November 25, 2014
Local governments across the country are searching for ways to more humanely and cost-effectively treat individuals with mental illnesses who come into contact with the criminal justice system. According to a report from the Bureau of Justice Statistics from 2006 (the most recent year for which these data are available), over half of all incarcerated individuals in federal, state and local jails and prisons suffer from a mental health problem. In addition, according to the National Association of Counties (NACO), over 13 million individuals are booked into county jails each year and, of those, the majority will one day return to their communities.
According to a July 2014 estimate from Cook County Sheriff Tom Dart’s office, one-third of the 10,000 inmates in custody suffer from serious mental illnesses. In an op-ed in the Chicago Tribune, Sheriff Dart said that these individuals are often arrested for petty crimes related to untreated mental health and substance abuse issues. The growing number of individuals with mental illness being held in the Cook County Jail contributes to issues of overcrowding and drives up the costs of public safety borne by the Cook County taxpayer. Additionally, Cook County Board President Toni Preckwinkle and Cook County Health and Hospitals System CEO Dr. Jay Shannon have brought attention to issues of treating mental illness in the Jail with their own op-ed on CountyCare’s potential impact on addressing mental health needs in the County.
One county in Texas is being held up as a model for its efforts in reforming its treatment of individuals with mental illnesses who come into contact with the criminal justice system. According to 2013 estimates from the United States Census Bureau, Bexar County is the seventeeth most populous county in the nation. It includes San Antonio, the seventh largest city in the United States. Almost 15 years ago, Leon Evans, current Chief Executive Officer of the Center for Health Care Services in Bexar County and trained social worker, began an initiative he terms therapeutic justice. The program aims to integrate treatment and justice through a collaborative partnership between the courts, the criminal justice system and the behavioral health system. Evans believes, “…the public safety net is able to provide the most efficient and effective support for persons who are in crisis and/or are experiencing psychiatric and substance abuse disorders.” In addition, Evans’ model holds that for those who suffer from a mental illness, treatment in lieu of incarceration is more cost-efficient and also positively impacts recidivism.
Similar to Cook County, Bexar County has struggled with the problem of jail overcrowding and exorbitantly high public safety costs. As a result of decreasing funding available for corrections budgets and a history of class action lawsuits and impending fines because of poor conditions in the jails, Bexar County could no longer afford its previous practices. In response Evans worked with Nelson Wolff, the Bexar County Judge (a position similar to County Board President), to bring together public safety and mental health stakeholders, including the county sheriff, the San Antonio Police Department and elected county officials. According to Evans, the many stakeholders realized they could improve care and save money if they pooled their resources. The group charted out a plan to unite the jails, hospitals, courts, police and mental health department in an effort to provide more effective and humane services for those suffering mental health crises.
The findings of the collaboration suggested the county needed to provide individuals with mental illness treatment and medical services instead of sending them to jail. Their goal was to provide comprehensive care, including crisis care and community linkages and follow-up services through community partnerships. In partnership with numerous stakeholders and over many years, Evans developed a number of initiatives including the Bexar County Jail Diversion Program, a 24/7 Crisis Care Center, Crisis Intervention Training for public safety officers, and the Restoration Center, an integrated clinic providing psychiatric care, substance abuse services, transitional housing and general health care services for the homeless population.
Bexar County opened the Restoration Center in April 2008. The Center is a facility with a full array of mental and physical health services, including a 48-hour inpatient psychiatric unit, outpatient services for psychiatric and primary care, centers for drug and/or alcohol detox, a 90-day recovery program for substance abuse, housing for people with mental illnesses, and job training. More than 18,000 people pass through the Restoration Center each year, and officials say their coordinated approach has allowed the city to avoid $50 million in projected expenditures since its inception in 2008. County officials also say that the comprehensive approach has contributed to a reduction in overcrowding at the Bexar County jail.
On November 14, 2014, Leon Evans gave the keynote address on his efforts in Bexar County at Loyola Law School in Chicago for a symposium organized by the Illinois Academy of Criminology. Evans outlined the model he guided into place and said it has improved the quality of life for individuals suffering from mental illness in Bexar County and has promoted greater efficiency in the use of law enforcement, courts, emergency rooms and public dollars. If the upfront costs could be balanced with documented cost savings and improved care, the Bexar County model could be a possible model for reforms in Cook County, as it has become for other counties and cities around the nation.