People with mental illness are overrepresented in our nation's jails and prisons. At least 400,000 inmates currently behind bars in the United States suffer from some type of mental illness according to the National Alliance on Mental Illness.
Currently, in 2021, on any given day, nearly half of those incarcerated at Cook County Jail suffer from some form of mental illness, making the jail the largest mental health hospital in Illinois – and one of the largest in the country.
Many of these individuals in custody are in jail for minor nonviolent offenses closely associated with their unmet mental health needs. People with mental illness deserve help, not prison. We need to reduce their criminal justice system involvement and increase investments in mental health care. How is this cycle perpetuated? How can we break this cycle?
1. Encounters with Police - Where to Put the Mentally Ill?
Chicagoans with mental illness end up in jail through a chain of small decisions by different local officials. Police officers can choose to take a mentally ill person home, to the hospital, to a shelter—or to jail. Prosecutors can choose whether or not to not bring charges.
A combination of a lack of mental health facilities, the inability of the mentally ill to follow directives, continual encounters for minor issues and punitive anti-crime policies have combined to increase the incarceration of the mentally ill for not severe crimes. There is a need for community crisis-trained personnel who can assess/divert unnecessary incarceration.
2. Hospitals - the Revolving Door
The mental health systems are in disarray, fragmented, and underfunded. There are inadequate resources for people with mental health issues as many mental health institutions were closed in the 1980s. Furthermore, there are barriers to access.
The inpatient psychiatric treatment options are limited due to the mental health code, lack of community resources and support, and lack of aftercare availability.
This creates a revolving door in hospitals; a cycle of admission to a hospital followed by discharging patients without an exit strategy.
3. Jails - Large Mental Health institutions
Even when the mentally ill are not charged or later found not guilty, they are often held for months in Jail. This is often far longer than their sentence would have been if they would have been found guilty.
There they are inappropriately medicated or sedated.They suffer horrible conditions within jails. The conditions are such within the jail that often their mental health issues deteriorate.
For example, anecdotally, we have clients who have developed permanent facial tics from poorly administered medication or additional symptoms like anxiety or PTSD.
4. Court - Guilty until Proven Innocent
The bar is set very high for access to mental health court and many people with mental health issues are encouraged to plead guilty within the regular court system without always understanding the long-term repercussions.
They often plead guilty just to get out of the horrific conditions within jail (Note: Most defendants plead guilty over 80-90% of the time as they are presented with extreme sentences if they don’t plead).
The mentally challenged often do not have money for bond or lawyers. Furthermore, it is hard for lawyers to represent clients when in Jail.
In addition, many have difficulty following their conditions post-release. There doesn't seem to be a good exit strategy; including simply providing for medication post-incarceration.
The families have difficulty dealing with the issues; sometimes they can't post bond because the person has nowhere to go that is safe. Ironically, many institutions do not afterward take clients who have charges. Prisons now become repositories for the mentally ill.
5. Prisons - Not Designed for the Mentally ill
Prisons are not designed for the mentally ill. Prisons have horribly inadequate health services and punitive policies.
They can't follow rules such as self-mutilation or destruction of state property. The mentally ill are disproportionately placed in solitary confinement.The staff are not qualified to administer medication and the medication is poorly administered and supervised or there is no treatment at all.
The condition of the patient deteriorates and they have further mental health breakdowns due to these inadequate mental health services. They often have more disciplinary hearings, receive maximum sentences, and do not get parole.
IDOC has been sued and lost, yet the cycle is not been broken.
6. Exit Strategy
When the mentally ill are released, there is no exit strategy and the cycle continues.
There must be a more efficient or compassionate system.
Is there anything more we can do?
Hinda works with our chaplains and legal advisory committee visiting cook county jail weekly and providing support. Caseworkers find housing and support for the mentally ill.
Most importantly, we depend on our partners in multiple mental organizations who are pioneers in the field.