Treatment system fails; jails pick up the slack

Jails treat more people than mental health programs do

There are now 10 times as many people with mental illness in jails and prisons as there are in state mental institutions.

Though this sad statistic has come about, in part, because most states have reduced their numbers of state hospital beds, it is more about the failure of “the system” to provide effective community treatment.

Science demonstrates that most people with mental illness recover faster, are treated more humanely, and live better lives when they are provided with effective community-based treatment in their own homes. The solution is not more hospital beds.

But until our states and communities start providing adequate access to care, it is more likely in the U.S. that someone with mental illness will encounter law enforcement personnel than well-trained mental health professionals.

Sheriff Thomas Dart

Sheriff Thomas Dart

“It’s a national disgrace how we deal with this,” said Cook County (Chicago) Sheriff Thomas Dart.

Sheriff Dart is in a position to know—at any given time, about one-third of his jail’s 8,600 inmates have a mental illness. The Cook County Jail is often described as the largest mental institution in the country.

The sheriff observed that having a mental illness is not a choice, and that most of this inmate group are in jail for minor offenses related to trying to their obtain basic needs without any community support.

“How is it different than locking up diabetics? Jails were never meant to be mental health hospitals.” — Cook County Sheriff Thomas Dart

Nneka Tapia Jones, PhD

Nneka Jones Tapia, PhD

To address this new reality head-on, earlier this summer Sheriff Dart appointed Dr. Nneka Jones Tapia, a clinical psychologist, as the new warden of the Cook County Jail. She’s already begun improvements. Under her guidance, the jail has begun providing several new things:

  • When entering the jail, inmates receive a mental health assessment to ensure proper diagnosis and access to any needed psychotropic medication.
  • Inmates are enrolled in health insurance to cover their mental health care when released.
  • Staff work to arrange case management to follow them when released.

And the Sheriff’s Department is considering providing some other common-sense community treatment elements:

  • Driving former inmates to medication appointments.
  • Ensuring that former inmates can get prescription refilled on time.
  • Sending a psychotherapist for house checks on former inmates.

Of course, what is missing here is the political will, and funding*, to provide common sense services like these, which could prevent the criminalization of people with mental illness in the first place.

Effective community-based, evidence-based, treatment is proven to keep recovering people in their own homes, in their own neighborhoods, and away from criminal justice institutions.

Sheriff Dart and Dr. Jones Tapia will do what they can to prevent re-arrest and re-incarceration, but where are their partners in community treatment?

To learn more about these issues in Cook County, click here

To learn about this growing crisis in another huge county jail, Los Angeles, click here.


*Community treatment is proven to be less expensive than hospital- or jail-based institutional care. It’s also more effective and humane.