Our prisons and jails are filled with people with mental illnesses. There are at least 8,000 people with mental illnesses in prisons operated by the Illinois Department of Corrections. There are at lest 3,000 people with mental illness in Illinois’ ninety nine county jails, including approximately 2,000 in the Cook County Jail.
It is difficult, if not impossible, to provide decent and human mental health services in prisons and jails. Prisons and jails lack the resources to attract and retain sufficient qualified professionals to address the mental health needs of inmates. Correctional staff are often not trained to work with persons with serious mental illnesses.
Prisons and jails are frequently violent, overcrowded, understaffed and chaotic places. Persons with mental illnesses are frequently victimized by other inmates. Moreover, when untreated or inappropriately treated for their illnesses, they frequently violate prison or jail rules and sometimes commit additional crimes. These behaviors commonly lead to discipline and lengthened terms of imprisonment.
Prisons and jails in Illinois have frequently been sued for failing to provide adequate mental health services. For example, the Illinois Department of Corrections is facing a class action making this claim and seeking dramatic (and expensive) improvements in mental health services. Cook County Jail is signatory to two consent decrees requiring comprehensive mental health services. Prison and jails across the state have been sued successfully for failure to provide mental health services to individual inmates and for failing to prevent suicides by persons with mental illnesses.
Every year thousands of persons with serious mental illnesses are released from prisons and jails without having been successfully treated for their mental illnesses. Whether or not their illnesses have been appropriately treated in these institutions, most will not be linked to appropriate treatment when released.
At least 250.000 Illinoians have schizophrenia or bipolar disorder and millions of others have other serious mental illnesses. Thousands have returned from military service in Iraq or Afghanistan with post-traumatic stress disorder.
As Illinois reduced the capacity of its state-operated mental hospitals from 33,000 in 1955 to 1,200 in 2015, it failed to fund or provide adequate community mental health services for it citizens. Private hospitals have also reduced their inpatient capacity.
Private insurance has typically failed to provide adequate coverage for mental illnesses. Only recently have the federal and state governments adopted “parity” laws, which require that mental illnesses be afforded the same level of coverage as other health conditions. Unfortunately, enforcement of these laws remains problematic.
Many persons with mental illnesses who end up in the criminal justice system had not received mental health services prior to their arrest because they did not have health insurance, were not eligible for or had not enrolled in Medicaid and other public funding for mental health services is inadequate.
Medicaid in Illinois does not provide for minimally adequate mental health services due to inadequate payment rates for providers and the failure to cover many necessary, evidence-based services.
Serious, untreated mental illnesses frequently result in a downward economic spiral due to loss of employment and loss of family support.
Create and expand effective mental health diversion programs including:
Police Crisis Intervention Team (CIT) programs
Crisis intervention programs where law enforcement can bring for treatment and other services persons witth mental illnesses and substance use problems who have been charged with low-level crimes
Bond-court diversion programs
Problem solving courts including drug courts, mental health courts and veterans courts
Enhanced mental health services for persons mental illnesses eligible for probation.
Take advantage of Illinois’ decision to expand Medicaid coverage under the Affordable Care Act to enroll every eligible person in Medicaid. Illinois should specifically focus on insuring that persons with mental illnesses leaving prisons and jails are enrolled in Medicaid.
Prison and jails must coordinate with the Departments of Human Services (DHS) and Healthcare and Family Services (DHFS) to create appropriate linkage to community services for every person with a mental illness leaving a prison or jail. As the Medicaid program moves to managed care, DHFS must contract with managed care entities to insure that they promptly arrange mental health services for persons leaving prisons and jails.
DHFS must take advantage of Federal Medicaid waiver programs to fund evidence-based community mental health services.
The Illinois Department of Insurance should take aggressive steps to enforce Federal and State parity laws so that persons with private insurance have access to mental health services.
Promptly and carefully screen for mental illnesses everyone entering a jail or prison.
Provide adequate and humane mental health services in every prison and jail.
Prisons and jails must coordinate with DHS and DHFS to insure that persons being effectively treated on psychotropic medications are not forced to switch medications when entering or leaving the criminal justice system.