Costly failures in the mental health system | Chicago Sun-Times

The Chicago Sun-Times has a six part series of article on structural failure in the provision of mental health care in Illinois, which often has dire consequences:

To try to understand the reasons behind a spate of shocking crimes in downtown Chicago between 2021 and 2024, the Chicago Sun-Times examined four unprovoked killings and two nonfatal attacks, including a bizarre assault on a flight attendant from Mexico. Most of the attacks happened during the day. The victims: people who were just going about their lives. I 

n each case, the people charged — three who’ve been convicted — had a history of serious mental illness or delusional behavior and had drifted in and out of jails and hospitals, sometimes for decades, their conditions never regularly treated. 

Reporters pored over thousands of pages of police reports and court records, went to court hearings for a year for those who were charged, and interviewed family members, mental health experts, law enforcement authorities and government officials. 

What emerged most clearly from this reporting is that there is no system in Chicago to identify — let alone to help — the small percentage of severely mentally ill and violent people who commit these crimes. In each of these cases, it was only when they have been accused of murder or some other terrible crime that they were put on regular mental health medication — a finding that experts say is troubling but not surprising.

I realize in my series of articles on a more ideal health and wellness care system, there needs to be a separate article on mental health care, which is both a health and wellness care issue, as well as one of public safety.

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River." (2018)
-- "Part Two: Creating a graduate health and biotechnology research initiative on the St. Elizabeths campus," (2018)
-- "Part three: the potential for donations around an expanded program," (2018)
-- "Revisiting East of the River medical care: United Medical Center," (2018)
-- "Update on DC's plans to build a new United Medical Center," (2018)

-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital," (2018)

-- "Community Health Improvement Planning," (2019)

-- "Big omission in blog series on advance hospital/health and wellness planning, public health planning: addiction services," (2024)

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"Failure to treat, failure to project," main homepage, Chicago Sun-Times series on mental health care issues

-- "For accused mentally ill killers and their victims, help comes too little too late"

-- "Family still grieves for grad student prosecutors say was killed by a man 'terrorizing downtown' Chicago"

-- "A killer’s brother and mother: Fix mental health system so others don’t die"

-- "Cheerful day on North Michigan Avenue turns into a ‘nightmare’ for young flight attendant"

-- "How can Illinois prevent violent outcomes with better mental health treatment?"

-- "Released from the hospital and left on a sidewalk: ‘He literally fell through the cracks’"

From article 5:

• There’s no single entity overseeing the mental health care system in Chicago. That means, for instance, that homeless patients discharged from private hospitals might be given a bottle of medication and told to follow up at a clinic without what experts say should be a “warm handoff” to a treatment provider.
• Even though people experiencing homelessness and severe mental illness are more likely to become victims than perpetrators of crime, a small but visible number of them repeatedly cycles through the criminal legal system.
• With only about 1,200 state psychiatric beds in Illinois, he says more funding for community mental health would allow people who don’t need 24/7 hospitalization to leave state mental hospitals — meaning hospital spots could go to people in even greater need.
• But replacing long stays at state mental hospitals like the one in Elgin with comprehensive outpatient treatment would require a radical shift in thinking — away from retribution and toward treatment aimed at reducing suffering.
• It also would require supporting mechanisms that largely don’t exist, like providing housing for homeless people who have severe mental illness so they can be reached by medical and social service providers.
• “If the person who doesn’t get decent services commits a crime, now we have a crime victim, and that’s a cost,” he says. “And we have the cost of prosecuting her or him, and that’s a cost. And who’s paying for that?”
• Illinois spent an average of $49,271 on each person in prison in 2024, far more expensive than the cost of so-called wraparound services to keep people in treatment. The two biggest Chicago social service providers pegged these intensive services at $15,000 to $35,000 per client per year, depending on the person’s needs — which is as much as 70% less expensive than incarceration.
• Ideally, Antholt says, when mentally ill people are arrested, they’d get help before their release with housing, employment, disability services and mental health treatment, which currently exist in “very siloed” systems.
• ... He says the “magic bullet” for solving the problem is a “very good use of resources up front instead of very expensive institutionalization” because “the cost of prison and jails and hospitals and ERs is very expensive, and we can’t afford this in the long run.”
• ... She says that, when she went to the Elgin hospital to ask about her missing brother, she was told, “ ‘Oh, we’re not responsible. Once he’s released, our responsibility is just to drop them off. We don’t have to walk them into the actual shelter.’ ”

Some exemplary programs 

Nonprofit providers say they’re doing their best to keep people healthy and out of the criminal legal system. 

Some, including the largest in Chicago, Thresholds, run “Assertive Community Treatment,” or ACT, teams, providing intensive wraparound services to people with severe mental illness. The teams meet people as they’re being discharged from hospitals and take them home, get their prescriptions filled, make sure they have food, connect them with psychiatrists and work out immediate transportation needs.