OFFICERS AND BOARD
OF DIRECTORS
CHAIRPERSON
Thomas More Donnelly
VICE CHAIRPERSONS
Judge Barbara J. Disko
Arthur Don
Alan I. Rubens
SECRETARY
Aviva Futorian
TREASURER
Edwin A. Burnette
PRESIDENT
James R. Coldren, Jr.
DIRECTOR, PRISONS AND
JAILS PROGRAM
Charles A. Fasano
BOARD OF DIRECTORS
Philip J. Carrigan
Thomas C. Cronin
Judge Brian Barnett Duff
Thomas Anthony Durkin
Laura Lane Ferguson
Hon. Michael B. Getty (Ret.)
Creasie Finney Hairston
Julius Hemmelstein+
Suzanne E. Jones+
Robert J. Matuzak
J. Kevin McCall
Bonnie McGrath
Jay A. Miller
Matthew S. Miller
Hon. Sheila M. Murphy (Ret.)
Frank J. Nicholas
Brenda A. Rossini
Judge Stephen A. Schiller
Chester Slaughter
R. Bruce Slocum
George L. Stewart
Brent D. Stratton+
Daniel R. Ventura
Joseph F. Vosicky, Jr.
ADVISORY COUNCIL
Roger S. Baskes
Jeffrey D. Colman
Ruthanne DeWolfe
Edward M. Genson
Rev. Donald M. Hallberg
Clifford P. Kelley
Hon. Paddy Harris McNamara
Norval Morris
Rudolph E. Nimocks, Sr.
Joyce O'Keefe+
William H. Rentschler+
Judge Jack B. Schmetterer+
Hon. Joseph Schneider (Ret.)
Stephen Wade Zucker
+Past Chairperson
John Howard Association
Incorporated Not For Profit
1901
http://www.johnhowardassociation.org/policystatements/MENTAL_HEALTH_PO
LICY_STATEMENT.doc
Adopted as revised by the Board of Directors: March 19, 2003
MENTAL HEALTH SERVICES FOR INCARCERATED ADULTS
Introduction
The John Howard Association adopted its first policy paper on mental
health and corrections in 1987. Sixteen years later, as Illinois correctional
populations have grown tremendously, problems in this area have also grown, as
has our knowledge of the nature and extent of mental health issues in correctional
settings. In our opinion, well-intentioned work in the area of mental health and
corrections in Illinois has produced some positive results but remains unfinished
and under-funded. We are now aware more than ever of the prevalence of cooccurring health, mental health, and substance abuse disorders among the
incarcerated. While this statement focuses on mental health issues in corrections,
we recognize the strong link between substance abuse and mental health issues.
Other Association policy statements address substance abuse issues in corrections.
Right to Mental Health Services
Incarcerated individuals in Illinois have a constitutional right under the 8th
and 14th amendments to the U.S. Constitution (ACLU, 1988; Ruiz v. Estelle) to
mental health services for the diagnosis and treatment of mental and emotional
disorders, as well as for thorough and competent discharge planning.1 Illinois jails
and the Illinois Department of Corrections (IDOC) have duties to provide those
services. Provision of such services prior to release will improve the incarcerationto-community transition for released inmates and ultimately save taxpayer dollars
through prevention of additional or more serious criminal offenses. Correctional
agencies in Illinois should design and implement up-to-date diagnostic, treatment,
suicide prevention, rehabilitation, and re-entry programs for all individuals under
their jurisdiction with bona fide mental health and needs and concerns. Yet, the
State has not conducted a formal, system-wide, needs assessment to determine the
incidence of mental illness in correctional populations in over 15 years, nor has the
State thoroughly examined the appropriateness of policies that place individuals
with mental health problems in lengthy isolation. Such a study is essential to the
design of treatment policies and programs that will meet the real needs of the
incarcerated individuals. Absent such research and information, existing treatment
and rehabilitation programs and resources define the need, rather than -- as is appropriate -research-based need defining the appropriate programs and resource levels.
Review of Research
Recent estimates suggest that up to 40 percent of individuals with mental health problems
in America come into contact with the criminal justice system (NCSL, 2001), and that up to 20
percent of incarcerated individuals have a major psychiatric disorder (NCCHC, 2002). Over
15,000 inmates in state correctional facilities (just under 2 percent of all state inmates) on any
given day are under 24-hour special mental health care or supervision, approximately 10 percent
receive psychotropic medication, and more receive counseling or therapy (Beck and Maruschak,
2001). Research conducted by Teplin, Abram, and McClelland (1997) suggests that mental
health needs in corrections populations far outpace available resources. Other research points to a
high prevalence of co-occurring disorders (e.g., mental health problems and drug addiction) in
correctional populations (Abram and Teplin, 1991; Regier et. al, 1990; Michaels, Zoloth, and
Braslow, 1992; SAMSHA 2002). In addition, the Bureau of Justice Statistics estimates that 14
percent of parolees in the U.S. have mental health problems (Hughes, Wilson, and Beck, 2001).
The Criminal Justice/Mental Health Consensus Project reports that “rates of serious mental
illness among these [jailed individuals] are at least three to four times higher than the rates of
serious mental illness in the general population” (Council of State Governments 2002, p. xii).
We estimate that Illinois correctional facilities routinely house more individuals with severe
mental health problems than all of the State’s mental hospitals combined. The Cook County
Department of Corrections, for example, routinely houses over 1,500 inmates under some form
of treatment for mental health problems, making it the second largest correctional psychiatric
facility in the nation. IDOC estimates that 40 percent to 50 percent of incoming inmates have
mental health or substance abuse problems, or both2. In effect, Illinois’ correctional facilities are
the State’s primary source of mental health services in institutional settings, with barely enough
resources to meet a small percentage of the demand. We also believe, based on research and our
own experience in facility monitoring and visitation (Kurki and Morris, 2001; John Howard
Association, 1999) that the practice of incarcerating mentally vulnerable individuals in harsh and
isolated conditions (especially placement in segregation, maximum security, and ‘super-max’
facilities) exacerbates their mental health problems.
John Howard Association – Policy Statement on Mental Health Services for Incarcerated Adults – Page 3
In the past several years IDOC has made concerted efforts to improve and expand its
mental health and substance abuse services. Information about mental health problems and
needs collected during the intake and reception process has improved and expanded. However,
the transfer of relevant information from one organization to the other (e.g., from adult jails to
IDOC, between IDOC and local mental health organizations) does not proceed smoothly, and
important mental health information needed by a receiving organization may not be at hand.
OASA (Illinois Office of Alcoholism and Substance Abuse) licensed substance abuse programs
are available at 13 IDOC adult facilities including all four women’s facilities. Special treatment
beds are available for inmates with co-occurring disorders at the Dixon facility (and more are
planned for the women’s facility at Dwight). IDOC has increased the number of mental health
professionals with masters- and doctoral-level academic credentials. Still, by IDOC’s own
estimates, they are currently equipped to meet approximately 20 percent of the mental health
needs of incarcerated individuals.
Need for Inter-Agency Cooperation
Lack of consistent inter-agency cooperation in Illinois produces other serious problems
such as:

Inconsistent approaches to the diagnosis and treatment of mental health problems
across systems and institutions,

Difficulty in transferring relevant mental health data across computer systems, and

Difficulty in assuring continuity of medication as individuals move from one system
to another, and in and out of the community.
There are promising models and approaches for improving the way criminal justice and
other professionals interact and provide services to individuals with mental health and substance
abuse needs and problems. Several jurisdictions have designed new law enforcement practices,
under the rubric of community policing, for sensitizing officers to and meeting the mental health
needs of residents and arrested individuals. In Memphis, for example, a Crisis Intervention Team
of trained law enforcement officers works to de-escalate or minimize encounters between police
and citizens with mental illness (Council of State Governments, 2002). The Illinois Police
Training and Standards Board offers mental health training for law enforcement officers and
recently launched a special task force on dealing with persons with mental illness. Mental health
courts may help divert non-violent offenders with mental health problems from jail or prison,
though opinions on their effectiveness or usefulness are mixed and extensive evaluation of
recently developed models has not been produced. The Cook County Adult Probation Unit
operates a Mental Health Unit to provide special services to probationers with diagnoses of
mental illness or mental retardation. The Thresholds Jail Program at the Cook County
Department of Corrections, which works to identify soon-to-be released inmates with mental
health problems and develop release plans and community-based care to prevent relapse and
recidivism. A comparable program is now in a pilot phase at the Dixon correctional facility in
Illinois. These developments underscore that fact that our criminal justice system can improve
John Howard Association – Policy Statement on Mental Health Services for Incarcerated Adults – Page 4
the ways in which it assesses, understands, and meets the mental health needs of individuals that
come into its jurisdiction.
Public Policy Institute Recommendations
In April of 2002 the Public Policy Institute of Southern Illinois University convened a
special work group of national experts on mental health and corrections. The Institute made the
following recommendations which the John Howard Association supports:

State and local government should improve the coordination between the mental
health and corrections systems.

The Illinois legislature should provide additional funding for community-based
mental health services.

State and local criminal justice training centers should provide adequate training to
corrections and law enforcement professionals regarding the identification of mental
health issues among people under their purview, and to reduce stigma toward people
with psychiatric disabilities and mental health problems.

Medicare and Medicaid should reimburse for mental health services and prescriptions
at the same rate as other medical and prescription reimbursements.

Corrections and mental health agencies should create mechanisms to insure a
continuity of care for individuals re-entering the community with mental health needs
and problems.
Conclusion and Recommendations
In conclusion, comprehensive and accurate documentation of the mental health needs and
problems in the Illinois criminal justice system do not exist. Community-based mental health
resources are lacking. Coordination of mental health information and services across systems,
organizations, and facilities needs improvement, as does the mental health-related training
provided to system professionals. In some cases, needs far outstrip the resources available to
meet them. In addition to, and in support of, the recommendations of the Public Policy Institute,
the John Howard Association recommends that:
1. The State of Illinois should undertake an immediate and comprehensive needs assessment
to determine the mental health and substance abuse treatment needs of inmates under its
jurisdiction (adult, juvenile, male, female, incarcerated, on parole, in community-based
programs), and then design diagnostic, treatment, rehabilitation, and transition-tocommunity programs to meet the needs as determined by the assessment.
2. Corrections officials in Illinois should conduct thorough, regular, and systematic
evaluations of mental health programs and services in correctional settings. Such
evaluations will improve the current delivery of services and provide much needed
information to policy makers and practitioners regarding promising and proven programs.
John Howard Association – Policy Statement on Mental Health Services for Incarcerated Adults – Page 5
3. All prisons, jails, and detention centers in Illinois should meet the accreditation standards
of the National Commission on Correction Health Care. Where it is fiscally feasible, they
should pursue accreditation by this Commission.
4. The Governor and General Assembly in Illinois should appoint an overarching oversight
board (located in the executive branch) to monitor and coordinate the delivery of mental
health and substance abuse programs by such agencies as IDOC, the Office of Mental
Health, the Division of Community Health and Prevention, the Office of Alcoholism and
Substance Abuse, and the Department of Children and Family Services.
5. The Governor’s office should work with existing state agencies and advocacy groups to
take the greatest advantage possible of federal incentives to develop community-based
mental health services in Illinois. An increase in community-based mental health
resources in the state will serve two purposes – improve the transition of incarcerated
individuals to the community, and prevent unnecessary incarceration of individuals with
mental health problems in the future.
6. The Illinois Department of Corrections, The Illinois Sheriff’s Association, the Illinois
Law Enforcement Training and Standards Board, and the Illinois Association of Chiefs of
Police, working with the John Howard Association and mental health advocacy groups,
should work more closely together to review and improve the current training standards
and materials relating to managing individuals with mental health and substance abuse
disorders
7. IDOC and Illinois jails should periodically review their formularies and their use of
psychotropic medications to insure that prisoners and detainees receive the most
appropriate medications.
8. The IDOC, together with other mental health agencies and other public agencies, at state,
county, and local levels should develop and implement diagnostic, treatment,
rehabilitation, habilitation, and re-entry programs to ensure continuity of mental health
and substance abuse service delivery for Illinois prisoners during and subsequent to
incarceration. This should include sharing of records between corrections, mental health,
and substance abuse agencies, ensuring continuity in the use of psychotropic medications
when individuals move between systems and programs, and special parole services for
individuals with mental health problems.
Adopted by the John Howard Association Board of Directors
John Howard Association – Policy Statement on Mental Health Services for Incarcerated Adults – Page 6
REFERENCES
Abram, K. M., & L.A. Teplin. Co-occurring disorders among mentally ill jail detainees.
American Psychologist, 1036-1045, October 1991.
American Civil Liberties Union. The Rights of Prisoners (Fourth Edition). Carbondale, Illinois:
Southern Illinois University Press, 1988.
American Psychiatric Association. Psychiatric Services in Jails and Prisons (Second Edition).
2000.
Beck, A. J., and L. M. Maruschak, Mental Health Treatment in State Prisons, 2000. U.S.
Department of Justice, Bureau of Justice Statistics. July 2001.
Council of State Governments. Criminal Justice/Mental Health Consensus Project. New York,
New York, June 2002.
Ditton, P.M. Mental Health Treatment of Inmates and Probationers. U.S. Department of Justice,
Bureau of Justice Statistics. July 1999.
General Accounting Office. Mentally ill inmates: better data would help determine protection
and advocacy needs. April 1991.
Harrington v. Kiley, et al., 74 C 3290; United States District Court-Northern District of Illinois
(Eastern Division); pending before Hon. James B. Zagel.
Hughes, T.A., D.J. Wilson, and A.J. Beck. Trends in State Parole, 1990-2000. U.S. Department
of Justice, Bureau of Justice Statistics. October 2001.
Illinois Department of Corrections (IDOC). Adult Correctional Center Capacity Survey, 1986.
Illinois Department of Corrections (IDOC). Population Data, July 2002. Springfield, Illinois,
http://www.idoc.state.il.us/subsections/reports/news/2003_DepartmentData.pdf.
John Howard Association. A Report on the Tamms Correctional Center, Illinois Department of
Corrections. Chicago, Illinois: John Howard Association, April 1999.
Kurki, L. and N. Morris. The Purposes, Practices, and Problems of Supermax Prisons, in Crime
and Justice: A Review of Research, Vol. 28. Chicago, Illinois: The University of
Chicago Press, 2001.
Michaels, D., S. R. Zoloth, and C.A. Braslow. Homelessness and indicators of mental illness
among inmates in New York City's correctional system. Hospital and Community
Psychiatry, 43, 2, 150-151, 1992.
John Howard Association – Policy Statement on Mental Health Services for Incarcerated Adults – Page 7
National Commission on Correctional Health Care (NCCHC). The Health Status of Soon-ToBe-Released Inmates, A Report to Congress, Volume 1, Chicago, IL, March 2002.
National Conference of State Legislatures (NCSL). Health Acts 2000: Summary, Mental Health
Courts. February 2001.
National Mental Health Association. Position Statement – Mental Health Courts. November
2001.
Osher, F. Co-occurring Addictive and Mental Disorders, Chapter 10 in Center for Mental Health
Services. Mental Health, United States, 2000. Manderscheid, R. W., and Henderson, M.
J., eds. DHHS Pub No. (SMA) 01-3537. Washington, DC: U.S. Government Printing
Office, 2001.
Public Policy Institute, Southern Illinois University. Mental Health and Prisons, Working group
recommendations. April 2002.
Regier, D. A., M.E. Farmer, D.S. Rae, B.Z. Locke, S.J. Keith, L.L. Judd, and F.K. Goodwin.
Comorbidity of mental disorders with alcohol and other drug abuse. Journal of the
American Medical Association, 264(19), 1990.
Ruiz v. Estelle, 503 F.Supp. 1265 (S.D. Tex. 1980); aff’d in part and rev’d in part, 679 F.2d
1115 (1982), am. in part, vac. in part, 688 F.2d 266 (5th Cir. 1982), cert denied, 460 U.S.
1042, 103 S.Ct. 1438 (1983).
Substance Abuse and Mental Health Services Administration (SAMSHA). Report to Congress
on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental
Disorders, Chapter 1 - Characteristics and Needs of the Population - Understanding CoOccurring Disorders. Washington, DC: U.S. Department of Health and Human Services,
2002.
Teplin, L.A., K.M. Abram, and G.L. McClelland. Mentally Disordered Women in Jail: Who
Receives Services? American Journal of Public Health 87:604-609, 1997.
Endnotes
1
See Bazelon Center for Mental Health Law (www.bazelon.org) for additional information on recent case law
regarding mental health and the criminal justice system.
2
Based on a discussion with IDOC representatives at a John Howard Association Policy Committee meeting,
February 4th, 2003.