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HomeMy WebLinkAboutSubmittal-Steve Leifman-Briefing DocumentSubmitted into the pahlic recor for itorn s) on 2�� i Z_, City Clerk Briefing Document: The Miami Center for Mental Health and Recovery (MCMHR) I. Overview of the Resolution The Resolution before the Miami -Dade County Board of County Commissioners seeks approval of the operating plan and budget necessary to open the Miami Center for Mental Health and Recovery (MCMHR)—a first -of -its -kind, comprehensive diversion and treatment facility designed to replace the costly and ineffective cycle of jail, homelessness, and acute -care hospitalization with a coordinated system of care. The City of Miami has already issued a certificate of completion and adopted a resolution expressing strong support for the immediate opening and operation of the Center, urging the Board of County Commissioners to act without delay so that the facility can begin serving the community. Under the current proposal, American Rescue Plan Act (ARPA) funds and Opioid Settlement funds will cover the first 2.5 years of operations at zero cost to Miami -Dade County, during which the University of Miami Department of Public Health Sciences will conduct an independent cost -savings and outcomes evaluation. Additional Ongoing Revenue Sources to Support Operations In addition to ARPA and opioid settlement funding, the MCMHR benefits from a diverse and sustainable portfolio of long-term revenue streams that significantly reduce future County financial obligations and strengthen operational stability: • Medicaid reimbursement will cover a portion of the Center's mental health and dental costs and a substantial portion of the primary, ophthalmology, and podiatry services, offsetting operating costs. • The State of Florida has committed to funding the Center's short-term residential treatment beds and has allocated a dedicated state appropriation to support the Center this year. • The Miami -Dade Homeless Trust has committed to funding housing components within the Center. • Workforce Florida has pledged to support the Culinary Supportive Employment Program, a key vocational pathway for participants. • The Miami Foundation for Mental Health, Inc. has committed to raising philanthropic resources to expand services, vocational programs, and system -of - care coordination efforts. • Miami -Dade County will co -locate its residential co-occurring treatment program, New Direction, at the Center, creating an additional and reliable revenue stream to support ongoing operations. lOO SL,bm4M' LarC004-eyiefifis rncwyeryL Submttd into tie Walk recor. for 'issn(s) • S on City Clerk Together, these braided funding sources —federal, state, local, philanthropic, and Medicaid — create a fiscally responsible and diversified funding model, safeguarding taxpayers while enabling the Center to deliver high -quality, evidence -based care at scale. II. Purpose and Vision of the Miami Center for Mental Health and Recovery The MCMHR fulfills a promise made to voters in 2004 to create an effective, cost-efficient alternative to jail for individuals with serious mental illnesses. It will serve individuals who are frequent and costly recidivists across the criminal justice system, individuals who are at -risk of criminal justice involvement, acute -care settings, and the homeless continuum of care. A Comprehensive Continuum of Care Under One Roof The Center's 181,000-square-foot, seven -story facility consolidates essential clinical, rehabilitative, and social -service supports otherwise fragmented or unavailable in the community. Services include: • Central receiving center • Crisis stabilization and addiction treatment • Multiple levels of residential treatment • Day treatment and activity programs • Outpatient behavioral health, primary care, dental, optometry, and podiatry • Vocational training, employment services, and classrooms • Transitional housing and housing assistance • An on -site courtroom, legal services, and social services This integrated design eliminates barriers to care, reduces recidivism, improves public safety, and provides pathways to stability and recovery. A Transformative Diversion Resource The Center will initially focus on individuals with five or more mental -health -related jail bookings over five years —a group with chronic illness, homelessness, and frequent justice involvement. This population (1,049 individuals') accounts for: • 21% of all mental health jail bed days' • 89% homeless2 • $17.7 million annually in costs to taxpayers3 By addressing their clinical, housing, medical, and social -service needs in one location, the Center will interrupt the repeated cycle of jail —> hospital --* homelessness, producing improved outcomes and significant cost savings. Submitted into k�e p lic record for i•'-n(s) OT . S oa 3 i 1 2124, . City Clerk III. Data Supporting the Urgency and Impact of the Project A. The Miami -Dade County Jail: Florida's Largest Psychiatric Institution • Houses as more individuals with serious mental illnesses than all state civil and forensic hospitals combined!' • 75% of inmates have identified with mental health needs; multiple months in 2023 exceeded 80% of the entire jail population.5 • The number of individuals with mental health needs in the Miami -Dade Jail increased 57% between 2020 and 20235 Individuals with mental illnesses also remain in custody nearly three times longer than the general jail population. B. Extraordinary Fiscal Burden Miami -Dade County currently spends:3,5 • $1.1 million per day • $414 million per year to incarcerate individuals with mental illnesses —approximately 3,500 people daily.5 Over the past decade, MDCR spent $3.9 billion on jail operations, of which 63% ($2.5 billion) was attributable to individuals with mental health needs.6 C. Recidivism and the Cost of Doing Nothing Over five years: • 16,405 individuals accounted for 1.27 million jail days (3,493 years) at a cost of $414 millionl,3 • 35% were repeat detainees, accounting for 65% of bookings and 63% of mental health jail days' • The top 6% of recidivists cost $88.8 million over five years"3 These are precisely the individuals the Center is designed to divert into treatment. D. Proven Success of Miami's Diversion Model Existing programs demonstrate the power of treatment over incarceration:7 • 83% of successful participants had no new arrests within one year. • 92% reduction in jail days among successful participants. • 88% reduction in new bookings. • $32,546 average cost avoidance per successful participant. • Total annual arrests in Miami -Dade declined from 118,000 to 53,000. • The average daily jail population was reduced from 7,400 to 4,400 inmates. • The County closed one jail facility, generating $239 million in savings to date (2025 dollars, adjusted for inflation). • Approximately 3,700 fewer arrests per year since implementation of Crisis Intervention Team (CIT) policing. • 109,704 fewer arrests to date — equivalent to 400 years of jail bed days avoided. • $29 million in annual cost avoidance just attributable to reduced arrests. • Significant reductions in police shootings, enhancing both public safety and officer safety. Submitted ittto t►ae pt#'lic record cr on 1? City Clerk According to an independent analysis conducted by the Boston Consulting Group, the Center is projected to achieve revenue neutrality within three years of commencing operations. Independent analysis by the Boston Consulting Group further projects that the Miami Center for Mental Health and Recovery will generate net community savings that exceed operating costs by the third year of operations. Estimated direct savings begin at approximately $13-14 million in the first year, increase to $23-25 million in year two, and rise steadily to $40-45 million annually by year five, driven primarily by reduced jail utilization, fewer hospitalizations and crisis admissions, and lower recidivism among individuals receiving coordinated treatment. The analysis conservatively estimates that individuals with longer stays at the Center generate approximately $50,000 each in community cost savings in the first year alone, with additional savings accruing over time, while shorter -term participants also demonstrate substantially lower recidivism than individuals released from jail without treatment. Together, these findings confirm that the Center is not only a critical public safety and public health intervention, but a fiscally responsible investment that produces measurable net savings within its early years of operation. E. Cost of Delay Miami -Dade County is currently spending approximately $1 million each year to maintain a fully constructed facility that remains closed —an avoidable expenditure that will be eliminated in the first year once the Center becomes operational. IV. Conclusion The Resolution before the Appropriations Committee represents a decisive opportunity to: • Improve public safety • Reduce homelessness • Suiraittacl into tine p`' lic recon for itc.: s) S on 1_ 2 City Clerk • Save hundreds of millions in taxpayer dollars • Provide life-saving treatment and stability for thousands of Miami -Dade residents The Center is built, funded for its initial operations, institutionally supported at every level, and validated by decades of data. All that remains is the Commission's approval to open its doors. The Miami Center for Mental Health and Recovery is not only a moral imperative — it is one of the most fiscally responsible and evidence -based public safety initiatives in Miami -Dade County's history. ' Jail population statistics based on analysis of daily mental health reports provided by MDCR for calendar years 2019 through 2023. 2 Data on history of homelessness was collected by reviewing "Last Known Addresses" from the Criminal Justice Information System (CJIS). Individuals listed as "Homeless," or some variation thereof, as well as those with listed addresses that correspond to one of the community's homeless shelters were considered to have had a history of homelessness. 3 Cost estimates based on bed/day costs of $325 per mental health bed. This figure is calculated by dividing the MDCR annual operating budget for FY2023-24 ($483 million) by the average daily population (4,661) = $103,569 annually per bed. Divided by 365 days = $284 bed/day. An additional $41/day per inmate is spent on mental health treatment services as reported by Jackson Health System, Corrections Health Services. 4 As of 2023, Florida had a total of 2,522 (1,414 civil and 1,108 forensic) state treatment facility beds according to the Treatment Advocacy Center: https://www.tac.org/map directory/tlorida/. Reports from Jackson Health System, Corrections Health Services indicate an average daily mental health population in 2023 of 3,494. s Based on reports provided by Jackson Health System, Corrections Health Services. s Based on review of county budget archives from FY2014-15 through FY2023-24. ' Based on analysis of data collected by the 1 lth Judicial Circuit Criminal Mental Health Project's Jail Diversion Program.