County Jail a Large Mental Ward: Dart

The sounds of chaos bounce off the dim yellow walls. Everywhere there are prisoners wearing orange, red and khaki jumpsuits. An officer barks out orders as a thin woman tries to sleep on a hard bench in a holding cell. This is a harsh scene of daily life inside what has become the state’s largest de facto mental institution: the Cook County Jail.

About 11,000 prisoners, a mix of suspects awaiting trial and those convicted of minor crimes, are housed at the jail at any one time, which is like stuffing the population of Palos Heights into an eight-block area on Chicago’s South Side. The Cook County sheriff, Tom Dart, estimated that about 2,000 of them suffer from some form of serious mental illness, far more than at the big state-owned Elgin Mental Health Center, which has 582 beds.

Dart said the system “is so screwed up that I’ve become the largest mental health provider in the state of Illinois.” The situation is about to get worse, according to Dart and other criminal justice experts. The city plans to shut down 6 of its 12 mental health centers by the end of April, to save an estimated $2 million, potentially leaving many patients without adequate treatment — some of them likely to engage in conduct that will lead to arrests.

“It will definitely have a negative impact on jail populations,” said Dart, who noted that the number of people coming into the jail with mental health problems was already increasing. “It will have direct consequences for us in my general jail population and some of the problems I have here, because a lot of the people with these issues act out more, as you would expect, so that’s a direct consequence.”

It costs an estimated $143 a day to house a typical detainee in the Cook County Jail. The cost to house someone with serious mental health issues is two to three times that amount. Dart said that prisoners with mental health problems are in a disproportionate number of fights and make more suicide threats, and managing them takes more resources.

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

The city’s mental health clinics serve thousands of people, many of whom are uninsured. Dr. Bechara Choucair, Chicago’s commissioner of public health, said those that remained open would treat all those who needed help or send them to private clinics paid by the city to accept the overflow of patients. But city data provided to aldermen showed that the cuts could cause a patient increase of up to 71 percent at some clinics, with no additional staff.

The police and mental health experts fear that without adequate resources to treat them, mentally distressed people will be more likely to end up in dealings with the police.

“It’s going to increase the number of calls they get,” Amy Watson, associate professor at the Jane Addams College of Social Work at the University of Illinois, Chicago, said of the Police Department, “because it is the only place left to call.”

Dart said the cutback in mental health clinics would lead to changes in behavior that in turn would foster criminal activity.

“It’s a vicious circle,” said Dr. Carl Alaimo, past director and chief psychologist of the mental health service at Cook County’s Cermak Hospital, which serves the jail population. He said the jail provides prisoners who are released up to two weeks’ worth of medication, but if those with mental-health problems do not receive help before they run out, they are likely to resort to street drugs or commit other offenses.

Dr. Alaimo said that the jail had a program to refer released prisoners to public mental health centers, but the waiting lists are likely to be long.

Dart said that everyone entering the jail undergoes a physical and mental examination by Cermak staff members. Based on their evaluation, the most acute cases are sent to Cermak. Some other inmates go to units at the jail for detainees with mental health issues.

Dart said he feared that the closings would add to the jail’s already overcrowded conditions.

“The overcrowding, when it gets to be an issue, when it gets to be serious, what I do is corner off an area and say ‘part of Division 2 now is going to house mental health people who are less acute,’ and so we’ll have more of them in there,” he said. “It wasn’t necessarily designed for this purpose, but we’ll make it work.”

Dr. Alaimo said the jail was not equipped to be a major mental health provider. Correction officers receive continuing training on dealing with mental health issues, but administrators are not sure it is adequate. “We shouldn’t be treating people in the jail, but that’s where they’re going to be treated,” Dr. Alaimo said.

Ms. Watson, the University of Illinois Chicago professor, said she believes that the reason the Cook County Jail has become the state’s largest mental health provider was the lack of resources at public mental health care centers. “We’re more willing to fund criminal justice than mental health,” she said.

The city described the clinic closings as consolidations, but Dart said the effect would be to limit the ability of patients to get to the remaining clinics.

“So many of these people are on a razor’s edge,” he said. “The fact that you have shut down this facility that was two miles from that individual, and you combined it over here, and now it’s 10 miles away is very likely the difference between that person following the program or not.”

The cutbacks could also add to the burden at emergency rooms and on ambulances.

“We have an upsurge in crisis calls when services are cut,” said Jeffry Murphy, a retired Chicago police officer and a consultant in crisis-intervention training. “We’re not saving any money closing down these clinics.”

He disputed the city’s claim that consolidation would minimize the impact of the closings. “It’s extremely shortsighted for a community to close down these mental health centers,” Murphy said. “We are reinstitutionalizing the mentally ill by incarcerating them.”

Benjamin S. Wolf, associate legal director of the American Civil Liberties Union of Illinois, said the impact of the closings should prompt a re-evaluation of the way the mentally ill are served in Chicago.

“We need to step back and rethink how we allocate mental health services,” he said. “We’re starving the system in the ways it helps people best.”