The Capacity Problem: What Cook County Can Do To Move Toward NYC’s Plan To Keep The Mentally Ill Out of Jail
The mayor of New York City, Bill de Blasio, recently unveiled a plan to reduce the number of mentally ill people kept in jail. The plan hopes to address a common and malignant feature of criminal justice systems throughout the country: that jails have been become–in many places–the only public housing and the only source of mental health services available to the mentally ill. According to the Treatment Advocacy Center, over 10 times as many mentally ill individuals are incarcerated as are residing in state hospitals.
Jailing these individuals is a costly business as they often represent a large proportion of the “frequent flyers” in the system–individuals who return to jail again and again, often because their mental illness creates circumstances in which they are more likely to commit crimes. In New York City, the portion of jail detainees suffering from serious mental illnesses has risen from 25% to 40% over the last seven years. The need in Cook County is similar, with Sheriff Tom Dart estimating that approximately one third of all the inmates in the Cook County Jail suffer from a serious mental illness. This number would far outstrip the current number of individuals, after they’re found guilty, who are admitted to diversion programs that supply mental health services.
These individuals are not typically violent cases either. As Sheriff Tom Dart noted in a recent piece in the Tribune:
“The vast majority of these inmates are charged with low-level crimes of survival: prostitution, trespassing, disorderly conduct. Many are facing drug charges — for those unable to get medication to make the voices in their heads go away, heroin is often the next best solution. They are, for the most part, good people who suffer from an illness beyond their control and simply need their government to have its priorities straight.”
Mayor de Blasio’s plan attempts to divert mentally ill individuals in three phases of the criminal justice process:
1) Street-level diversion: Investing in drop-off treatments centers where police officers can send people directly without further engaging them in the criminal justice process. Appleseed is currently researching and exploring options on how to implement more street-level diversion in Cook County.
2) Improving services and diversion during the pre-trial phase: Implementing a validated risk assessment so that judges can know about an individual’s risk and needs as they enter into the system and giving them greater ability to release these individuals from jail and send them to service providers.
3) Better post-disposition and reentry services: for those who are convicted and sentenced to probation or otherwise released from the jail, providing better treatment options and services for adjusting to life outside the jail.
The plan is an expensive one, costing approximately $130 million over four years. And one of the trickiest pieces is to find funding and space for residential housing in the community. Currently this portion is not paid for by the expansion of Medicaid under the Affordable Care Act, and NYC–along with Chicago for that matter–faces a shortage in affordable public housing.
For a similar plan to be enacted here, what we need–beyond and antecedent to the need for money–is coordination between criminal justice stakeholders and the treatment provider community. Under the Affordable Care Act, the financing opportunities for treatment providers have shifted and expanded. More and more individuals are insured and can have their treatment paid for; and, although the roll out for payments to service providers has struggled with some obscure provisions in the ACA, the new system has created the opportunity for hospitals and the funders of treatment providers to shift over and address the housing problem. What criminal justice stakeholders need to do, particularly judges, PDs, and the State’s Attorneys is coordinate and make it known to both the treatment provider funders and the state and federal legislatures that they want and require greater capacity for community-based treatment for the mentally ill.
In the October policy meeting hosted by SPAC (the Illinois Sentencing Policy Advisory Council) on the subject of treatment provider capacity, representatives from TASC, the Corporation for Supportive Housing, the Safer Foundation, the Governor’s Office of Health Innovation and Transformation, and the Region V Coordinator for SAMHSA all urged judges and other criminal justice stakeholders to make their needs and voices known to the funders and legislatures in order to address the capacity gap.
We at Chicago Appleseed Fund for Justice add our voice to this movement and urge the criminal justice stakeholders to work together and lead the push for expanding capacity. And, moreover, we ask that a permanent coordinating council of criminal justice stakeholders be convened at the county and state levels–something akin to a permanent version of the Illinois Supreme Court commission currently addressing the pre-trial process in Cook County–to address this issue.