New Chapter? Miami-Dade Looks to Form Oversight Board for Mental Health Facilities

Miami-Dade County is weighing whether to create a central advisory board that would oversee its mental facilities and advise on treatment programs.

By Theo Karantsalis

On October 10, 2023

Miami-Dade County is considering the formation of a Mental Health Advisory Board to oversee local psychiatric centers, with an eye toward improving care in the metro area and helping mentally ill patients avoid cyclic trips to jail and acute care facilities.

County commissioners voted 9-1 last month to approve the first reading of an ordinance to create the Mental Health Advisory Board, which would “review and monitor the management and operations of centers owned, operated or under the control of Miami-Dade County.”

The creation of the board would mark another step in a more than 15-year-long overhaul of the county’s mental health system that followed national outcry over the treatment of mentally ill inmates at the Miami-Dade Pretrial Detention Center.

A public hearing on the measure has been tentatively scheduled for 2 p.m. on November 13 at the Stephen P. Clark Government Center before the county’s Community Health Committee. After the hearing, the county commission will hold a second reading and take another vote.

Among the mental health centers that would be under the board’s purview is the new seven-story, 150,000-square-foot Miami Center for Mental Health and Recovery at 2200 NW Second Avenue in Miami. The center is designed to help treat mentally ill patients who “frequently cycle through the criminal justice and other acute care treatment systems.”

A decade in the making, the 200-bed facility is expected to open in early 2024.

Plans for the Mental Health Advisory Board involve a 13-member panel that would include an agent from the Public Health Trust, a representative from Miami-Dade Corrections, and a county commissioner.

Other members will include representatives from veteran services, Miami-Dade Police, Miami-Dade Public Schools, mental health providers, the county’s juvenile justice system, the Miami-Dade County Homeless Trust, and “a person who is diagnosed with or has suffered from mental illness.”

The board would oversee facilities treating patients with schizophrenia, psychosis, bipolar disorders, depression, and obsessive-compulsive disorder, among other conditions.

In support of the ordinance, the county points to a 2021 Florida report from the National Alliance on Mental Illness that notes:
Approximately 180,000 adolescents aged 12 – 17 in Florida have depression
Seven in 10 youth in the state juvenile justice system have a mental health disorder
More than 2.8 million adults have a mental health disorder, and more than 640,000 adults have a serious mental illness in Florida
About two in five adults in jail or prison have a history of a mental health disorder
One in six homeless people in the state lives with a serious mental illness
Of the estimated 1,150 homeless people in Miami-Dade County with mental illness, 497 – nearly 50 percent – live on the street, the Homeless Trust tells New Times.

However, these numbers are self-reported, and the trust suspects the count is much higher.

“This is why our continuum of care is housing first,” Ronald Book, chair of the Miami-Dade County Homeless Trust, tells New Times. “Once stably housed, individuals are better able to take advantage of wrap-around services to help support housing stability, employment, and recovery.”

Turning the Page

Miami-Dade is hoping the creation of the mental health board and opening of the new treatment center will help close the book on the county’s troubled past in treating mentally ill patients.

The Miami-Dade Pretrial Detention Center’s ninth-floor psychiatric ward, where at one point naked prisoners were reportedly crammed into suicide watch cells reeking of urine and feces, with just a sink and a toilet, was shuttered in 2015 following years of controversy and a federal investigation.

The Department of Justice in 2011 described the wing as a “foul-smelling” and “chaotic” environment” that was “unacceptable for housing prisoners who are mentally ill or suicidal.”

The buildout of the new Miami Center for Mental Health and Recovery, which involved renovating an existing structure, cost more than $51 million, primarily drawn from county bond funds, according to the Miami Herald.

Led by Miami-Dade Judge Steve Leifman, the county has also ramped up criminal court diversion programs in recent years for defendants with mental illness who are charged with misdemeanors or low-level felonies. The Miami Foundation for Mental Health credited the program with helping reduce the number of annual jail bookings in Miami-Dade from 118,000 in 2008 to less than 60,000 in 2020.

Still, more than 11,000 people are booked into the Miami-Dade jail system annually with mental illness. The cost of jailing and treating them exceeds $230 million a year, according to the county.

North Miami Beach psychiatrist Joseph Poitier, who used to work in the notorious ninth-floor jail ward, says that while the county is looking to revamp its mental health treatment system, a lack of awareness of psychiatric illness remains a problem in underserved local communities.

“[A] family may not understand the nuances of dealing with someone with a mental disorder,” Poitier tells New Times. “They simply call police, and now the criminal justice system is involved.”

“It is going to take a village to help those with severe brain disorders,” Poitier adds.

In addition to monitoring county-owned psychiatric facilities, the new Mental Health Advisory Board would advise county commissioners on community psychiatric issues, assess county programs, and recommend local legislation to improve treatment.

If approved, the board’s formation is expected to be finalized by the end of the year.

Tragedy Close to Home

The ordinance to create the new mental health board was introduced shortly after Miami-Dade Police Director Alfredo “Freddy” Ramirez shot himself in the head on Interstate 75 on a drive home from a Tampa hotel where he was staying with his wife during a police conference.

The incident brought focus onto the intricacies of the involuntary psychiatric commitment process under Florida’s Baker Act and the difficulties faced by law enforcement when considering whether to take a person into custody under the statute.

Prior to Ramirez’s suicide attempt on July 23, he was cuffed and interrogated at the JW Marriott Tampa Water Street after a reported incident involving his wife. A Tampa police officer asked him if he wanted to harm himself and whether he had any suicidal thoughts, to which Ramirez replied, “No, sir, not at all,” according to police records.

“The male [Ramirez] did not meet Baker Act criteria and was released at the scene,” Tampa police officer Clayton Stewart wrote in his report.

However, records show that the Hillsborough County Sheriff’s Office told Tampa police they wanted to Baker Act Ramirez that night.

While investigative reporter and mental health author Rob Wipond’s work often underscores how forced treatment measures are abused, he believes Ramirez’s predicament represents a situation where intervention would have been permissible.

“Obviously, they had more than enough to go on to take him for a precautionary psychiatric evaluation — not that I want to encourage more interventions, but when they’re taking 6-year-old children to the psych ward from school…” Wipond says, referencing an incident where a local Florida police department invoked the Baker Act on a young child. “Of course, they knew if they took Ramirez against his will to the psych ward, his career was likely over with that on his police record.”

Since Ramirez’s suicide attempt, county officials have sought to raise awareness of mental illness, including Miami-Dade Mayor Daniella Levine Cava, who highlighted the high rate of suicide among first responders.

“This incident is also a tragic reminder of the critical role that mental health plays in our law enforcement officers,” Levine Cava said at a press conference following the incident. “The reality is that these jobs are very demanding; they’re stressful, and they’re emotionally taxing.”

During National Suicide Awareness Month in September, leaders on the local and federal levels spread the message that it’s no sign of weakness to seek help.

“It is distressing to note that, in 2021, per the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, roughly 12.3 million adults and 3.3 million adolescents had serious suicidal thoughts,” said Health and Human Services Secretary Xavier Becerra.

Suicide is the second-leading cause of death among youth and young adults, according to the Centers for Disease Control and Prevention.

“What is the one thing you want to happen when you or anyone is in extreme unrelenting physical pain? You want that pain to stop, go away, or end,” suicide prevention activist Kevin Hines tells New Times.

In 2000, suffering from severe bipolar disorder, Hines leapt from the Golden Gate Bridge and slammed into the ocean at 95 miles per hour. He has since become a motivational speaker on mental health awareness, seeking to stem the rising suicide rate in the United States.

“Turn to anyone willing to listen and say I need help now,” Hines advises.

This piece was republished from The New Miami Times.