The Circuit Court The Circuit Court of Cook Countyof Cook County

Honorable Timothy Evans, Chief JudgeHonorable Timothy Evans, Chief JudgeHonorable Paul Biebel, Presiding Judge, Criminal DivisionHonorable Paul Biebel, Presiding Judge, Criminal Division

Mental Health Court ProjectMental Health Court Project

The United States is the world leader The United States is the world leader in incarceration, with a higher proportion in incarceration, with a higher proportion of its population behind bars than any of its population behind bars than any other country.other country.

5% of world’s population – 25% of world’s jail population5% of world’s population – 25% of world’s jail population

The nation’s prisons and jails held more The nation’s prisons and jails held more than than 2 million2 million inmates for the first time on inmates for the first time on June 30, 2002 (Bureau of Justice). June 30, 2002 (Bureau of Justice).

By the end of 2004, that number reached

2.14 million.

By the end of 2004, that number reached

2.14 million.

~ 7 million people were on probation, ~ 7 million people were on probation, in jail or prison, or on parole in jail or prison, or on parole

~ 3.2% of all U.S. adult residents or ~ 3.2% of all U.S. adult residents or 1 in every 31 adults1 in every 31 adults

(Retrieved 02/17/2006 from: http://www.ojp.usdoj.gov/bjs/correct.htm)

The Mentally Ill IncarceratedThe Mentally Ill Incarcerated

~ 10 million people enter ~ 10 million people enter 3,365 county jails each year3,365 county jails each year

~ 6-15% of these jail ~ 6-15% of these jail detainees suffer from detainees suffer from serious mental illnesses serious mental illnesses compared to the ~ 2%-5% of compared to the ~ 2%-5% of the US population that have the US population that have a serious MIa serious MI

Jails Become Mental InstitutionsJails Become Mental Institutions Daily, ~ 200,000 people behind bars, Daily, ~ 200,000 people behind bars, or more than 1 in 10 inmates, suffer or more than 1 in 10 inmates, suffer from:from: schizophreniaschizophrenia bipolar disorderbipolar disorder major depression major depression

70% of MI population are nonviolent 70% of MI population are nonviolent offendersoffenders

Nearly 90% of inmates with MI have aNearly 90% of inmates with MI have aco-occurring substance abuse problem co-occurring substance abuse problem

(Abram KM, Teplin LA, 1991)(Abram KM, Teplin LA, 1991)

Jails Have Become the Mental Hospitals and Jails Have Become the Mental Hospitals and Social Service Systems of Last ResortSocial Service Systems of Last Resort

Cermak’s Mental Health Services is the Cermak’s Mental Health Services is the largest provider of psychiatric largest provider of psychiatric services in the State of Illinois.services in the State of Illinois.

The Cook County Jail is now, in effect, the largest The Cook County Jail is now, in effect, the largest mental hospital in Illinois. There are more people with mental hospital in Illinois. There are more people with mental illness in our state prisons than in all our public mental illness in our state prisons than in all our public

and private psychiatric institutions combined.and private psychiatric institutions combined.

60’s – 60’s – deinstitutionalizadeinstitutionalizationtion

70’s – increase in 70’s – increase in homeless homeless populationspopulations

80’s – “War 80’s – “War Against Drugs”Against Drugs”

Jails Have a Constitutional Jails Have a Constitutional Duty to Provide Duty to Provide Mental Health TreatmentMental Health Treatment

88thth Amendment – prohibits Amendment – prohibits “Cruel and Unusual “Cruel and Unusual Punishment”Punishment”

1414thth Amendment – for pretrial Amendment – for pretrial detainees and juveniles “Due detainees and juveniles “Due Process”Process”

Mental Heath CourtMental Heath Court

Since 1990’s Over 100 Courts Since 1990’s Over 100 Courts Nationally Have Been DevelopedNationally Have Been Developed

Most are adult criminal courtsMost are adult criminal courts Have a separate docket dedicated to Have a separate docket dedicated to persons with mental illnessespersons with mental illnesses

Divert criminal defendants from Divert criminal defendants from jail into treatment programsjail into treatment programs

Some courts monitor the defendants Some courts monitor the defendants during treatment and have the during treatment and have the ability to impose criminal ability to impose criminal sanctions for failure to complysanctions for failure to comply

Three Basic Critical ProblemsThree Basic Critical Problems

The public safety risk posed The public safety risk posed by the mentally ill offendersby the mentally ill offenders

The difficulties associated The difficulties associated with housing the mentally ill with housing the mentally ill in local jailsin local jails

The inadequacy of the criminal The inadequacy of the criminal justice process in dealing justice process in dealing with the mentally ill with the mentally ill defendants in all mattersdefendants in all matters

The Cook County Model The Cook County Model Target population:Target population:

All voluntary admission to programAll voluntary admission to program Works exclusively with MI felony Works exclusively with MI felony offendersoffenders

24 month probation24 month probation Four phases of treatment, including a Four phases of treatment, including a discharge transition phase (six discharge transition phase (six months) months)

State of Illinois Division of Mental State of Illinois Division of Mental Health open casesHealth open cases

Generally non-violent, non-sex Generally non-violent, non-sex offendersoffenders

Economically disadvantagedEconomically disadvantaged Co-occurring substance use disorderCo-occurring substance use disorder

Unique Program FeaturesUnique Program Features Primary Focus: Primary Focus: Community Case ManagementCommunity Case Management Crisis Intervention Team (CIT) – Chicago Crisis Intervention Team (CIT) – Chicago Police DepartmentPolice Department

Clinical Emphasis-Multidisciplinary Team Clinical Emphasis-Multidisciplinary Team Sanctions-based system that keeps the Sanctions-based system that keeps the mentally ill offender (MIO) out of mentally ill offender (MIO) out of jail/prison and in community servicesjail/prison and in community services

Open state mental health cases: services Open state mental health cases: services are paid through Medicaid and SAMHSA are paid through Medicaid and SAMHSA grantsgrants

Focus on high-risk clients: all felony Focus on high-risk clients: all felony probationers with extensive criminal probationers with extensive criminal justice and mental health backgrounds justice and mental health backgrounds

System-wide Collaboration of State System-wide Collaboration of State and Countyand County (2001-The Process Begins)(2001-The Process Begins)

Cook County Criminal Justice SystemCook County Criminal Justice System LeadershipLeadership

Chief Judge Timothy EvansChief Judge Timothy Evans Presiding Judge Paul BiebelPresiding Judge Paul Biebel Lead Judges – Judge Jay Crane and Judge Thomas Lead Judges – Judge Jay Crane and Judge Thomas V. Gainer, Jr.V. Gainer, Jr.

Adult Mental Health Probation UnitAdult Mental Health Probation Unit Cook County State’s Attorney OfficeCook County State’s Attorney Office Cook County Public Defender’s OfficeCook County Public Defender’s Office

System-wide Collaboration of State System-wide Collaboration of State and Countyand County (2001-The Process Begins)(2001-The Process Begins)

Cermak Health Services of Cook Cermak Health Services of Cook County-Department of Mental Health County-Department of Mental Health Services Services

TASCTASC Illinois Department Human Services, Illinois Department Human Services, Divisions of Mental Health and Divisions of Mental Health and Alcohol Alcohol and Substance Abuse and Substance Abuse

Chicago Police Department – Chicago Police Department – Crisis Intervention TeamsCrisis Intervention Teams

Community Service ProvidersCommunity Service Providers

Chicago PoliceChicago PoliceCrisis Intervention TeamCrisis Intervention Team Voluntary program of specially trained Voluntary program of specially trained officersofficers

Mental health crisis responseMental health crisis response Coordinated tactical responseCoordinated tactical response Collaborative trainingCollaborative training Linkage to the mental health service systemLinkage to the mental health service system

TrainingTraining

40 hour State Certification 40 hour State Certification coursecourse

Mental Health Court trainingMental Health Court training Office of Emergency Communication Office of Emergency Communication call taker trainingcall taker training

Mental Health Service System Mental Health Service System trainingtraining

Focus groupsFocus groups

Chicago PoliceChicago PoliceCrisis Intervention TeamCrisis Intervention TeamProgram goals:Program goals: Enhance outcomesEnhance outcomes Officer safetyOfficer safety De-escalationDe-escalation DiversionDiversion Crisis preventionCrisis prevention

Chicago PoliceChicago PoliceCrisis Intervention TeamCrisis Intervention TeamProgram goals:Program goals:

Identify mental health callsIdentify mental health calls Quantify mental health callsQuantify mental health calls Identify best practice methodsIdentify best practice methods

The Beginning ProcessThe Beginning Process(What we thought the reality was)(What we thought the reality was)

Ongoing evaluationOngoing evaluation Program modifications Program modifications ExpansionExpansion

TimelineTimeline

April 5, 2004 – screening process beganApril 5, 2004 – screening process began May 12, 2004 – first cases admittedMay 12, 2004 – first cases admitted October, 2005 – program funding: SAMHSA October, 2005 – program funding: SAMHSA jail diversion grant for program jail diversion grant for program expansion & increased community expansion & increased community programmingprogramming

May 25, 2006 – first graduationMay 25, 2006 – first graduation Six semi-annual graduations to date; Six semi-annual graduations to date; 11/13/08 to have the most graduates to 11/13/08 to have the most graduates to date (18), bringing total of successful date (18), bringing total of successful graduates to 43graduates to 43

The Process as of NowThe Process as of Now(What we are finding reality to be)(What we are finding reality to be)

The program individuals have:The program individuals have: Much more extensive criminal Much more extensive criminal backgroundsbackgrounds(compared to a 9 year review of Cook (compared to a 9 year review of Cook County drug court participants)County drug court participants)

Much more extensive psychiatric Much more extensive psychiatric histories (including major Axis II histories (including major Axis II Personality Disorders)Personality Disorders)

Few, if any, community resources with Few, if any, community resources with adequate funding to service the level adequate funding to service the level of of care neededcare needed

Stabilization became a priority prior to Stabilization became a priority prior to being released from the jailbeing released from the jail

Most identified individuals have had long Most identified individuals have had long histories with addiction/dependency issueshistories with addiction/dependency issues

Housing needs became essential, leading to Housing needs became essential, leading to

a collaboration with the Chicago a collaboration with the Chicago Department Department of Housingof Housing

Many individuals have minimal, if any, Many individuals have minimal, if any, benefits in placebenefits in place

The Process as of NowThe Process as of Now(What we are finding reality to be)(What we are finding reality to be)

Criminal Justice History of Program Criminal Justice History of Program Participants at Admission Participants at Admission

0

5

10

15

20

25

30

35

Average TotalArrests

Average FelonyArrests

Average TotalConvictions

Average FelonyConvictions

AveragePrison/Probation

(Years)

Males

Females

Total

Program ImpactProgram Impact

Decreased criminal activityDecreased criminal activity Decreased hospitalizationsDecreased hospitalizations Decreased incarceration Decreased incarceration Decreased county cost Decreased county cost expendituresexpenditures

Improved quality of lifeImproved quality of life

Reduction of Criminal Activity Reduction of Criminal Activity While in ProgramWhile in Program

0

10

20

30

40

50

60

70

80

90

100

% never held incustody

% no newarrests

% no newfelony arrests

% no newconvictions

% no newfelony

convictions

Criminal Activity Criminal Activity Pre- and Post-AdmissionPre- and Post-Admission

0

0.5

1

1.5

2

2.5

3

3.5

Average arrests 1year prior toadmission

Averageconvictions 1 yearprior to admission

Average arrests 1year afteradmission

Averageconvictions 1 yearafter admission

Males

Females

Total

In Custody Days and CostsIn Custody Days and Costs

0

20

40

60

80

100

120

140

Average dayscustody yearprior to adm

Average totaldays custody

year afteradm

Average dayscustody yearafter adm,following anew arrest

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

Average jailcosts year

prior to adm

Average totaljail costsyear after

adm

Average jailcosts yearafter adm,following anew arrest

Average Days in Custody Average Jail Costs

Cook County, IllinoisCook County, IllinoisMental Health Court (MHC) ReportMental Health Court (MHC) Report

April 4, 2004 – November 1, 2008April 4, 2004 – November 1, 2008

Cook County MHC ReportCook County MHC Report Referrals – 281 Referrals – 281

– Sources of Referral:Sources of Referral: Cermak Health Services - 178 Cermak Health Services - 178 Other – 103Other – 103

Active clients – 78 (of 159 total Active clients – 78 (of 159 total admissions) admissions) – 37 Females 37 Females – 41 Males– 41 Males

Pending cases – 8 Pending cases – 8 – 4 Female 4 Female – 4 Male– 4 Male

Other dispositions – 114 Other dispositions – 114

Current ChargesCurrent Charges

(reflect multiple charges against some participants)(reflect multiple charges against some participants) Prostitution – 1 Prostitution – 1 Possession of a controlled substance Possession of a controlled substance (PCS) – 62(PCS) – 62

Retail theft – 24 Retail theft – 24 Theft/labor or service – 4 Theft/labor or service – 4 Aggravated battery – 3 Aggravated battery – 3 Burglary – 7 Burglary – 7 Unlawful use of a weapon – 1 Unlawful use of a weapon – 1 Criminal damage to property > $300 – 1 Criminal damage to property > $300 – 1

Data on Clients Admitted to Data on Clients Admitted to Cook County MHCCook County MHC

Age range of female clients: 24 Age range of female clients: 24 - 60- 60

Average age of female client: Average age of female client: 39.039.0

Age range of male clients: 20 – Age range of male clients: 20 – 5656

Average age of male client: Average age of male client: 38.738.7

Data on Clients Admitted to Data on Clients Admitted to Cook County MHCCook County MHC VOP’s – 191 VOP’s – 191

– Filed against 106 clientsFiled against 106 clients Probation terminated unsuccessful (PTU) Probation terminated unsuccessful (PTU) – 7 – 7

New arrests – 123 New arrests – 123 – 75 misdemeanors, 48 felonies 75 misdemeanors, 48 felonies – Filed against 23 participantsFiled against 23 participants

Clients with no new arrest – 60%Clients with no new arrest – 60% Active clients terminated from program – Active clients terminated from program – 8181

Successful Graduates (PTS), as of Successful Graduates (PTS), as of 11/13/08 - 43 11/13/08 - 43

Active Warrant Status – 10 Active Warrant Status – 10 Cook County Department of Corrections – Cook County Department of Corrections – 1010

Death of client - 2 Death of client - 2

Mental and Health Issues Mental and Health Issues Affecting ClientsAffecting Clients (many participants with (many participants with more than one diagnosis)more than one diagnosis)

Schizophrenia – 18 Schizophrenia – 18 Schizoaffective Schizoaffective Disorder – 17Disorder – 17

Bipolar Disorder – 28 Bipolar Disorder – 28 Major Depression – 25 Major Depression – 25 Dysthymia – 1 Dysthymia – 1 Psychotic Disorder Psychotic Disorder NOS – 6 NOS – 6

Substance Abuse Substance Abuse Disorders – 74 Disorders – 74

Mood Disorder NOS - 6Mood Disorder NOS - 6

Impulse/Explosive Impulse/Explosive Disorder – 2 Disorder – 2

Post-traumatic Post-traumatic Stress Syndrome – Stress Syndrome – 64 64

Anti-social Anti-social Personality Personality Disorder – 0 Disorder – 0

HIV+ – 1 HIV+ – 1 Developmentally Developmentally Delayed – 2 Delayed – 2

Hepatitis C – 4Hepatitis C – 4 Pancreatitus - 1 Pancreatitus - 1

Types of Facilities Currently in UseTypes of Facilities Currently in Use

Residential treatment facility – 67Residential treatment facility – 67 Psychosocial rehabilitation (PSR) day program – 16 Psychosocial rehabilitation (PSR) day program – 16 Nursing home – 10 Nursing home – 10 Inpatient psychiatric unit – 1 Inpatient psychiatric unit – 1 Receiving ACT services – 29 Receiving ACT services – 29 Employed – 3 Employed – 3 Substance abuse treatment groups only – 0 Substance abuse treatment groups only – 0 Recovery/halfway house – 17 Recovery/halfway house – 17 Individual housing (alone or with family) – 29Individual housing (alone or with family) – 29 Enrolled in educational program – 3 Enrolled in educational program – 3 Enrolled in methadone/suboxone treatment - 2Enrolled in methadone/suboxone treatment - 2

Vignette of Male Client from Vignette of Male Client from Cook County Mental Health CourtCook County Mental Health Court

Family backgroundFamily background HistoryHistory Circumstances at time of arrestCircumstances at time of arrest Arrest and mental health court Arrest and mental health court referralreferral

Mental health court outcomesMental health court outcomes

QuestionsQuestions