Institutionalized: Mental Health Behind Bars


There is a paucity of mental health services in the community. Are you worried? A little bit, yeah. There’s really no system that’s really looking out for them. We’re just leaving them to fend for themselves. Today, man, I am a better man. I am getting better. I just can’t think to myself that a thoughtful society would agree this is how we should treat people. We’re here at Cook County Jail in Chicago, which is the largest single-site jail facility in America. Right now it houses 9000 inmates, and it’s estimated that 30% of them have mental illnesses. That makes this what’s thought to be the largest mental health care provider in America right now. CORRECTIONAL OFFICER: Fellas, when we go around this corner, you’re going to go on the left hand wall. Keep and your hands behind your backs. So right now we’re headed to the morning intake area that’s where everyone who was arrested last night is brought in and where their mental health is assessed. It’s the first point of contact in this sort of mental health treatment process that happens in Cook County Jail. *unintelligible speaking* Over 100 arrestees were shuffling through lines, getting checked for weapons and drugs, and moving in and out of various bullpens. ELLI: And what’s your charge today? Possession? ARRESTEE: Yeah. ELLI:Okay, anything else? ARRESTEE: No. Elli Montgomery is a social worker who heads up the sheriff’s pre-bond initiative. ELLI: My job is to help you, okay? Before you ever started using, was there depression or anxiety? Do you suffer from that? She screens each arrestee that passes through the intake center before they see a judge, a process that is unique to Cook County Jail. ELLI: Have you ever tried to hurt yourself? Okay, how many times? Three attempts. Okay, you think a lot about ending your life and death? Okay. And then who helps you outside with your meds? Just in here? See this? This is a suicide hotline number. If you ever feel like hurting yourself. You gotta get off the heroin. You’re self medicating. Right. Do you understand you’re self medicating for the depression and the voices with the heroin? Do you have violent charges or what? ELLI: You think that nobody likes you and that’s why? Sweetie, the judge doesn’t make the decision based on whether they like you. They look at the charges. ELLI: Okay, that’s not going to happen. ELLI: Sarge! ELLI: Okay. Come on. Can you explain to us what just happened with that young man? Okay, so he is actively suicidal, he is bipolar. He is very, very worried about his case. But more than anything he’s not oriented to time. So some concerns is, he’s got a plan, he’s had several suicide attempts before. HOST: So what would have happened to that young man had he not been screened here right now? He would probably have a suicide attempt. Because of the bipolar disorder and the illness, his thinking is a little off. He’s putting the pieces together right now, and the more he puts that together, the more anxiety and fear he has, the more likely that he’s gonna… he’s really gonna do something. CORRECTIONAL OFFICER: Line up, gentlemen! As morning intake came to a close, we were told by Elli and her team that 45% of the individuals that they screened that day showed clear signs of mental illness. CROWD CHANTING: Hey Rod, you should know, closing clinics has got to go! Illinois was one of the top ten states to cut mental health funding between 2009 and 2012 with a 32% cut. It was an attempt to help fix the state’s fiscal crisis. These budget cuts hit Illinois’ already beleaguered mental health system hard. The irony of this approach is that it actually cost the state more money. During this time, the state saw a $131 million increase in spending on hospitalizations and institutionalizations. That was the beginning of what some refer to as an all-out public health crisis. Amid rampant budget cuts in 2012, Rahm Emanuel closed 6 out of 12 public mental health facilities in Chicago, sparking outrage across communities and a flurry of media coverage. HOST: Thank you. We went to meet Cook County Sheriff Tom Dart, who runs the jail and has frequently spoken out for the mentally ill population he houses and treats in his facility. This thing is massive. It is a massive complex. Hey, Sheriff Dart. How are you doing? Very nice to meet you. DART: My pleasure, nice to meet you! We headed to Division 2, one of the tiers designed and operated especially for inmates who struggle with mental illness. DART: I’ll check on your stuff today. DART: I mean, I don’t know if I can do anything before the next court date. DART: But this is complete bullshit and we all know it. Sherriff Dart visits these facilities frequently and is familiar with the inmates and their cases. DART: Do you have any violence in your background? PRAVEON: No violence at all. DART: None at all? PRAVEON: None at all. DART: Where have you been living before you got arrested? PRAVEON: On a train. DART: On a train? What are you accused of stealing? PRAVEON: One pair of jeans. HOST: You were just telling the sheriff that you’ve been here for two months over one pair of stolen jeans Yes sir. And you were homeless before that living on the train? Yes, sir. And what are they telling you in terms of your trial, of what’s going to happen? Anything of that nature? They’re not telling me anything at all. I just been waiting, like, for three months. And nothing, no information? No information at all. They have been kind of helping me with like, my mental health issues because I’m being medicated for bipolar and depression. HOST: Were you receiving any treatment while you were outside the system? No. I was like, using drugs instead of taking my medication. Using drugs to help medicate yourself? Yes. DART: $150,000 bond was set on him. That’s what he’s got? So that gentleman we just spoke to for stealing a pair of jeans has $150,000 bond set on him. That’s why he’s here. In one of the mental health dorm units, a group therapy session was taking place. These are where we house our low level mentally ill offenders. These units are almost always filled. That’s one of the points I always try to explain to people. With these national crime trends all going down around the country and the same here we have been able to close down a couple of our divisions The only place we’ve ever been overcrowded in the last seven years has been our acute mentally ill floor. That’s overcrowded almost every day. And what are we watching right here right now? DART: This is a program that we contract out with a group called Westcare. It’s a program where they sit and they talk with the individual who is really trying to go through a whole litany of things here. They’ll say OK, give me the philosophy and the theory of why this person should be in here. All I keep coming back with is “Well, they’ve committed a crime.” I say well, when they’re showing up at my door within hours of having committed an offense and they are accutely mentally ill, how can you show the intent? Take care. Hi, guys. Hi, guys. They’re there for just however long it takes. And then they’re shot back out into the street with no support mechanisms and they come right back in and all the numbers show that. So they come back in and they do it over and over and over again. And it costs outrageous amounts of money. It’s estimated that the cost of incarcerating an individual runs around $150 a day. Sheriff Dart told us that when you’re dealing with somebody with serious mental illness the cost could be three times that number. Experts estimate that to treat the same individual outside of a correctional facility is just a fraction of this cost, about $10,000 annually. That’s $27 per day. So how is this financially sustainable? How is it make sense? It doesn’t. It’s horrible. I mean honest to God. I can’t think to myself that a thoughtful society would agree this is how we should treat people. One of the initiatives that the Sheriff has implemented is the Mental Health Transition Center where inmates are offered therapuetic treatment services as they prepare to reenter their communities. JANELLE: And guys, this is the importance of understanding the cycle. So how do we break this cycle? How do we understand our triggers and our cues? So let’s look at the events in a situation. What are those precipitating factors that make us angry? That pisses us off? JANELLE: George, can you go through your cycle with us? GEORGE: Yeah. I know like mental health is really messed up. Something that really angers me is when I see other people better off than I am. That just like, pisses me off, you know. And the feelings I feel is, um, anger, resentment, sadness, bitterness, all mixed into one. And like, I know I have a mental illness cause that’s not normal, you know. That’s not a normal way to think. You should be happy for your next man, you know. But with my substance abuse and my mental illness I don’t know how to deal with it so I just resort to drinking and drugging. I think the best thing for me is to be like in the community getting help. That would change my whole future. JANELLE: Jose, can you walk us through your cycle of anger? JOSE: My cycle of anger is like, when people tell me things good or bad I get confused. What are they telling me? I easily get real mad right away. I snap out and that’s what got me starting to abuse alcohol, cocaine until worse lately heroin. It’s just like I was always a walking suicidal man, confused man, and a destructive man. You know, so that’s what I’m thinking. SAMUEL: Jose, I can understand because we feel comfortable being uncomfortable. That’s how I was for a long time. In some form, I used to think I was trying to commit suicide in some way. just on a small scale. I just bang some narcotics. It’s a form of suicide because I’m not knowing what I’m about to put in my body. It doesn’t matter to me sometimes. You guys mention key things: resentment, abandonment, trust issues. How do we let that go? How do we deal with that finally and move forward? Who do we say it to? And what I want you guys to do is come up and do an exercise where you come to this board here and pretend it’s a mirror and whoever hurt you in the past in your life, whether it’s your parents, you’ve been bullied throughout school – let go of that anger. let go of that resentment. And tell that person what it is that you feel. So who would like to be the brave one and come up and try this exercise? Okay, come up here and you can stand in front of this. So guys this is our mirror and what I have for you is different feelings and emotions. So talk to that person. SAMUEL: I want my father. Yeah Dad, I’m very angry at you because I feel like you abandoned me. You wasn’t there for me. When I tried to see you, you wouldn’t try to see me. And I was your only kid. I didn’t see you for seven years. When I finally saw you at 13, it was like, man, I had so much resentment and as I got older I became just like you. I abandoned everything I did. Everything that I loved, I abandoned it. You know, I felt so much resentment. And for the next 25-30 years, I just refused to even see you. So when you finally passed away, you know, just seeing you in the hospital, it’s like you was trying to make amends to not being there with me. And you tried to actually get out the bed. You tried to embrace me, but I’m just so cold I couldn’t even embrace you. Because I had so much going on in me. At that time man I couldn’t even express it. Two months later, you passed. Now, I can’t even explain these things to you man, because you’re gone. You know, and all the hurt that I did to other people, I believe it was a direct result from all the stuff that I didn’t get out of you. And then to top all that off, when they called me and said that you had passed, they told me I had all the rights to pull the plug on you. You had given that right to me. How can you give that right to me? I ain’t been no son. These are things I wanted to tell you, man. And I’m just, you know, I forgive you. I know you probably wasn’t the best dad, but I forgive you, man. So today I am a better man. I’m getting better. I realize I don’t have no resentments. I love you. I’m not disappointed in you because you know, you did what you could. I love you, Dad. *applause* INMATES: Starting right here, right now, we’re choosing to make the necessary changes in our lives to be successful productive members of our community. We would no longer be what others think of us or what we think about ourselves. We are a community of men aspiring for a new way of life. Change is our only option and this change must be forever. *clapping* Why were you seeing so many mentally ill inmates coming in here? DR. NNEKA JONES: You know, unfortunately, there is a paucity of mental health services in the community. It’s much easier for many of these individuals to see the local drug dealer on the corner, waiting for them, than it is to take two trains and a bus to the north side of Chicago to see a psychiatrist for five minutes. What actually happened here in 2012 with the mental health care system and how has that affected this jail? In 2012, the city of Chicago, which had run 12 mental health clinics spread throughout the city decided to cut that in half and make that six. There was no rhyme or reason. There was no discussion. There was no plan put together. They just cut it and as a result of it, we found that countless detainees here waiting on their trial who would come to me and tell me over and over again “You know, where am I going to go? What am I going to do? That was my clinic. I don’t know what to do.” You know, due to budget cuts and closures of mental health clinics here in the city of Chicago, many of them don’t receive psychiatric services. And just being able to navigate finding them is often too difficult. The state of mental health care in Chicago has become a hot button issue and was discussed during the March 26th mayoral debate. A huge percentage, some days more than half of the people arrested by the Chicago Police Department show up at the Cook County Jail and are diagnosed The initial diagnosis is that they have a mental illness. I became mayor. Our mental health entities here in the city of Chicago had lost 90% of the state funding because of how badly they were managed. Many of the clinics Mayor Emmanuel closed were situated in vulnerable urban communities that have been generally under-served. N’Dana Carter is an activist who represents these communities. She is a strong supporter of Rom Emmanuel’s opponent, Jesus Chuey Garcia and a spokesperson for the mental health movement. We met up with her on Chicago’s Southside to pay a visit to some of the shut down facilities. Can you just tell us what are we looking at right here? That is the old Woodlawn Clinic. Where you see it says, Woodlawn Adult Health Center, it was also the Woodlawn Mental Health Clinic It was one of the oldest. It was over 20 years old. It had won national awards for excellence in helping stabilize families and communities. So what’s there right now? Right now there is, uh, one of the private providers was given that space by the City of Chicago. They are able to treat 50 people but no one knows who those 50 people are that they are treating. The problem here is that the clinic beforehand had treated over 300 people. N’Dana took us to the site of another closed down facility on Ashland, in a nearby Hispanic community. N’DANA: There you go. Yeah sure. We’re talking about these mental health clinics. They never came back right? SECURITY GUARD: No. Where are people going? Do you know? SECURITY GUARD: Oh, I don’t know. We got a sign on the window. I don’t know if it’s open. This was one here. N’DANA: Yeah, I know. SECURITY GUARD: Can you see the sign on the window? N’DANA: Yeah. They don’t even have psychiatrists at Greater Lawn. Greater Lawn has no psychiatrists at all. So Greater Lawn is losing patients. They have no psychiatrists at all. So this was shut down April 9, 2012 It was part of the 6 clinics that were shut. This place has no psychiatrists. And the place that was here had psychiatrists? It had psychiatrists, had therapists, it had a nurse. These are all the things that you need when dealing with mental health. Just as with the African-American community, there is a stigma in the Latin community, in the Hispanic community. Mental illness is not an accepted diagnosis. So if you have a chance to go to a place like this, that is walking distance, you go. How far away is the new…? We’re 1600, this is 1600 West That is 4100 West. So we’re talking bus rides. We’re talking.. Yes. It’s about three bus rides Behind me is the Tinley Park Mental Health Center and at one point these buildings housed and treated up to 2000 mentally ill individuals. Right now it’s abandoned. It was shut down by the governor to a huge uproar. And that’s sort of emblematic of the problem that we’re seeing in Chicago and actually, across this country in general, where these facilities are being shut down and there is no real safety net provided for the people that were housed and treated here. Psychiatric hospitals, like Tinley Park, made their debut in the United States in the late 18th century, and were initially intended to provide therapeutic care. Quite the opposite of the reputation they earned for themselves by the mid-twentieth century. Lack of funding and competent staffing and ineffective treatment led to abusive warehouse-like environments. By the 1950’s, horrific treatment of patients in these facilities became standard practice and they began de-institutionalizing across the country. These facilitites were closed under the pretense that individuals who need care would be able to access community based treatment and live in their homes, which remains widely accepted as the most therapeutic approach. In many cases, the safety net was not adequately delivered, a trend that persists to this day. Since the 1950s, there has been a 95% decrease in psychiatric hospital bed capacity around the nation. And Chicago has one of the lowest psychiatric bed capacities per capita out of any urban area in the country. With mental healthcare infrastructure in Chicago hanging on by a thread, and the county jail overloaded, Illinois Governor, Bruce Rauner, is proposing another 87 million dollars in cuts to mental health spending for the 2016 budget. What comes out on the other end of these policies and budget cuts is under-served urban communities, where thousands of people with serious mental illnesses are out on the street untreated and unmedicated. And the criminal justice system ultimately ends up having to pick up the pieces. Division 8 is the last tier we visited during our time at the jail. It’s a huge facility, designated for inmates with severe mental illnesses, such as bipolar disorder and schizophrenia. The inmates are grouped into dorm-like settings, where they play cards and board games, and sleep on small cots. We spoke to two of the inmates housed here. DON: I’m here because I’m bipolar and antipsychotic CHARLES: I am diagnosed with ADHD, schizoaffective, and anxiety disorder. Were you getting help when you were outside? When you were in Chicago? DON: The only place I know to get my meds is Aunt Martha’s. For me to get to Aunt Martha’s from my town to Hazelcrest is five to six bus transfers and a whole day. So what’s it like for you when you’re not on your medication when you’re having an episode? What goes through your head? CHARLES: I usually get real manic and real anxious. Like I get real fidgety and nervous. and I’m actually kind of violent usually. Like if I get into an altercation with somebody, it will usually turn out to be violent. For example, my criminal damage to property residential burglary. At the time, I was taking schizophrenia medication, bipolar anxiety and depression. What happened was me and my fiancee at the time had gotten into an altercation and she was staying with a friend of hers. Due to me not having my medication to have a sound mind, I went and I busted out all the windows on his house. I ended up breaking into his house. I blacked out. I don’t remember what all else happened. But I remember I woke up in the city police station. They’re telling me I am charged with burglary and criminal damage to property and I’m facing four to fifteen years. And what’s it like for you when you are off your meds? It’s horrible. But that right now ain’t my main concern. My main concern is where I’m going to live. What am I going to eat? Meds are one thing that’s not even… First I got to put a roof over my head. Are you worried? A little bit, yeah. Because I know I have three felonies already. I’ve been to prison three times. Every time was because I was off my medication and I ended up self medicating. Once you get in the system, it’s almost impossible to get out. [muffled speaking on intercom] You know, you hear what these guys have to say and it speaks for itself. You know, they need treatment. They need help and they’ve sought it out. Sometimes they can get it and sometimes they can’t. And every time they come back in it’s another job lost, it’s a home lost. They’re left with nothing. There’s really no system that’s really looking out for them. We’re just leaving them to fend for themselves. The folks here are real people. Their lives matter. They’re objectively mentally ill though. And yet, you hear these stories from them and yet we’re supposed to treat them like a number and we’re supposed to wait? I often tell people, we have about 200 some people leave this jail everyday. What am I supposed to do as they’re leaving? Say “hey you wait, we’re gonna get around to a study and we’re gonna get this thing taken care of in the next 20 or 30 years. You just hang in there okay?”