The man running the largest mental health institution in the United States is not a doctor. He did not major in psychiatry, nor did he spend his formative years studying bipolar disorder or working with schizophrenics.
That man is me, a history major turned lawyer who went on to become the sheriff here. As sheriff, I run the Cook County Jail, the largest jail on a single site in the country with approximately 10,000 inmates on any given day – and approximately 30% of them suffering from a serious mental illness.
With dramatic and continued cuts to mental health funding on the federal and local level, county jails and state prisons are where the majority of our mental health care is being administered today. According to the Treatment Advocacy Center, the largest mental health institutions in 44 of our 50 states are jails or prisons. And 10 times as many mentally ill individuals reside in jails and prisons than in state mental health hospitals, where they should.
The conclusion is heartbreaking but no longer undeniable: we have criminalized mental illness in America, and you are paying for it.
It is shameful. Deplorable. Immoral. Simply put, the mentally ill belong in treatment – not in jail. It would be cheaper that way, too.
While some of the mentally ill population in our jail has been charged with violent crimes, the majority has been charged with non-violent, lesser offenses such as retail theft, trespassing and drug possession. These inmates end up staying because they can’t afford to post bail – or because they have nowhere to go. Ultimately, many of them are sentenced to probation. Often, their cases are dropped. Then they’re released into the community, and the vicious and predictable cycle repeats.
There are workarounds to break the cycle:
we've tried to re-route new inmates to treatment before they arrive; we've introduced discharge plans to place inmates in treatment when they leave; we remain available to former inmates going through mental health crises or going off their medication; more than 4,000 people who started an application in Cook County Jail for Medicaid coverage under the Affordable Care Act are now carrying an insurance card; and while they're in the jail, many inmates note that it's where they get their best – or only – treatment, which is simply sad.
But the priority needs to be funding mental health care, not throwing mentally ill patients-in-waiting behind bars. It’s not only the moral thing to do – it’s the most cost-effective solution.
From 2009 to 2012, states cut mental health funding by $1.6bn (nearly 10%), according to the National Alliance on Mental Illness.The current math here in Chicago now adds up like this:
But this is about more than money. The answer to treating mental illness is not incarceration – it’s case management.