The Cook County Jail in Chicago, often described as the largest mental health facility in the nation, sits at the epicenter of a crisis that our criminal justice system has yet to solve: the intersection of mental health and incarceration. A staggering number of individuals within the system suffer from untreated mental health issues.

Cook County Sheriff Tom Dart estimates that around 30-40% of the Cook County Jail population suffers from some sort of mental illness. Many of these individuals have cycled through the system before, and typically find themselves re-arrested for minor, non-violent offenses. Their behavior, which is typically rooted in untreated mental health issues, is criminalized rather than remedied. Jails, by design, are institutions of punishment, not treatment.

Cook County’s initiative, implemented in the early 2010’s, to treat mental illness in jail is a significant reform. Sheriff Dart addressed the issue by establishing the Mental Health Transition Center, providing therapy, counseling, and medication. Responding to inmate’s mental health problems might be the best that the Jail itself can offer, but preventative measures well before criminal legal entanglement can target the root causes of mental health problems and criminality. A preventative approach includes increasing investments in community-based mental health services, implementing early intervention initiatives, and within the justice system, expanding both diversion programs and post-release support.

States with more funding for community mental health programs report lower incarceration rates for individuals with mental illness. A study conducted in California showed that every $1 spent on community mental health services saves around $6 through reduced police interventions, emergency room visits, and jail time. Wisconsin saw a 10% drop in arrests among participants in its crisis intervention and community mental health programs. Another example comes from San Antonio’s Restoration Center, founded in 2008, which provides detox services and short-term mental health treatment, complemented with long-term care referrals. The jail population in San Antonio has decreased by 20%, saving taxpayers over $10 million annually.

Adult-focused intervention programs are vital, but insufficient. Identifying and treating mental health issues during adolescence is critical for preventing later run-ins with law enforcement. Individuals with high Adverse Childhood Experiences (ACE), as encapsulated in what are known as ACE scores, are significantly more likely to develop mental health issues and engage in criminal behavior. Studies also show that early interventions, such as family therapy, can reduce the impact of ACEs by up to 50%. Unfortunately, most US schools have too few counselors for their student bodies, leaving many children without the support they need to address incipient mental health concerns. The benefits of early interventions have been demonstrated for decades. In 1995, to address the increasing number of children placed in psychiatric hospitals, an initiative called “Wraparound Milwaukee” was implemented. This program was school-based, providing family counseling, therapy, and case management. This comprehensive initiative has been associated with a host of good outcomes, including increased school attendance and lower juvenile recidivism.

Although both adult and childhood community intervention programs can play a significant role in reducing the number of mentally ill individuals who commit crimes, it is critical to expand diversion programs to ensure that the individuals who do end up in trouble with law enforcement are directed toward treatment options rather than incarceration. Crisis Intervention Teams (CIT) can train officers to handle mental health crises, leading to fewer arrests. CIT officers in Memphis, Tennessee diverted 75% of mental health-related calls to treatment centers instead of jail. Also, pre-booking diversion programs, such as the one implemented in the early 2000s in Miami-Dade County’s Mental Health Project, work to divert non-violent offenders into treatment, reducing arrests by 40% and saving over $12 million annually. It is also important to keep law enforcement and public service employees up to date with intervention protocols such as “The Sequential Intercept Model (SIM)”. SIM is a conceptual model that helps communities identify and address how people with mental health and substance use disorders interact with the criminal justice system. A nationwide implementation of this approach could reduce incarceration rates for mentally ill individuals by up to 30%.

To fully address the mental health crisis in the criminal justice system, prevention and diversion strategies must start outside of the jail. Through the implementation of a model of care that integrates childhood and adulthood preventive measures with informed law enforcement intervention, it is possible to reduce the number of inmates who cycle in and out of jail due to mental illness. We know such reforms work; it is time to ensure they are undertaken.