eight of them are appear 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, you know, I have mental illness, you have 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, you know, people just give up, you know, 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 and it's, you know, a lot of people, I call us civilians that the mental health issues, um, you know, the civilians 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 arrested because they just don't care. And what appears help do is re establish 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 helped them navigate these very complex systems of care and, 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. Um, you know, 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 helped 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. 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 costs as a result of that. And so, you know, 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. And, 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, 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 re traumatize 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 we're trying to address the behavior as opposed to addressing their illness. 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, and so, you know, it just is is so important that, you know, 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. I think you're so right. There is such a big gap across the, I think the entire justice system on knowledge around mental health and and also around accessing care and those barriers to care. So I think even what you mentioned about, you know, 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 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, you know, in a few short months come july uh and there's a bunch of knowledge that has to happen and 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? Well, let me build on a previous comment about judges in their role, but also the importance of psychiatrists, collaborating with judges and other players in the in the judicial system, law enforcement systems to build solutions. It's extremely important that that that psychiatrists and mental health professionals are at the table in uh identifying the need and identifying innovative solutions that work right for that community that they live and and work in? Uh and it's important to say that they work in in terms of providing services, but that they live in as well. Of course, we know that behavioral conditions do not discriminate in who who experiences them, so it affects us across the board. So, of course, we're invested on many different levels in finding innovative solutions. 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 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 in interfacing with somebody who's in crisis 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 behavior health crisis or suicidal in need attention and and and needed quickly. So, um 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 uh start going down the criminal justice pathways through contact with law enforcement. And so this is um particularly pertinent now that we're in the midst of a pandemic because Covid has increased the stress on all of us and the incidence of behavioral health conditions has really exponentially increased and more and more of us in the community need these kind of services. And so, ah Psychiatrists know if clinicians collaborating with judges and other stakeholders in the build out of 988 and it's implementation is absolutely key. You know, dr chairman 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 gonna be with us for a very long time and we already don't have enough psychiatrists. And 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. And so while we saw a significant reduction in arrest during Covid, the number of people with mental illnesses seems to have stayed steady. And and so, um 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, you know, cultural sensitivity and cultural appropriateness, um, to be able to get people of color and different minorities, you know, access to doctors that are more representative. So the system is really stretched right now. Um, and I think all of us have to figure out how we're going to continue to work together, um to try to improve access and care. And, you know, there's been this Since 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 1,000%, but I also think there is a need to improve the justice system's response, not just the criminal justice response to people with mental illnesses. 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, you know, we don't have to criminalize. And as you talk in your introduction, this is about reducing the criminalization of mental illness. And one way to do that, and I'm gonna get back to 988 in a minute, but it's also to structurally change how we do things and maybe passed 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 now. Yes, the criminal justice system does have, it's 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 the services. But still leaving us with a record makes everything so much more difficult. It makes it harder to get housing and makes it harder to get employment. It makes it more likely you're gonna, you know, make new bad friends, you know, people that like to commit crimes that take advantage of you in the criminal justice system when you get out and so we're not doing society or the individual many favors by using the criminal justice system as the de facto 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 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. And so I think we have to be careful and and I think also, You know, people are communicating differently today. It's not just the phone, it's, you know, zoom, it's and and and in 2030 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. And and so I think there's a lot that can be done there, but as a premise, that's wonderful. And and we should limit when we can law enforcement's response and we should have a medical response. And you know, I remember um when I was actually out in Hawaii, I think it was before I was there with dr, champion um 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 for a harbor happened And people kind of forgot about making those kinds of 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, you know, medical personnel transferring people from hospital to hospital or home to hospital or wherever they need to go and not the police. And and so we've had the answers for many years. We just unfortunately haven't implemented it and in many ways, you know, things have gotten much worse than they were before. You know, the the closure of the hospital's 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 streets and into the criminal justice system. And and now we've got to go back and try to figure out a way to restructure it and I'll turn it back to DR Champion. But one of the other projects that jpl i is working on is with the uh conference of Chief Justices and the Conference of State court administrators, which I think is taking what we've done in jpl, I 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. Yes, thank you. I totally agree that that the National Judicial Task Force that were 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, uh scaling up examples from local jurisdictions and states and identifying best practices and disseminating them broadly across the country in a 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 the local level, in in in in 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 is in the States rolling out these changes across the board. Yeah. And and you know, it's kind of 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. 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 a tribute to the plea because we helped bring it to them and they have come to recognize that this is an incredibly important initiative. Um the C. C. J. And Costco, which is the conference of Chief Justices in the Conference of State court administrators. Um They've been around a long time and this is only the third time in their history that they've ever developed the 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 um Arizona Illinois. And and and you know, put it into a coherent new system where the chief justice's can then deliver it to their states. And so I'm really, I'm actually as picky 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 gonna see outcomes change significantly. And I've been In this space for almost as you said, 22 years now and you know, as a result of the work that my staff has been able to do in Miami, you know, we've reduced the number of arrests from 118,000 year to 53,000 before Covid, The number of people in our jail went from 7300 to about 4300. We closed one of our three main jail, say at $12 million $86 million bucks or something. So I have that wrong. And I think it's $96 million dollars and and it's it's it's a lot of money and you know, 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. 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, you know, 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. And psychiatrists and judges each have such an important role to play and they can't do this important work alone as I think you both really highlighted throughout our conversation today, as you both know dr champion and Judge Lightman last year, the judges and psychiatrist leadership initiative honored the life and legacy of Judge Stephen? S got us through a named 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. 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, as a model for the country moving forward, an alleged life. Hman riff off of that and provide some of the details, but I would say before before wrapping up my comments on that is that Judge Lightman 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 in mutual commitments and getting on the same page about what the challenges and how to solve it. 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 often times 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 uh 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, of what that looks like. So Judge Lightman would appreciate hearing a little bit more particular about what Judge goss accomplished during his career, you know, steve was one of those gentle giants. He was from rural Georgia. He was not in an urban area, it 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 um, he set up some of the first diversion systems and mental health courts in rural Georgia, which then, you know, went on to help us address a lot of these rural issues around the country. And he was one of these people who it 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 whose 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 um, you know, and 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 and and look out for each other. Um, but he had a huge impact. There's a wonderful chapter in Rosalyn carter's book mental health about his work and um he was one of the early pioneers of the JPL I and helped us get where we are today and we miss him 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. Thank you both for for sharing a little bit about what judge costs meant to the work that we're doing. And then also I think just the importance of partnerships and and that they are so key and they can be accomplished wherever you are, whether you are in rural Georgia to you know, Miami dade county. Ah and I think our two award winners last year, one looked at Ohio and and stepping up and the state approach and that was retired Justice Evelyn Stratton who is the current foundation board member and then dr kristen Ochoa out of L. A. 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 with some of our experts through the JPL I so I think that that's so key and so important and yeah, I just wanted to mention, we also recognize Dr Mark Nunez who is one of the co authors of the sequential intercept model also from Ohio and you know, 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 um it's just important to recognize people that are champions and that are doing this kind of work in in moving these issues forward. And so for kind of our final question before I give the two of you are our last words to end the podcast. You know, 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 life man or you know, looking at DR Champion and your experience of looking at that penitentiary and and now, you know, I know we've talked and how you haven't seen that happen anywhere else, you know, and and how do we kind of get to these individuals sooner? So Dr Champion, Judge Life man. 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. Well, I can speak about psychiatrists, I 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 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 was an important piece of what I wanted to accomplish while I was on this planet. And so uh in thinking about how other people can get started in making these connections no matter where they're at in their career. In one place that we've already talked about is the Judge's psychiatrist leadership Initiative. The JPl. I has a website and a newsletter that people can sign up for that will give resources and information and notifications about work at the center face once you become part of that community and also is a channel into identify who in your local jurisdiction is is doing some work in this area, but also opens the door for partnership for psychiatrists to become part of this initiative and and join us on our broader team in rolling out these trainings and initiatives around the country. 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 will 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 facetime with those folks. 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 Mh A 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 but who can help point you in the right direction wearing my, my public mental health system hat, I would say you can also 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. And then the last thing I would say which is a way of maybe handing the baton over the judge life man is contacting the county or state judiciary and and asking about how to get connected with people who are working on this interface and I think that the nuances and the details of something like that. Judge Lightning can't answer with more fidelity. Thank you Dr champion and chris thank you so much again for putting this together. No, 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 um, this has just been one of the most fulfilling professional aspects of my life and I don't think I would have 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 and put people in jail every day. It's just not something that's healthy but to watch people recover is really tremendous. And if you're a judge listening or a psychiatrist and want to get involved in a greater level, we are recruiting right now. We are looking for judges and psychiatrists to get involved. We're going to be doing a lot more train the trainer programs um aside with the National Center for State courts and this initiative. I discussed, we discussed about the Chief Justices and so you can go to the uh Michael mentioned, we have a website for the Judges, psychiatrist 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. Um and you can learn more about the Chief Justice's 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. We would love you to sign up on our list, serve we do not inundate, we're not in advertising mechanism, but once a quarter you will get the best in the 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, you know, 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, you know, a strong community psychiatry in your community that's very interested in this field. And so we're looking for psychiatrists and judges now to join us to become part of this movement, And, you know, 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 reduced the reliance on the criminal justice system and and 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. And and, you know, I guess the one thing that I've taken away that'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 giving the access to care that they need to allow them to maintain homelessness. It's absurd, and and we need to get a little angrier about it and we need to do more about it. And the only way that's gonna 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. Yes. Yes. Well, uh 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 they're 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. Uh and so thank 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 life, man, I'm going to start with you and then pass it to dr champion for just final words or takeaways for this evening. Um, as I mentioned already, I just think this is an amazing opportunity. It's the one area and 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 illness is not the entry point and I think through an initiative through initiatives like this, the jpl I 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. 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. So thank you chris and thank you, Judge Life Man, thank you to the American Psychiatric Association Foundation for this opportunity and other collaborators that we've mentioned during this call in this opportunity to speak about the many stakeholders and examples of partnership that we value blind, um I'd like to say in closing that sometimes when, 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. And I think the main take away from me and my life experience, but also from what's been discussing this call is oftentimes, the solutions are not complicated treating folks equally, having parody in the way that we address both physical and mental 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 of movement and have a huge amount of impact on many, many different people. And so I would say as a 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 center face beyond the tipping point where things are being, 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. 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, packed on many vulnerable people who live in our community or in our families in a very, very broadway. I think this is when we're operating at this interface together in a collaborative way, it's really an example of our best selves selves showing up for addressing very important needs around us. So the bottom line take home point is hope. Mhm. 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're having a medical emergency, please contact your local emergency response number.