Five county inmates face delayed transfers to mental health treatment centers: What to know
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A new face is leading the Illinois Department of Human Services, a department looking to improve its servicing ability to those needing mental health treatment.
Dulce Quintero began their tenure as acting secretary of the state's largest agency on Monday, having served as assistant secretary of operations at IDHS since 2019. Among a plethora of responsibilities, the department is tasked with providing psychiatric care for those deemed mentally unfit to stand trial.
With shortages of available beds and proper staffing at mental health treatment facilities, however, many inmates have instead been seeing extended time at county jails.
State law signed by Gov. JB Pritzker in January requires the department to find beds for these inmates within 60 days of a court's placement order. If that is not achieved, IDHS must provide updates to the court every 30 days if a transfer has not been made.
Critics of the law, passed during the lame duck session, claim it's a low bar to clear for the department to prove its effort in finding beds for the unfit inmates. IDHS must prove "good faith efforts at placement and a lack of bed and placement availability," per the legislation.
For Sangamon County Sheriff Jack Campbell, the standard effectively allows these inmates to stay in county jails in perpetuity. His office originally sued IDHS and Pritzker last year after failing to find beds within the original 20-day standard.
The situation is a decades-long issue impacting Sangamon and many counties throughout the state, he said.
"The inmates remain in our jails across the state and they deteriorate because we don't have the ability to provide the level of care that state of Illinois can provide," Campbell said in an interview last week at his office.
At the Sangamon County Jail, there are currently five inmates who have been deemed unfit that have stayed beyond the 60-day standard- one spending an additional 110 days behind bars. All told, the sheriff said 31 inmates have been kept in jail after 60 days since Jan. 1, 2023.
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Providing mental health care for those awaiting transfers is a responsibility held by the county, where Campbell estimates a third of his jail population requires this help. Most attention, however, has to be focused on those deemed unfit to stand trial.
"They require extra attention," the sheriff said. "And therefore, the hours we have available, get focused on those four or five or six, and the other ones in the jail are not getting the amount they need."
While Campbell's office pleaded the governor to not sign it into law, several IDHS staffers supported the bill who saw it as a needed step when addressing a brewing mental health crisis in the state.
Moving these inmates to beds remains the priority for IDHS, department spokesperson Rachel Otwell said. Still, the legislation gives it needed additional time amid an increased number of referrals and a struggle to find mental health professionals to serve them.
Local legislators on both sides of the aisle voting against it, Otwell said in an email: "Allowing IDHS the flexibility to admit based upon a clinical assessment of the individual not only protects that individual, it also protects those who are providing their immediate care – such as jail and court personnel – as well as other justice-involved individuals."
Quintero will replace Grace Hou who is transitioning to Deputy Governor for Health and Human Services. In an email, they expressed support for Hou's work in adding 2,100 staff members in the first six months of 2023 and increases in available beds.
The Elizabeth Packard Mental Health Center, formerly known as the McFarland Mental Health Center, in Springfield has seen the hire of more than 20 nurses, which the department says has allowed to utilize all 100 of its forensic beds.
IDHS has added 141 beds to its forensic network within the last two years, including 54 so far in 2023, Otwell told The State Journal-Register.
"I look forward to continuing her efforts to open additional forensic beds and carrying on the good work that began under Secretary Hou’s leadership," Quintero said. "This includes continuing to address the forensic waitlist through a combination of expanded bedspace, expedited hiring, and utilization of intensified community placement options."
How did we get here?
When it comes to the referrals - court orders for the department to transfer an unfit inmate to a treatment facility - received by IDHS before and after the COVID-19 pandemic, the difference is night and day.
Otwell said the department received between 50 and 60 forensic referrals in a typical month before the pandemic. Now that number has reached as high as 110.
The department posits a host of factors contribute to this trend, including "limited capacity of community mental health services, long-term impacts of social isolation in the wake of the COVID-19 response and a shortage of housing resources available for individuals with behavioral health issues."
Increases in referrals during COVID-19 was only part of the struggle in finding treatment for unfit-for-trial inmates. Also at-issue was a lack of psychiatric providers- a shortage that is being felt nationwide.
"The State of Illinois can only transfer someone to a bed when it can adequately meet the individual’s treatment needs," Otwell said, where state data finds that 4.8 million Illinoisans reside in a Mental Health Professional Shortage Area.
In addition to a $140 million investment in last year's state budget, IDHS released a strategic plan that emphasizes hiring more staff and an overall expansion of community access. Quintero believes this will make operations more efficient for the department.
"By increasing our staffing and retaining those who are committed to serving people with mental illness, we will have a positive impact in not just forensics, but in all our service areas," they said.
Jim Kaitschuk, executive director of the Illinois State Sheriff's Association, however feels the plan only identifies the problem and makes little mention of providing solutions.
Both he and Campbell point to a host of mental health center closures over the years, leading to a loss of 580 beds statewide according to data from the Illinois Hospital Association. Locally, the closures of the Lincoln Developmental Center and Jacksonville Developmental Center have caused most unfit inmates to be transferred to either the Packard or the Chester Mental Health Center.
Jacksonville's center has been closed since 2012, leading to its 181 residents to be relocated and a loss of 400 state jobs. Plans for the site opened in 1851 appear to be demolition, where legislation pending in the Illinois General Assembly allocates $67.6 million for its razing and remediation.
Campbell said the state lacked foresight in closing these sites, when it should invested in keeping the doors open. At the time of JDC's closure, the administration of former Gov. Pat Quinn estimated it would need $3.3 million to cover renovation expenses.
The closures of sites like Jacksonville has placed a burden of providing care increasingly on county jails, Kaitschuk said.
"We've been talking about a mental health crisis across the board, across this country and unfortunately, you know, jails have become the de facto mental health institutes," he said. "That's not what they should be."
Cashless bail impact
Since Sept. 18, cash bail has been eliminated in Illinois. Critics of the Pretrial Fairness Act warned this would lead to an emptying of jails, although pretrial detention is still allowed if a judge deems an accused person as a threat to the community or willful flight risk.
The jail population in Sangamon County has in fact gone down so far where 259 inmates were in jail as of Wednesday. Campbell predicted this decrease and said the jail's capacity is 314 inmates, which was exceeded last year on average after dropping during the pandemic.
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"We haven't been this low since COVID hit," the sheriff said, the jail reaching as low as 200 inmates in 2020.
The lower jail population could provide for staff to be more attentive to the mental health needs of those either awaiting trial or a transfer to a treatment facility. Still, Campbell and Kaitschuk believe this drop is only temporary, suggesting that many will fail to show up for hearings and then be arrested again.
"It may be a wash in terms of where we were before the 18th (of September) and where we are in the future," said Kaitschuk.
Data from New Jersey, which eliminated cash bail in most cases, found that rates of court appearances actually increased after its 2017 implementation. Approximately 97% of those ordered before the courts did so in 2020, up from 89% three years prior.
Editor's note: This story has been updated to correct the Illinois State's Attorney Association's position on the law giving IDHS 60 days to find mental health treatment facility placement for inmates unfit to stand trial. ISSA did not file proponent or opponent testimony.
Contact Patrick Keck: 312-549-9340, pkeck@gannett.com, twitter.com/@pkeckreporter.
This article originally appeared on State Journal-Register: Moving inmates to mental health facilities responsibility for new IDHS secretary
