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Thursday, March 27, 2014

‘We Have Criminalized Mental Illness In This Country’ - Illinois Cook County Sheriff Tom Dart testifies to U.S. Congress

(below are a couple of recent articles on Sheriff Dart, & prisons have become institutions for people with mental illness)

CBS2 Chicago | March 26, 2014

Cook County Sheriff Tom Dart
WASHINGTON (CBS) – Cook County Sheriff Tom Dart has taken his appeal for more help for mentally ill jail inmates to Capitol Hill.
WBBM Newsradio Political Editor Craig Dellimore reports Dart testified Wednesday morning before a Congressional subcommittee looking at mental health services.
The sheriff told members of Congress the Cook County Jail remains the nation’s largest mental health facility, with at least 30 percent of its 9,000 inmates suffering from serious mental illness.
“The unfortunate undeniable conclusion is that, because of the dramatic and sustained cuts in mental health funding, we have criminalized mental illness in this country; and county jails and state prison facilities are where the majority of the mental health care and treatment is administered,” Dart said.
Many inmates are awaiting trial for relatively minor – often drug-related – offenses.
He said those people should be getting medical and psychological help, not simply incarcerated awaiting trial.
“What we have done in our county now, is my staff interviews every detainee before they appear in bond court regarding their mental health history. Those who admit to a history are identified for the Public Defender’s office, and then we make efforts to try to appeal to the judges for alternative programs,” he said. “Unlike state prisoners who have fixed release dates, pretrial detainees may be released at any time, which significantly complicates our ability to provide discharge planning.”
Even so, Dart said he tries to get help for those leaving the jail, too.
However, cuts in mental health funding make it hard to find help for those who need it.
“The question that plagues me, that keeps me up at night, is where do we go from here?” Dart said.
Division 1, the oldest building in the Cook County jail complex.

Cook County Sheriff Rips Mental Health Cuts: ‘We Have Criminalized Mental Illness In This Country’

BY SY MUKHERJEE | ThinkProgress.com | March 26, 2014

Cook County Sheriff Tom Dart isn’t mincing words when it comes to his frustrations with Chicago’s — and America’s — broken and underfunded mental health care system.
“Every single day, I am faced with the mental health crisis in this county,” said Dart during testimony before the House Energy and Commerce Committee’s Subcommittee on Oversight and Investigation on Wednesday. “The unfortunate and undeniable conclusion is that because of dramatic and sustained cuts in mental health funding, we have criminalized mental illness in this country, and county jails and state prison facilities are where the majority of mental health care and treatment is administered.”
Illinois made the fourth-largest cuts to mental health services of any state in the country between 2009 and 2012, including the shuttering of two state-run psychiatric facilities. Combined with a lack of affordable housing units, those cuts have propagated a system wherein Americans with mental illnesses wind up in jails rather than clinics.
Dart said that the Cook County Jail houses approximately about 3,500 inmates with serious mental illnesses on any given day (about a third of its total inmate population), making it the largest de facto mental health provider in the nation.
To be clear, these inmates shouldn’t be in a jail setting. The most common illnesses that Dart encounters are mood and psychotic disorders, including severe depression, bipolar disorder, and schizophrenia. And many wind up in jail because they’re simply trying to grapple with a mental health safety net riddled with holes. “While some mentally ill individuals are charged with violent offenses, the majority are charged with crimes seemingly committed to survive, including retail theft, trespassing, prostitution and drug possession,” said Dart.
Keeping the inmates in jail is a pricey endeavor, as caring for a prisoner with mental illness is “easily” two or three times as expensive as the $143 per day that it costs to keep an average person in jail, according to Dart. The care isn’t particularly effective, either. Dart told ThinkProgress that the doctors who treat inmates with mental illnesses are more focused on simple triage rather than holistic care. “Their mission is to get [the inmates] stabilized, make sure they’re on their meds, and when they’re on their way out, [the doctors] give them a plastic baggie with two weeks’ worth of meds,” he said.
Dart also recounted several tragic stories about sick prisoners who were released into a society where they had little recourse for medical care or even simple housing during Wednesday’s hearing. “We’ve had inmates get released and try to break back into the jail so they can keep getting treatment,” he told the House committee. He then urged the committee to consider legislation that would make it easier to keep track of severely mentally ill patients’ cases.
One bill that might go a long way toward achieving that goal has actually already been proposed by the head of the Oversight and Investigation subcommittee, Rep. Tim Murphy (R-PA). Murphy’s Behavioral Health IT Act, introduced right around the one-year anniversary of the massacre at Sandy Hook Elementary School, would increase community mental health treatment funding, appropriate more money for emergency psychiatric care facilities, set up screening programs in schools, and create electronic infrastructure to keep track of available mental health beds — an infrastructure that only about half of all states currently have — and the sickest patients’ records.
That electronic records system alone would “help in terms of identifying people who are becoming ill, who are actively psychotic, and allow for an emergency room to electronically transmit to a community agency information on someone they need to follow up on,”according to Linda Rosenberg, president and CEO of the National Council for Behavioral Health.

Psychiatric Patients With No Place to Go but Jail

By BRIDGET O'SHEA | The New York Times | February 18, 2012
A version of this article appeared in print on February 19, 2012, on page A25A of the National edition with the headline: Psychiatric Patients With No Place to Go but Jail.

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.

Mr. 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 Mr. 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 Mr. 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. Mr. 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.”

Mr. 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.

Mr. 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.

Mr. 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 Mr. 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,” Mr. 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.”


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