1. The Circuit Court of Cook County Honorable Timothy Evans, Chief Judge Honorable 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 ~ 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 ~ 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 ~ 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 ~ 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: Daily, ~ 200,000 people behind bars, or more than 1 in 10 inmates, suffer from: schizophrenia schizophrenia bipolar disorder bipolar disorder major depression major depression 70% of MI population are nonviolent offenders 70% of MI population are nonviolent offenders Nearly 90% of inmates with MI have a co-occurring substance abuse problem Nearly 90% of inmates with MI have a co-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 8 th Amendment – prohibits “Cruel and Unusual Punishment” 8 th Amendment – prohibits “Cruel and Unusual Punishment” 14 th Amendment – for pretrial detainees and juveniles “Due Process” 14 th 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 Most are adult criminal courts Have a separate docket dedicated to persons with mental illnesses Have a separate docket dedicated to persons with mental illnesses Divert criminal defendants from jail into treatment programs 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 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 public safety risk posed by the mentally ill offenders The difficulties associated with housing the mentally ill in local jails 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 The inadequacy of the criminal justice process in dealing with the mentally ill defendants in all matters

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

15. Unique Program Features Primary Focus: Community Case Management Primary Focus: Community Case Management Crisis Intervention Team (CIT) – Chicago Police Department Crisis Intervention Team (CIT) – Chicago Police Department Clinical Emphasis-Multidisciplinary Team Clinical Emphasis-Multidisciplinary Team Sanctions-based system that keeps the mentally ill offender (MIO) out of jail/prison and in community services 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 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 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 Cook County Criminal Justice System Leadership Leadership Chief Judge Timothy Evans Chief Judge Timothy Evans Presiding Judge Paul Biebel Presiding Judge Paul Biebel Lead Judges – Judge Jay Crane and Judge Thomas V. Gainer, Jr. Lead Judges – Judge Jay Crane and Judge Thomas V. Gainer, Jr. Adult Mental Health Probation Unit Adult Mental Health Probation Unit Cook County State’s Attorney Office Cook County State’s Attorney Office Cook County Public Defender’s 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 Cermak Health Services of Cook County- Department of Mental Health Services TASC TASC Illinois Department Human Services, Divisions of Mental Health and Alcohol and Substance Abuse Illinois Department Human Services, Divisions of Mental Health and Alcohol and Substance Abuse Chicago Police Department – Crisis Intervention Teams Chicago Police Department – Crisis Intervention Teams Community Service Providers Community Service Providers

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

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

20. Chicago Police Crisis Intervention Team Program goals: Enhance outcomes Enhance outcomes Officer safety Officer safety De-escalation De-escalation Diversion Diversion Crisis prevention Crisis prevention

21. Chicago Police Crisis Intervention Team Program goals: Identify mental health calls Identify mental health calls Quantify mental health calls Quantify mental health calls Identify best practice methods Identify best practice methods

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

23. Timeline April 5, 2004 – screening process began April 5, 2004 – screening process began May 12, 2004 – first cases admitted May 12, 2004 – first cases admitted October, 2005 – program funding: SAMHSA jail diversion grant for program expansion & increased community programming October, 2005 – program funding: SAMHSA jail diversion grant for program expansion & increased community programming May 25, 2006 – first graduation 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 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: The program individuals have: Much more extensive criminal backgrounds (compared to a 9 year review of Cook County drug court participants) 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) 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 Few, if any, community resources with adequate funding to service the level of care needed

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

26. Criminal Justice History of Program Participants at Admission

27. Program Impact Decreased criminal activity Decreased criminal activity Decreased hospitalizations Decreased hospitalizations Decreased incarceration Decreased incarceration Decreased county cost expenditures Decreased county cost expenditures Improved quality of life 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 Days in Custody Average Jail Costs

31. Cook County, Illinois Mental Health Court (MHC) Report April 4, 2004 – November 1, 2008

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

33. Current Charges (reflect multiple charges against some participants) Prostitution – 1 Prostitution – 1 Possession of a controlled substance (PCS) – 62 Possession of a controlled substance (PCS) – 62 Retail theft – 24 Retail theft – 24 Theft/labor or service – 4 Theft/labor or service – 4  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

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

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

36. Mental and Health Issues Affecting Clients (many participants with more than one diagnosis) Schizophrenia – 18 Schizophrenia – 18 Schizoaffective Disorder – 17 Schizoaffective Disorder – 17 Bipolar Disorder – 28 Bipolar Disorder – 28 Major Depression – 25 Major Depression – 25 Dysthymia – 1 Dysthymia – 1 Psychotic Disorder NOS – 6 Psychotic Disorder NOS – 6 Substance Abuse Disorders – 74 Substance Abuse Disorders – 74 Mood Disorder NOS - 6 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

37. Types of Facilities Currently in Use Residential treatment facility – 67 Residential 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) – 29 Individual housing (alone or with family) – 29 Enrolled in educational program – 3 Enrolled in educational program – 3 Enrolled in methadone/suboxone treatment - 2 Enrolled in methadone/suboxone treatment - 2

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

39. Questions