Why Public Health: From Court to Courses (and Back)

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Today, I tell the story of why I am leaving my practice of law to study public health.  This is temporary; I don’t intend to leave law completely.  I love law.  I love being a lawyer, and I love litigating. I strongly believe in the rule of law, the Constitution, and the Bill of Rights. The courtroom is where I feel most at home, professionally.

So, why am I leaving?  Why, after 15 years of practice, am I going back to school for an MS in public health? Because for 12 of the past 15 years, I have been the Felony Mental Health prosecutor in the Miami-Dade County State Attorney’s Office, and over these years, I have witnessed countless tragedies.

My practice has almost exclusively involved cases where individuals were either (1) charged with felonies and found incompetent to proceed due to mental illness or intellectual disability or (2) adjudged not guilty by reason of insanity.  As a result, I have become, without intending to or even wanting to, one of the main gatekeepers to the largest psychiatric facility in the state of Florida — the Dade County Jail.

I have held grown men as they cried because they couldn’t keep their children or parents safe from predators.  I have been yelled at, spat on, and almost punched.  I have seen people come back to jail after hours, days, months, or even years of relative stability.  I have ordered more death certificates for people that I tried to help than I can count. I have tried to convince people to get treatment, to live in stable housing, to stop taking drugs. I have advocated on behalf of people who keep hitting barriers to needed treatment, housing, and employment.

Because of these experiences, I realized that the mental health system in Miami, in Florida, in the United States is horribly and recklessly broken. There aren’t enough resources in the community.  There aren’t enough psychiatrists, psychologists, or licensed mental health counselors. People must traipse all over our (very large) county to get treatment – a psychiatrist might be at one facility, a therapist at another, medication is dispensed somewhere else, and the individual and group therapies are in still elsewhere. 

From what I’ve seen over the years in Miami, people with limited financial means and mental health issues are less likely to have stable housing, less likely to have friends and family who can support them (both emotionally and financially), and less likely to have a car.  Getting around Miami-Dade County without access to a car is difficult, at best.  Case managers can help, but in my opinion, they are overworked, undertrained, underappreciated, and underpaid.  Additionally, I strongly believe that there aren’t enough residential treatment beds and there isn’t enough affordable housing for people to be able to live.  

As a result, many with mental health issues end up on the streets.  They self-medicate with drugs and alcohol. They buy, sell, and use illegal substances.  They commit property crimes in order to obtain money to buy drugs.  They engage in risky behavior, like drinking and driving, because of their substance use, lack of impulse control, or both. Some engage in violent and aggressive acts, acts that may not happen if they had the treatment they need.

Over the past 19 years, the 11th Judicial Circuit of Florida (the one comprising Miami-Dade County) has done a great deal to try to fix the mental health crisis in the criminal justice world. I am proud to say that for the past 12 years I have been doing my part.  Building on the success of the first ever drug court in the nation, founded 30 years ago in Miami in 1989, we have created a jail diversion program, a felony mental health diversion program, and a veterans treatment court, all of which divert people charged with crimes from trial postures with the goal of getting them into treatment. We have also created a forensic hospital diversion program, which diverts people headed to the state hospital into a smaller program, with the goal of re-integration into the community.  The Judicial Circuit has done the herculean task of getting the Dade Police Chiefs on board with the Crisis Intervention Team (CIT) program, which trains police officers in crisis interventions in the hopes of diverting people away from the criminal justice system.   

But I have realized in the past few years that only so much can be done by the courts, only so much can be done by the police, only so much can be done by the criminal justice system at all.  The focus needs to shift. To prevention.  To treatment.  To helping individuals get what they need before they ever commit a crime.

I believe that if people get treatment early, if they get treatment in their communities, if programs are fully funded and appropriate housing is available, if they don’t have to jump through a million hoops to get the treatment and care they need, then crime statistics will go down.  More people getting help will mean less arrests, less people getting found incompetent, less people getting found not guilty by reason of insanity, less people being incarcerated in our jails and prisons. I believe that this saves tax money, not to mention the obvious societal benefits.

Taking the year to learn the research methodologies and theories will help me take a deep dive into the intersection of the mental health and criminal justice system — the intersection of public health and criminal law. I have a strong background in the law — a JD from a top-tier law school and 15 years of practice — so I feel confident in my abilities to do legal research and writing.  Now I need to learn the public health side to hone my skills in public health research and writing.

This is why public health. I want to do my part to help local, state, and national decision-makers fix the mess that is the mental health/criminal justice system.

Joanna Sandstrom
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