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Ill. jail thinks outside the box for treatment of inmates with mental illness

Correctional staff at the Livingston County Jail found the tools needed for the job had expanded to include crayons and children’s books

Livingston County Sheriff

Livingston County Sheriff

Drew Zimmerman
The Pantagraph, Bloomington, Ill.

BLOOMINGTON, Ill. — At the Livingston County Jail recently, correctional staff found the tools needed for the job had expanded to include crayons and children’s books.

An inmate detained there was operating with a child’s mental capacity, said Sheriff Ryan Bohm, but the jail’s mental health services are limited. Employees had to think outside of the box.

Livingston County Jail Superintendent Lisa Draper had to consult the person’s counselor for information about appropriate coping mechanisms. Staff brought in coloring books and donated materials that were at his reading level to provide some degree of comfort.

"(He) shouldn’t have been in our facility; he needed to be in a hospital,” Bohm said. “Unfortunately, we just don’t have the resources.”

The situation represents a symptom of a larger problem law enforcement and social service leaders have experienced for decades: ensuring detained inmates have access to timely and adequate behavioral health services despite a dwindling number of beds in state-operated mental health centers and a critical shortage of workers to staff the ones that remain.

Earlier this year, Lee Enterprises spoke with officials from multiple counties who said they were waiting more than 100 days to transfer inmates mentally unfit to stand trial or declared not guilty by reason of insanity to an Illinois Department of Human Services mental health facility.

Starting in the early 1960s, state law required inmates unfit to stand trial to be transferred to a state-operated mental health facility within 20 days of a court order for inpatient treatment. The deadline was extended to 60 days after inmate transfers were delayed at the height of the COVID-19 pandemic, which prompted a lawsuit last year from sheriffs of six counties, including McLean .

The agency is required to evaluate the inmate and determine the most appropriate mental health facility for them within the first 20 days of a court order being issued. But so long as the department is demonstrating “good faith efforts” to secure a bed, it only needs to update the court of availability every 30 days.

Lawmakers and agency leaders acknowledge the gulf between the number of people in need of treatment and resources available to provide it. Last month, the Illinois Department of Human Services released a strategic plan identifying steps to ensure that each state inpatient mental health facility has sufficient staff and methods to increase access to community-based mental health services.

The General Assembly received the report more than three months after the May 27 deadline set last year by state statute. IDHS officials attributed the delay to the project being larger in scope than originally anticipated.

“IDHS was required to gather and synthesize data, conduct extensive analysis and draw meaningful conclusions,” said Rachel Otwell, the department’s director of communications. “This comprehensive approach towards identifying effective options for corrective action took additional time to complete.”

The 34-page report lays out four priorities: hire and retain more staff, expand community access to care, build out data infrastructure to better manage capacity in the existing facilities, and define and measure evidence-based treatment phases — including an estimated timeline that could be communicated to families and used to predict future capacity.

But some law enforcement leaders are questioning the effectiveness of the plan, including one who helped craft it.

Jim Kaitschuk, executive director of the Illinois Sheriffs’ Association, said he doesn’t see any specifics on how those goals of increased staffing and community access will be achieved in the report.

“These are all things to me that they’d already previously enumerated in reports and discussions,” said Kaitschuk, who was part of the Forensic Work Group that includes law enforcement leaders, attorneys, judges and advocates collaborating with IDHS on the subject. “The question really is how are you going to solve those, and I don’t see solutions in here.”

Asked about that characterization, Otwell said the report identified barriers to treatment, set benchmarks and conducted periodic assessments that would speed up restoration efforts and move long-term patients from inpatient care to outpatient services. Short-term solutions to staffing may include hiring outside contractors.

“These strategies and others are already being implemented and are expected to reduce the number of days that defendants remain in the care of the Department — thereby increasing capacity and reducing the wait time to admission,” Otwell wrote.

Hiring staff

Sangamon County Sheriff Jack Campbell said he was in contact with an IDHS representative about the strategic plan during the Illinois Sheriffs’ Association’s summer training conference in September.

And although he felt the strategic plan would be effective if fully implemented, Campbell said the time it took to draft the report could have been used to find immediate relief for county jails.

“I suggested to (the representative) since DHS didn’t have enough beds, they could send doctors to our jails,” Campbell said in an email to the Pantagraph. “I also suggested they could reimburse monetary costs to the jails to find their own mental health care providers. Neither were provided as of (Oct. 25).”

Over the years, the state has closed several mental health centers, including Rockford’s H. Douglas Singer Mental Health Center on Oct. 31, 2012; the Tinley Park Mental Health Center on July 2, 2012; Peoria’s George A. Zeller Mental Health Center on Aug. 30, 2002; and Decatur’s Adolf Meyer Mental Health Center in 1995.

There are seven state-operated facilities that accept inmates unfit to stand trial or declared not guilty by reason of insanity: Alton Mental Health Center, Chester Mental Health Center, Chicago-Read Mental Health Center, Choate Mental Health and Development Center, Elgin Mental Health Center, Madden Mental Health Center and McFarland Mental Health Center, which recently was renamed the Packard Mental Health Center.

Earlier this year, reports of patient abuse and misconduct at the Choate facility in Anna — highlighted by the work of Lee Enterprises’ Public Service Journalism Team, Capitol News Illinois and ProPublica — prompted Gov. J.B. Pritzker to announce that the facility would downsize.

Currently, the agency has 889 inpatient beds available. The state-operated psychiatric hospitals have a roughly 12% staff vacancy rate, contributing to the problem. Although the exact number of vacant positions varies between hospitals, the department’s Division of Mental Health had around 275 vacancies across its hospitals as of Oct. 19 .

To fill positions in the short term, IDHS suggested that it may turn to outside contractors. It would then work to convert contracted staff into full-time positions and build a hiring and training pipeline.

Doing so, the agency said, would require working with the state’s Department of Central Management Services and unions to “normalize compensation and shorten hiring timelines.”

Otwell said they have implemented expedited hiring procedures that have led to 2,100 hires in 2023 alone.

“This includes the medical doctors, nurses, and social workers that IDHS relies on to provide restoration care and treatment,” she wrote. “Although full-time hires are preferred over contract staff, given the emergent needs of the Department, as well as the need to provide a safe environment for the people entrusted to its care, IDHS has been required to turn to contractors in some cases to maintain necessary staffing levels.”

Inmate wait times

Previous reporting from Lee Enterprises showed that several county jails in the region were holding inmates deemed unfit to stand trial or not guilty by reason of insanity to stand trial for more than 100 days.

As of Oct. 19, 199 inmates were waiting for beds at DHS and another 80 were waiting to be evaluated to determine whether inpatient admission is necessary, according to IDHS.

McLean County Sheriff Matt Lane said the department had notified sheriffs across the state that they are addressing wait times. However, he is not sure if there will be a solution any time soon.

“As soon as one (bed) opens up, there’s probably three more to take that person’s place,” Lane said.

In May, Lane said one of his jail’s inmates had been waiting since Nov. 1 — more than six months — to be transferred to a DHS inpatient facility. This month, the longest wait was about four months and counting.

Campbell, the Sangamon County sheriff, said last week that the county was holding 14 inmates declared unfit to stand trial. Four have been waiting more than 60 days to be transferred to an IDHS facility.

Another eight inmates are awaiting fitness hearings, he added.

Draper, the Livingston County superintendent, said the jail is holding three or four inmates unfit to stand trial or found not guilty by reason of insanity. One inmate has been waiting since June for a bed to open up at a DHS inpatient facility.

IDHS proposed having a liaison among inmates, jails, courts and community providers to guide support and advocate for consumers undergoing competency evaluation, competency restoration and community reintegration.

Community access

The strategic plan proposed to increase access to funding so community partners can develop and deploy new services and to reduce the friction local providers may have when working with the state’s Division of Mental Health .

IDHS officials said the fiscal 2024 budget included $22 million to support “forensic response.” The new funding supports additional staff costs associated with the increase in forensic bed capacity.

It also proposed a team of community mental health liaisons that can provide one-on-one support and training to help community agencies with court and grant reporting, statutory obligations and other challenges.

A small team of state-certified trainers could also create tailored training sessions for a county’s community providers, law enforcement, judges and attorneys.

In Livingston County, the jail has a partnership with the Institute for Human Resources in Pontiac, which offers substance abuse counseling and mental health resources for inmates once they’ve been released.

Inmates who are declared by a judge to be unfit to stand trial, however, must be detained in a secure facility, which puts the burden on the jails to hold the individuals until they are transferred to an IDHS facility.

Although many Illinois county jails are not equipped to treat inmates with mental health problems, it is possible for those who receive behavioral health services while in custody to be declared competent to stand trial without transferring to an inpatient facility.

This has happened for 11 inmates detained over the past three years in McLean County, said Jackie Mathias, director of inmate services and behavioral health for the McLean County Jail. Another six inmates declared not guilty by reason of insanity were released to community treatment without a transfer as a result of the jail’s mental health services.

Mathias attributed these successes to the opening of the jail’s special needs housing unit for male inmates in 2019.

This 16-unit housing unit isn’t solely for those found unfit to stand trial or not guilty by reason of insanity. Instead, this unit is reserved for any of the jail’s most vulnerable population.

“Being in that housing unit allowed us to expand counseling and direct contact with our mental health professionals for those individuals on a more regular basis,” she added.

Once an official determination on the inmate’s mental fitness is made, Mathias said an IDHS psychologist assigned to the county sets up a time to interview that inmate and determine the appropriate hospital referral.

If the psychologist feels the inmate is close to meeting the legal criteria for fitness, Mathias said they may contact her for a follow-up visit to reevaluate the inmate’s status.

“We also stay in regular communication about our persons on the waitlist and where they are with their mental health symptoms and treatment,” Mathias said. If a defendant has shown improvement over time, Mathias said she would ask the psychologist to see the person again and notify the jail if he or she may be ready to stand trial.

However, a judge makes the final decision — based on IDHS recommendations — about whether an inmate is competent to stand trial or, in the case of those not guilty by reason of insanity, ready for referral to outpatient treatment.

Kaitschuk said members of the Forensic Work Group have been talking for 10 months about potential pilot programs for small jails that aren’t equipped to have mental health services, but nothing has been rolled out yet.

“The last thing we want is for people to continue to deteriorate in terms of the challenges with mental health and end up in our custody because they committed a crime as a result of all those things and not getting timely access to services,” Kaitschuk said.

He added that there should be a more comprehensive and holistic approach to community accessibility, especially for smaller regions that may be two to three hours away from mental health treatment options.

Next steps

IDHS intends to kickstart the plan’s implementation by creating a communication network with representatives of the state’s mental health centers, community service providers and judicial and correctional staff.

The agency also will work with Central Management Services, human resource departments and unions on employee engagement strategies.

But IDHS isn’t the only state agency working to ensure inmates unfit to stand trial are referred to mental health services as quickly as possible.

The Administrative Office of Illinois Courts earned a $50,000 grant in December to evaluate the best legal practices regarding competency of inmates to stand trial.

The money will allow the Illinois Supreme Court , in collaboration with the National Center for State Courts , to improve the court system’s response to individuals with serious mental illness.

Scott Block , statewide behavioral health administrator for the Illinois Supreme Court , said there’s has been a nationwide effort to reform the legal process of determining an inmate’s competency to stand trial.

Over the last year, Block said those grants money has been used to contract with the National Center for State Courts to develop a list of concrete and practical actions the courts can take. These recommendations are expected to be released by the end of the year.

“Really, the consensus is that there is no single panacea to alleviate pressure,” Block said. “There has to be a full continuum of resources and strategies.”

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