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Mental Health Court Project

The Circuit Court of Cook County Honorable Timothy Evans, Chief Judge Honorable Paul Biebel, Presiding Judge, Criminal Division. Mental Health Court Project. The United States is the world leader in incarceration, with a higher proportion of its population behind bars than any other country.

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Mental Health Court Project

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  1. The Circuit Court of Cook CountyHonorable Timothy Evans, Chief JudgeHonorable Paul Biebel, Presiding Judge, Criminal Division Mental Health Court Project

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

  3. 5% of world’s population – 25% of world’s jail population

  4. The nation’s prisons and jails held more than 2 million inmates for the first time on June 30, 2002 (Bureau of Justice). By the end of 2004, that number reached 2.14 million.

  5. ~ 7 million people were on probation, in jail or prison, or on parole • ~ 3.2% of all U.S. adult residents or 1 in every 31 adults (Retrieved 02/17/2006 from: http://www.ojp.usdoj.gov/bjs/correct.htm)

  6. The Mentally Ill Incarcerated • ~ 10 million people enter 3,365 county jails each year • ~ 6-15% of these jail detainees suffer from serious mental illnesses compared to the ~ 2%-5% of the US population that have a serious MI

  7. Jails Become Mental Institutions • Daily, ~ 200,000 people behind bars, or more than 1 in 10 inmates, suffer from: • schizophrenia • bipolar disorder • major depression • 70% of MI population are nonviolent offenders • Nearly 90% of inmates with MI have aco-occurring substance abuse problem (Abram KM, Teplin LA, 1991)

  8. Jails Have Become the Mental Hospitals and Social Service Systems of Last Resort Cermak’s Mental Health Services is the largest provider of psychiatric services in the State of Illinois.

  9. The Cook County Jail is now, in effect, the largest mental hospital in Illinois. There are more people with mental illness in our state prisons than in all our public and private psychiatric institutions combined. • 60’s – deinstitutionalization • 70’s – increase in homeless populations • 80’s – “War Against Drugs”

  10. Jails Have a Constitutional Duty to Provide Mental Health Treatment • 8th Amendment – prohibits “Cruel and Unusual Punishment” • 14th Amendment – for pretrial detainees and juveniles “Due Process”

  11. Mental Heath Court

  12. Since 1990’s Over 100 Courts Nationally Have Been Developed • Most are adult criminal courts • Have a separate docket dedicated to persons with mental illnesses • Divert criminal defendants from jail into treatment programs • Some courts monitor the defendants during treatment and have the ability to impose criminal sanctions for failure to comply

  13. Three Basic Critical Problems • The public safety risk posed by the mentally ill offenders • The difficulties associated with housing the mentally ill in local jails • The inadequacy of the criminal justice process in dealing with the mentally ill defendants in all matters

  14. The Cook County Model • Target population: • All voluntary admission to program • Works exclusively with MI felony offenders • 24 month probation • Four phases of treatment, including a discharge transition phase (six months) • State of Illinois Division of Mental Health open cases • Generally non-violent, non-sex offenders • Economically disadvantaged • Co-occurring substance use disorder

  15. Unique Program Features • Primary Focus: Community Case Management • Crisis Intervention Team (CIT) – Chicago Police Department • Clinical Emphasis-Multidisciplinary Team • Sanctions-based system that keeps the mentally ill offender (MIO) out of jail/prison and in community services • Open state mental health cases: services are paid through Medicaid and SAMHSA grants • Focus on high-risk clients: all felony probationers with extensive criminal justice and mental health backgrounds

  16. System-wide Collaboration of State and County(2001-The Process Begins) • Cook County Criminal Justice System • Leadership • Chief Judge Timothy Evans • Presiding Judge Paul Biebel • Lead Judges – Judge Jay Crane and Judge Thomas V. Gainer, Jr. • Adult Mental Health Probation Unit • Cook County State’s Attorney Office • Cook County Public Defender’s Office

  17. System-wide Collaboration of State and County(2001-The Process Begins) • Cermak Health Services of Cook County-Department of Mental Health Services • TASC • Illinois Department Human Services, Divisions of Mental Health and Alcohol and Substance Abuse • Chicago Police Department – Crisis Intervention Teams • Community Service Providers

  18. Chicago PoliceCrisis Intervention Team • Voluntary program of specially trained officers • Mental health crisis response • Coordinated tactical response • Collaborative training • Linkage to the mental health service system

  19. Training • 40 hour State Certification course • Mental Health Court training • Office of Emergency Communication call taker training • Mental Health Service System training • Focus groups

  20. Chicago PoliceCrisis Intervention TeamProgram goals: • Enhance outcomes • Officer safety • De-escalation • Diversion • Crisis prevention

  21. Chicago PoliceCrisis Intervention TeamProgram goals: • Identify mental health calls • Quantify mental health calls • Identify best practice methods

  22. The Beginning Process(What we thought the reality was) • Ongoing evaluation • Program modifications • Expansion

  23. Timeline • April 5, 2004 – screening process began • May 12, 2004 – first cases admitted • October, 2005 – program funding: SAMHSA jail diversion grant for program expansion & increased community programming • May 25, 2006 – first graduation • Six semi-annual graduations to date; 11/13/08 to have the most graduates to date (18), bringing total of successful graduates to 43

  24. The Process as of Now(What we are finding reality to be) • The program individuals have: • Much more extensive criminal backgrounds(compared to a 9 year review of Cook County drug court participants) • Much more extensive psychiatric histories (including major Axis II Personality Disorders) • Few, if any, community resources with adequate funding to service the level of care needed

  25. The Process as of Now(What we are finding reality to be) • Stabilization became a priority prior to being released from the jail • Most identified individuals have had long histories with addiction/dependency issues • Housing needs became essential, leading to a collaboration with the Chicago Department of Housing • Many individuals have minimal, if any, benefits in place

  26. Criminal Justice History of Program Participants at Admission

  27. Program Impact • Decreased criminal activity • Decreased hospitalizations • Decreased incarceration • Decreased county cost expenditures • Improved quality of life

  28. Reduction of Criminal Activity While in Program

  29. Criminal Activity Pre- and Post-Admission

  30. In Custody Days and Costs Average Jail Costs Average Days in Custody

  31. Cook County, IllinoisMental Health Court (MHC) ReportApril 4, 2004 – November 1, 2008

  32. Cook County MHC Report • Referrals – 281 • Sources of Referral: • Cermak Health Services - 178 • Other – 103 • Active clients – 78 (of 159 total admissions) • 37 Females – 41 Males • Pending cases – 8 • 4 Female – 4 Male • Other dispositions – 114

  33. Current Charges (reflect multiple charges against some participants) • Prostitution – 1 • Possession of a controlled substance (PCS) – 62 • Retail theft – 24 • Theft/labor or service – 4 • Aggravated battery – 3 • Burglary – 7 • Unlawful use of a weapon – 1 • Criminal damage to property > $300 – 1

  34. Data on Clients Admitted to Cook County MHC • Age range of female clients: 24 - 60 • Average age of female client: 39.0 • Age range of male clients: 20 – 56 • Average age of male client: 38.7

  35. Data on Clients Admitted to Cook County MHC • VOP’s – 191 • Filed against 106 clients • Probation terminated unsuccessful (PTU) – 7 • New arrests – 123 • 75 misdemeanors, 48 felonies • Filed against 23 participants • Clients with no new arrest – 60% • Active clients terminated from program – 81 • Successful Graduates (PTS), as of 11/13/08 - 43 • Active Warrant Status – 10 • Cook County Department of Corrections – 10 • Death of client - 2

  36. Schizophrenia – 18 Schizoaffective Disorder – 17 Bipolar Disorder – 28 Major Depression – 25 Dysthymia – 1 Psychotic Disorder NOS – 6 Substance Abuse Disorders – 74 Mood Disorder NOS - 6 Impulse/Explosive Disorder – 2 Post-traumatic Stress Syndrome – 64 Anti-social Personality Disorder – 0 HIV+ – 1 Developmentally Delayed – 2 Hepatitis C – 4 Pancreatitus - 1 Mental and Health Issues Affecting Clients(many participants with more than one diagnosis)

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

  38. Vignette of Male Client from Cook County Mental Health Court • Family background • History • Circumstances at time of arrest • Arrest and mental health court referral • Mental health court outcomes

  39. Questions

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