The Definition of Insanity

A review of the new PBS documentary.

Posted Apr 11, 2020

"The Definition of Insanity" premieres Tuesday, April 14, 2020, 10 a.m.-1 p.m. ET (check local listings) on PBS, PBS.org, and the PBSVideo App.

A few years ago, I was in Miami for a conference. I had contacted Judge Steven Leifman (Associate Administrative Judge, Miami-Dade County Court, 11th Judicial Circuit of Florida), who kindly agreed to meet and talk. Instead of going to his judicial chamber, we went to a large, concrete building, under construction, within the city of Miami.

The space had been hollowed out. Echoes bounced off its cement walls and floors. Yet, Leifman gave me a virtual tour, explaining what each area of the building would become and provide. The story I also heard of the building’s genesis humbly revealed how his dedicated, humanitarian work had convinced County officials to finance not just the building but what became The Miami-Dade Criminal Mental Health Project (CMHP).

I remain incredulous that other counties, cities, and states have not adopted this approach to people with serious mental illnesses (SMI, like schizophrenia, schizoaffective disorder, bipolar illness, and some with PTSD). It is their SMI-induced disturbing behaviors (during states of psychosis) that result in their entering the criminal justice system, rather than being served by community-based, mental health services. When in good treatment, those illness driven behaviors abate. I hope this documentary opens many an eye to saving people, families, and money.

As Patrisse Cullors, founder of Black Lives Matter and whose brother has schizophrenia (and has been through the criminal justice system), says, “No one gets well in a cell.” In fact, people with serious mental disorders are more symptomatic in the confines of a jail or prison. Their incarceration stays are longer. When released, they are without the treatment necessary for their recovery, and thus suffer further, as do their families. Those with untreated SMI also are far more likely to re-offend, adding further financial and social burden to government and communities.

The three institutions in the U.S. “housing” the greatest number of people with SMI are: the Los Angeles County Jail, Chicago’s Cook County Jail, and NYC’s Rikers Island. That fact seems a crime, in a manner of speaking.

The Definition of Insanity takes us deeply into the groundbreaking work of the CMHP. We follow a number of patients (clients of the CMHP), including a formerly-incarcerated peer counselor (a “peer” is someone with life experience with a mental disorder) whose work is to assist current clients from their jail release to receiving community services; and another young man, who is employed while still under his court-ordered and supervised mental health care. 

This essence of the CMHP program is to divert people charged with a (generally non-violent) criminal offense from incarceration to care. Each person seen by the mental health court(s) that Leifman pioneered is given a choice between incarceration and trial—though should they decide upon treatment, it will be under the court’s supervision. If they do not adhere to their treatment plan, they are subject to re-arrest and potentially further jail time. By the way, many do not choose treatment.

District attorneys and law-enforcement agencies, not only county government, have come to recognize the value of this program because it works—as we witness in this remarkable and compelling film. Since the inception of the CMHP, 10 years ago, arrests in Miami-Dade County have gone from 118,000 to 56,000, annually. Moreover, recidivism in clients who complete the program (both for felonies and misdemeanors) is less than 25%—a stunning reduction from the rate of approximately 80% before it began. To add to the proof of its effectiveness, jails are closing, which has saved Miami-Dade County $12 million a year. All of which, as I mentioned, leaves me greatly puzzled as to why this court diversion and treatment approach has not propagated throughout our country. 

It takes a team to produce these kinds of results, including judges, peer counselors, and treatment providers, as well as the clients themselves. "We want people to be part of their own change," says Leifman.

This impetus and support for this film is deeply personal for Norman Ornstein and his family. They established the Matthew Harris Ornstein Memorial Foundation; Matthew is the son of Ornstein and his wife, Judith Harris, whom I have had the privilege of knowing. Their son died in 2015 after a 10-year struggle with serious mental illness. Ornstein knew and asked filmmaker Gabriel London to produce and direct this documentary. It was written and also produced by Charlie Sadoff. The Definition of Insanity is narrated by Rob Reiner.

It was Winston Churchill who said, “You can count on the Americans to do the right thing, after they had tried everything else.” Perhaps this is the time for this country to move beyond incarcerating people with serious mental illnesses, to do the right thing. To provide programs that will enable these people to receive the care that can benefit them, their families, and their communities—and save taxpayers a lot of money.

I am a psychiatrist, public health doctor, and medical journalist; visit my website here.