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How Chicago’s Cook County Jail Became America’s Largest Mental Health Care Provider

By Sy Mukherjee on July 12, 2013 at 5:15 pm

"How Chicago’s Cook County Jail Became America’s Largest Mental Health Care Provider"

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(Credit: Cook County Sheriff's Office)

The Cook County Jail in Chicago, Illinois, holds over 9,000 men and women, making it the largest correctional facility in America. But a perfect storm of cuts to community mental health services, affordable housing projects, and state psychiatric institutions has ensured that the prison also serves as America’s largest mental health care provider.

In an interview with ThinkProgress, Cook County Sheriff Tom Dart detailed the struggles awaiting thousands of mentally ill prisoners who simply don’t belong in the prison system. “Conservative numbers are 25, but we think it’s closer to 30 or 35 percent of our jail population that has a mental illness… so we’ve effectively become the largest mental health hospital in the country,” said Dart. “I don’t know anybody who could say that someone suffering from serious mental illness should be put in a tiny, confined area that is populated by another individual who has a mental illness — who you don’t know and may or may not have some issues with violence as well — be medicated and treated as if you were a criminal.”

Cook County is one of two in the country that has an unusual division between its prisons and the medical services provided to those prisons. While Dart oversees the jail, the county’s Board of Commissioners has the authority to allocate funding and choose the health care providers that service it — and the ones they choose tend to focus on triage rather than holistic treatment.

“Their mission is to get [the inmates] stabilized, make sure they’re on their meds,” said Dart. “And when they’re on their way out, [the doctors] give them a plastic baggie with two weeks’ worth of meds.”

Once the inmates are out on the street, they often have no medical recourse — and many times, they don’t even have a home, according to Dart. He recounted the story of one inmate who was so reluctant to leave the prison that, upon his release, he ran toward the county court, stripped naked, threw an ash tray through the court window and walked around bleeding on the broken glass. “When I go to the mental health unit, they’re saying, ‘Sheriff, can you help me get a place to stay when I get out of here, I have nowhere to go, no one will take me.’ It’s horrible.”

Between 2009 and 2012, Illinois made the fourth largest cuts to mental health care services of any state in the country, reducing appropriations by over 31 percent. Those cuts included the shuttering of two state-run mental health facilities in 2012, which Gov. Pat Quinn (D) said would save Illinois $20 million. Amid criticism of the cuts, Quinn promised that the savings from the now-defunct hospitals would “follow” the patients — but Dart says that advocates have seen little follow-through on that in over a year.

Inpatient mental health hospitals are a controversial topic among advocates, most of whom say that decentralized, community-based care is both a more humane and more effective way of treating patients and reintegrating them into society. But as Quinn’s example shows, that type of care requires funding that lawmakers are often reluctant or slow to dispense.

“Let’s look at the realities and look at what governments have done to mental health funding and how they’ve destroyed it, and how often they find it to be the easiest and quickest thing to get rid of,” said Dart.

In the absence of both state-run and local mental health resources, many of the poor and mentally ill end up homeless. There were over 105,000 homeless people living in Chicago in 2012 — a rise of 12 percent over the previous year. Studies estimate that anywhere from 25 percent to 30 percent of the homeless have a serious mental illness such as schizophrenia or bipolar disorder, and many of the mentally ill who lose their homes actually do so due to their underlying condition.

An expansion of affordable housing could help Americans in that situation, since advocates have found that a placing patients into a permanent home is critical to addressing their mental problems. Unfortunately, affordable housing units have also been on the decline due to cuts in the Department of Housing and Urban Development (which were exacerbated by the sequester). In 2011, the demand for affordable housing in Cook County was over 20 percent higher than what was available, and that disparity has only grown from pre-recession levels as more landlords charge market rates for their properties.

Given those interlinked barriers to treatment and housing, it’s not surprising that many mentally ill Americans end up in facilities like the Cook County Jail — contributing to massive overcrowding in prisons and hiking up city crime rates. Dart estimates that the recidivism rate for mentally ill inmates who are pushed out onto the street is between 20 and 30 percent.

Funneling the mentally ill into prisons is also far more inefficient than just giving them care in the first place. Researchers from the North Carolina State University and the University of South Florida have found that psychiatric patients who received affordable outpatient mental health care and medication were far less likely to end up in prison than those who didn’t. The government also spent almost $30,000 less over seven years on those patients than it did on Americans who had to get emergency mental health care and go through the criminal justice system. So while lawmakers may see savings in mental health care cuts in the short-term, rolling back services only serves to increase long-term costs and decrease the quality of mental health services in America.

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