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Fighting for Better Community Mental Health: Cook County, Illinois Sheriff Tom Dart
By Robert Winters, JD, Professor, School of Criminal Justice, Kaplan University
Published: 01/27/2014

Mental health

Tom Dart, the sheriff of Cook County, Illinois, has no shortage of responsibilities. One of the largest is the Cook County Jail, a 96-acre facility with a capacity of 10,200 that currently runs at 99 percent capacity. But a closer look inside the jail reveals a single fact that speaks volumes about the fight that Sheriff Dart faces: Cermak Health Services, the county’s contracted healthcare provider, operates the department that cares for seriously mental ill inmates.

That department is at 130 percent of capacity.

The significance of the issue is borne out by the sheriff’s department homepage, which as of this writing is headlined with a pie chart and a bold red “46%,” which is the percentage “of arrestees at the January 21 Cook County Jail intake self-identified as mentally ill.” Department data indicates that on average 25 to 30 percent of the overall inmate population is classified as mentally ill. According to the sheriff, sometime in 2008 the jail became the largest mental health provider in the state of Illinois.

That is at least in part because over the last three years half of Chicago’s mental health clinics have closed, as well as half of the state hospitals in the city, thanks to budget cuts. According to data from the National Alliance on Mental Health, statewide the Illinois budget for mental health care dropped from a 2009 level of $590.7 million to $403.7 million in 2012. For the most vulnerable on the bottom rung of society, those changes have, in many cases, meant jail is the only alternative.

In a January story on Sheriff Dart and the Cook County Jail, National Public Radio quoted one inmate who acknowledged right up front that on occasion he would “commit a crime just to make sure I would get my meds.” Two others present in the lockup during the interview made the same admission. During a September 2013 visit by retired Rhode Island congressman Patrick Kennedy, inmates voluntarily disclosed diagnoses ranging from depression and anxiety to schizophrenia and bipolar disorder.

The breakdown in the system—and this breakdown is nationwide, not limited to Chicago or Illinois—dates back half a century. At that time states began closing the large, centralized psychiatric hospitals that had become little more than dumping grounds for the severely mentally ill, particularly those with no family able (or willing) to provide care. The horror stories coming out of such institutions were endemic, and many cited the barbarity of the conditions as the foremost reason for shutting them down.

The argument can be made (and is by some) that the closures of those hospitals were motivated as much by budgetary concerns as by compassion. Whatever the reasons were, the assumption was that smaller mental health clinics and facilities at the community level would step in to provide treatment and medication. Unfortunately, that was not the reality. Budget constraints meant that this network of community clinics never materialized.

Mental illnesses tend to require ongoing, consistent, and sometimes complicated treatment regimens if the sufferer is to remain fully functional. Continual counseling, multiple medications, and often the need to monitor levels and adjust dosages means patients must have constant access to care, and furthermore, the medicines in question are often expensive. For obvious reasons, the homeless and even those just unemployed face difficulties in keeping disorders under control.

The inmate mental health question is a budgetary issue with real and significant costs. The Cook County Sheriff’s Office pegs the daily cost to house a Cook County Jail inmate at $143. By comparison, the cost for a mentally ill inmate is estimated to be at least $190 and in many cases much higher depending on the level of care and specific medications required.

There are also quantifiable indirect costs. The mentally ill are often booked on relatively minor charges such as trespassing and low-level drug- and alcohol-related offenses. Nevertheless, they must be processed through the criminal justice system, and since the Cook County Jail is the primary pretrial facility, slowdowns in processing mean everyone stays longer. Just in the course of a few years the average length of stay has increased by eight days, which translates to an additional $10 million in annual costs.

Tom Dart’s background is somewhat different, although not necessarily unusual for someone heading a large, urban agency. He is a former state legislator and prosecutor, so the “soft on crime” label does not cling to him very well. Sheriff since 2006, in 2009 he was named as one of the 100 Most Influential People in the World by Time magazine primarily for his efforts in creating a more effective and progressive department and county corrections system. But he did not seek the office of sheriff with the intent to fight for reform of the county and state mental health systems. Nevertheless, the processing of the mentally ill through the traditional criminal justice system has become a key issue for him, and he has spent plenty of time telling the story to the media.

At times his frustration has been palpable. Referring to the numerous compliments his jail has received on its handling of the mentally ill, he reflected “…it’s depressing as hell when they tell you you’re the leader…. [W]e’re doing the bare minimum, and we’re the leaders?” He was quoted in a 2013 interview as saying “First we were naively trying to alert people,” referring to the mental health crisis in his jail. “Then we found out no one cared.” Perhaps he was referring to government officials; in his January 2014 interview with NPR he was more upbeat, saying “I know people care. I don’t think they know.”

He finds it ironic that horrid conditions led to the closure of state psychiatric hospitals only to result in the same population of mentally ill individuals now ending up incarcerated. He also insists that the cost of handling them through the criminal justice system is ultimately more expensive than building the community-level mental health care network that was originally supposed to replace the state hospitals.

Dart summed up his views succinctly in his NPR interview: “I can’t conceive of anything more ridiculously stupid…than [for government] to do what we’re doing right now.”

About the author:

Corrections.com author, Robert Winters, holds a Juris Doctorate degree and is a Professor with Kaplan University. He is also a member of the National Criminal Justice Association and serves as a Western Regional Representative, a member of the National Advisory Board and their National Elections Committee.

Other articles by Winters


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