“More willing to fund criminal justice than mental health:” Chicago’s Criminalization of the Mentally Ill

“The largest mental health provider in the state of Illinois is the Cook County Jail.” ~ Tom Dart, Cook County (IL) Sheriff

Thus Tom Dart welcomes you to the largest mental health facility in the state of Illinois–Cook County jail. Just last month, on April 30th, 2012, Chicago closed the last 4 of the 6 mental health clinics whose funding was cut by mayor Rahm Emanuel’s 2012 budget plans, leaving only 6 remaining.

It is an accepted fact that much of the slack in treating the mentally ill will be picked up by the county jails, with Cook County leading the pack.

And the systemic problem of cutting funding for mental health starts higher up. According to Hugh Brady, president of the Illinois board of National Alliance on Mental Illness (NAMI), the state earned the “Number One Cutter” status for its mental health budget cuts in 2011, which totaled over 31% of the budget. Adding the additional 40% proposed by IL governor Pat Quinn for his 2012 budget, Illinois will have cut over 71% of its mental health budget in the past five years [see “Illinois No. 1 state for mental health care budget cuts“].

And money matters when it comes to keeping the mentally ill out of the prisons, despite what the Chicago mayor and Illinois governor may think. “Funding Sources and Expenditures of State Mental Health Agencies: Fiscal Year 2002,” from the National Association of State Mental Health Program Directors Research Institute in 2004, found a significant correlation between states with more mentally ill in jails, and states that spend less money on mental health services.

Among the ten states most likely to be using hospitals, six were also among the ten states spending the most money per capita. Conversely, among the ten states mostly likely to have mentally ill individuals in jails and prisons, five were also among the states spending the least money per capita.

Thankfully Illinois isn’t in the top of the bottom, so to speak, but it did rank 34th in terms of per capita spending on mental health, which earned it one giant raspberry of an “F” from the National Alliance for the Mentally Ill (check it out–it’s like a good old scarlet letter).

So the mentally ill, with very few places let to turn, are often picked up for nuisance crimes–disorderly conduct, trespassing, public drunkenness–which put them into a penal system ill-prepared to meet their needs.

And their needs are greater all the time, as their numbers swell as a result of losing community-based support.

In fact, as of 2004-5, the  mentally ill person was three times more likely to be jailed than hospitalized.


Thus as the mayor shuts down fully half of the mental health clinics in the city, the percentages of mentally ill in the prison systems increase proportionately–as is happening all over the country.

In the most systematic studies of Cook County jail, the first in 1990, Linda Teplin, Professor of Psychiatry and Director of the Psycho-Legal Studies Program, Northwestern University Medical School, and colleagues, interviewed randomly selected men admitted to  the prison. Her findings?

6.4% met criteria for diagnoses of schizophrenia, mania, or major depression.

In a second study of women admits, 6 years later, researchers found that 15% had had major psychiatric disorders within 6 months leading up to admission, 1.8% had schizophrenia, 2.2% were experiencing a manic episode, and 13.7% met the criteria for major depression.

But by 2000 the American Psychiatric Association estimated about 20% of prisoners had a serious mental illness, with 5% actively psychotic at any given time.

Prison isn’t where such people belong–but more and more it’s where they are–not just in Illinois, but across the country.

[Note: there’s an interesting interactive map with statistics about mentally ill prisoners by state (although some of the data is as much as 12 years old, some is more current, and you can get a general idea from it.) Check out: “Map the Situation: State by State,” and hover the cursor over your state to find out the percentages of incaracerated mentally ill in your home state.]

That old trig phrase ‘asymptote’ comes to mind when I see how close the prison rate compares with the total rate of institutionalization. It’s not a pretty picture.

Currently 23 people in Cook County jail are so ill that  have been declared mentally unfit to stand trial–and they wait for a bed to open in a state psychiatric institution. . .and wait. . .and wait some more, as deterioration sets in, and as the prison staff try to figure out how to both manage and help them.


Infuriated, as far back as last May Tom Dart threatened to sue the state for negligence over the mental health budget cuts.

Dart is, of course, overwhelmed at the task of meeting the mental health needs of the jail’s residents, many of whom rightfully belong in inpatient units, resentful that so much money has been stripped out of mental health with the assumption that the penal system will take up the slack, and concerned about the smooth running of his jail, which is, at times, disrupted by the mentally ill..

With fighting words Dart told ABC News the cutting of funding was all an

elaborate game where we just squeeze off all of the service so there aren’t any so these folks just end up going into jails frequently, and then we all act as if there’s not the reason. We need to call it like it is.

It is a year later, and Dart remains lawsuit-less, even as the situation continues to deteriorate.

Dart’s frustration with managing his end of the broken system is quite real.

The ill prisoners stay longer, return more often, cost more, and generally cause more trouble.

There are two documented examples of the length-of-stay dilemma. In Florida’s Orange County Jail, inmates’ average stays are 26 days. The mentally ill? They stay an average of 51 days. And at the infamous Riker’s Island, the ratio is 42 to 215 days.

Additionally, those with psychiatric issues can have more difficulty following the rules. One study found that the mentally ill were twice as likely to be charged with rule violations as the average inmate (see “More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States”).

Those with mental health issues also tend to get into more fights.  One in five state prisoners with mental health problems has been injured in a fight in prison, compared to one in 10 of those without a disease (2005 Bureau of Justice Statistics report, “Mental Health Problems of Prison and Jail Inmates”).

And they make more suicide threats, frightening staff, and–worse–carry them out.

In one well-studied example, a study published in 2001 of 25 suicides in a  Texas prison, the authors found that 60% of the victims had a history of psychiatric disorders, with 64% having mood disorders and 44% suffering from a psychotic disorder.

In short, managing the ill simply takes more resources–and resources require money.

While the cost of housing an average inmate, for example,  in 2011 was $45/day, it takes $137 per day for an inmate with a serious mental illness to be housed in prison (see “Impact of Proposed Budget Cuts to State Hospitals”).


The South Town Star reports that the situation has gotten so bad that Cook County jail had to face the fact that it would also be operating in some capacity as a mental institution.

So a little over two years ago all guards began receiving training on how to deal with the mentally ill, something unthought of before these days and times.

And interns from the Chicago School of Psychology are coming in to treat the mentally ill, perhaps not with the degree of experience these inmates require, but at least with the intention of providing some relief.

About 2000 of the current residents receive psychiatric medication, monitored by Cermak Health Services, an affiliate of Cook County Bureau of Health Services. Thus the same people who oversee Cook County Hospital–not widely known for its excellence–oversee medical treatment at the jail, as well.

Leonard Bersky, chief operating officer of Cermak Health Services, actually said that every inmate actually receives a psychiatric assessment when he/she enters the facility and that there are psychiatrists available (from Cermak) to prescribe.

But what sounds positive on initial hearing can sound quite worrying when the details are investigated.

Cermak psychiatrist Dr. Choong Hun Lee explained (when testifying at a hearing) how psychiatric meds are given out at the jail.

As revealed by the Chicago Tribune’s article, “Mental Fitness Exams Taxing Court System,” Lee clarified that, rather than taking into serious consideration the mental health needs of the patient, potential side effects, possible interactions, and long-term effects of taking serious meds, something else altogether is going on.

“Lee said that he prescribes a psychotropic drug to inmates after an interview as brief as five minutes . . . .’My role is, as I said, to help the patient just feel better,’ Lee testified. ‘So I assume by giving him some medication he can adjust better, behave better.’ [emphasis mine]

Given the potency of these drugs, this fails to inspire confidence–in a big way.

But these options may already create a relatively good scenario in Cook County, compared to most jails. Most prisons have no qualified mental health professionals on staff, and guards often punish or place in restraints inmates who are psychotic. It’s common for inmates with mental illness to lack access to the newer atypical antipsychotics,  due to cost. And it is a very rare jail that has proper rehabilitative services to help segue the mentally ill inmate back into society (see NAMI’s “The Criminalization of People with Mental Illness“).


Dart certainly has reason to complain, as running his jail has been made manifold harder by the introduction of the mentally ill, who need health services the prison is ill-equipped to provide. He is overworked and running a more chaotic institution than he did in former days.

Yes, Dart has his woes, but also realizes

there’s the humane side of it. Not treating people with mental illness is bad enough, but treating them like criminals? Please, what have we become?

That’s the question. What have we become, as a society, to allow this to happen–and, more importantly: what will we DO, as a society, to fix the situation?

Because right now, we’ve got little to be proud of.

Amy Watson, associate professor at the Jane Addams College of Social Work at the University of Illinois, Chicago, said of the Chicago mayor’s budget plan, but it applies to all states and most cities:

We’re more willing to fund criminal justice than mental health.


Chicago’s the city of “City of the Big Shoulders. . .proud to be  Hog Butcher, Tool Maker, Stacker of Wheat, Player with Railroads and Freight Handler to the Nation.” It’s the city that provided the country with the first African-American president. It’s the city that doesn’t accept the designation “Second.”  It’s the city where men know they can “vote early and vote often.”

So get out there, hog butchers, freight handlers, to-be-presidents–and, most of all, serial voters–and tell your mayor and governor–through your ballot box, through your protests, through your newspapers–that the time for criminalization of the mentally ill in this city has ended, and the era of more satisfactory distribution of resources for the mentally ill has begun.

Just think how Tom Dart will thank you.


A Picture Is Worth. . .


American Psychiatric Association. Psychiatric Services in Jails and Prisons, 2nd ed. (Washington, D.C: American Psychiatric Association, 200), Introduction, xix.

He XY, et al. Factors in prison suicide: one year study in Texas. Journal of Forensic Science 2001; 46(4):896-901.

“Impact of Proposed Budget Cuts to State Hospitals.” Presented to the Texas Conference of Urban Counties in 2011.

Psychiatric Patients With No Place to Go but Jail (http://www.nytimes.com/2012/02/19/health/in-chicago-mental-health-patients-have-no-place-to-go.html?_r=2)

Teplin LA.  The prevalence of severe mental disorder among male urban jail detainees: comparison with the Epidemiologic Catchment Area program. American Journal of Public Health 1990; 80:663-669.

Teplin LA, Abram KM, McClelland GM. Prevalence of psychiatric disorders among incarcerated women. Archives of General Psychiatry 1996; 53:505-512, 1996.

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