How Sending the Mentally Ill to Jail Is a Cost to Us All

Failure to address mental health issues ultimately costs our society.

(Photo: Getty Images)

May 15, 2015· 5 MIN READ
Deborah L. Shelton is managing editor of The Chicago Reporter, an investigative news organization that focuses on race, poverty and income inequality.

Annie Parker remembers the day she brought her son Alex Bailey home. He wasn’t a newborn swaddled in a baby blanket; he was a frightened 12-year-old foster child with whom she’d started to bond. “You’re gonna be my mama,” she remembers him saying happily.

A few hours after he arrived, Parker was startled by a commotion in one of the bedrooms. Alex was crying and banging his head against the headboard of his bed. His behavior was disturbing, but not a surprise. As his foster-care mother, she had visited him at a suburban Chicago psychiatric facility.

Now, 20 years later, Parker, 72, continues to be flustered about the behavior of the son she adopted. Bailey has been arrested and charged 34 times as an adult, mostly for crimes like retail theft. He was locked up in Cook County, Illinois, jail in July after his latest arrest.

Parker, a home care worker, feels overwhelmed by years of trying to solve a problem no parent can fix alone: how to keep her mentally ill son from cycling in and out of jail.

On average, about 2,000 of Cook County Jail’s 9,000 detainees are living with a mental illness, making it one of America's largest psychiatric facilities. Like Bailey, many of these detainees funnel into the jail from zip codes on Chicago’s mostly black and Latino South and West sides, and the city’s majority-black south suburbs, where mental health services are scarce. They’re part of what can be described as a neighborhood-to-jail pipeline. About 70 percent of the jail population is African American. “There is an injustice inherent in our criminal justice system here,” says the jail’s executive director, Cara Smith.

This is a national crisis: It’s estimated that more than 450,000 people with a recent history of mental illness are incarcerated in jails and prisons. Nearly one-quarter of state prison inmates have suffered from a mental illness, as have about 21 percent of local jail inmates. And, according to a new Human Rights Watch report, mentally ill inmates are enduring more abuse from prison and jail staff.

Addressing mental health issues before people are incarcerated should be the solution. But it isn’t, experts say, because of a lack of services in the communities from which most of these inmates come. Chicago vividly illustrates how the national crisis is playing out. The city’s patchwork mental health safety net has been fraying for years. Now, people are falling through the holes.

Criminalizing mental illness is costly, inhumane, and counterproductive. On average, at the Cook County Jail, it costs $143 a day to incarcerate someone who is not mentally ill, but twice as much if the individual has a psychiatric condition and requires a doctor’s care, medication, and extra security.

Experts say the money used to lock people up could be better spent helping them get the mental health and other social services they need. Incarceration can also exacerbate psychiatric illness, especially when detainees are placed in segregation.

Smith sees people like Bailey circling through the revolving doors of the county’s criminal justice system every day. Many of them have committed so-called crimes of survival. “These are cases people should care about,” she says, “because I don’t know how being in jail is a good answer for this type of crime.”

From Foster Care to Jail

Bailey’s path to incarceration began in foster care. For years, he bounced between several families. Finally, in June 1995, he moved in with Parker. He’d been diagnosed with depression and attention deficit hyperactivity disorder. (Bailey could not be reached for comment.)

According to school records provided by Parker, Bailey was categorized as being TMH, shorthand for trainable mentally handicapped. He attended classes for students with emotional and behavioral disorders and severe cognitive delays.

“Alex is functioning at an overall cognitive level commensurate with a 5½- to 6-year-old youngster,” read school records dated Aug. 8, 1995, when Alex was 12. “He appears emotionally very fragile.”

The documents paint a gloomy picture of his psychological state: “He hears voices. He cried during reading because he can’t read.”

About four years ago, Parker toted his records to court in a worn, red three-ring binder to show attorneys and judges documentation of his troubled history. But she says no one seemed interested. “He’s persistent on trying to do things, but he’ll be doing the wrong things. He’s not a dangerous person. He’s a sweetheart,” she says, throwing up her hands in frustration. “He needs help, and I can’t seem to get it through them people’s heads that that’s what he needs.”

The Limits of Treatment Behind Bars

On one recent morning, loud voices echo against grimy walls in the intake section of Cook County Jail. New arrivals wait in caged holding areas or on long, worn benches.

Elli Petacque Montgomery, a licensed social worker and deputy director of mental health policy and advocacy at the sheriff’s office, oversees the intake process. Before being sent to bond court, each arrestee is briefly interviewed to determine if mental illness may have played a role.

By 11 a.m., 36 men have been processed, including three sitting on a nearby bench. One is a fragile, elderly black man with schizophrenia and bipolar disorder who told Montgomery he had run out of one of his antipsychotic medications. “When they can’t get medication, they self-medicate [with alcohol and drugs] to drown out the voices,” Montgomery says. She turns toward the bench and nods. “That’s someone I have some concern about.”

It costs money to get someone well, Montgomery says. “You can’t do therapy in jail. You can’t do true intensive treatment in jail. We do pretty good, but we don’t give them the treatment they really need.”

Closures Worsen Problem

In Cook County, vast swaths of the South and West sides and south suburbs are considered “mental health deserts.” These are communities where unemployment, discrimination, and poor education cluster and ultimately lead to poor mental health, says Ruth Shim, a psychiatrist in New York and an expert on mental health disparities. “Things we consider commonplace in our communities—like violence and crime—are really damaging to our mental health,” Shim says. “We take that for granted, but people act out. Instead of addressing mental health problems, we put people in jail.”

Mental health and social service agencies—private and public—are threatened. Proposed cuts in next year’s Illinois state budget raise even more uncertainty about services. Chicago Mayor Rahm Emanuel was criticized when the city closed six mental health clinics in 2012. Officials reported an increase in detainees after the closures. Chicago’s six mental health clinics have a patient caseload of nearly 1,000. Currently, there’s only one full-time psychiatrist and one part-time psychiatrist. A temporary psychiatrist also works part time.

Every day, 30 people who have been diagnosed with mental illness are discharged from Cook County Jail. To help reduce recidivism and improve community safety, Chicago plans to launch an initiative to link every citizen released from the jail who needs mental health treatment to a community provider.

“To make the strides we need to make, we’re talking about huge shifts in the way we do things,” Shim says. “But providing people with serious mental illnesses and substance-use disorders early access to mental health services in their communities instead of in jails and prisons is a start.”

“I Wanna Be Free”

Annie Parker's son has faced incarceration, and mental illness.
(Photo: Grace Donnelly)

Bailey received counseling at a hospital when he was a minor. But Parker says when he got older and wasn’t in the foster care system, it was harder to access services.

Bailey was arrested in April 2014 after a security guard observed him leaving a Target with nine bottles of Patrón tequila, worth $191.61, that he hadn’t purchased. He was found guilty and received credit for 182 days of time served. But after he was transported to the prison and processed, he was released, because his sentence did not exceed the time he had already spent behind bars. In July, he stole liquor from a supermarket and was arrested again.

“You have to really wonder how, under anybody’s analysis, jail is a good idea for people suffering from mental illness and committing crimes for which there is no real identifiable victim,” says Smith.

During a mental health screening conducted in May 2010, Bailey reported a 2003 psychiatric hospitalization and being prescribed medication for depression and anxiety. He also reported that he participated in a hospital outpatient program for eight months but said he didn’t know the name of his doctor or his medications.

In 2010, Bailey tried to hang himself, the first of two suicide attempts in jail. When correctional officers stopped his second attempt last year, he told them: “I wanna die. I wanna be free.”

Bailey’s problems have worn down his mother, who says she cannot afford more collect calls from the jail or trips to court. She stopped visiting him in jail. On March 23, Bailey was sentenced to five years in prison. Yet, Parker remains devoted to the young man she bonded with when he was a troubled boy in need of a stable home. When he gets out of prison, she says he is welcome to move back into her home. And she will try to help him. “He doesn’t need to be locked up,” Parker says. “He needs to be someplace where he can get help.”

This is an edited version of a story produced by The Chicago Reporter, an investigative news organization focused on race, poverty, and income inequality.