The tragic consequences of closing psychiatric centers

A new op-ed by Cook County Sheriff Tom Dart shows that the promised benefits of closing government-run psychiatric centers have failed to materialize – and the consequences have been devastating for people with mental illnesses and the state as a whole.

Dart, writing in the Chicago Tribune, notes that, since the 1960s, the number of beds in state-run psychiatric hospitals has plummeted from 35,000 to fewer than 1,500.

The latest wave of closures – which AFSCME fought vigorously – came in 2012. The loss of state facilities was made even worse by Chicago Mayor Rahm Emanuel’s decision to close half of its mental health clinics, another action AFSCME strongly opposed.

When these closures took place, public officials offered assurance that patients with mental illnesses would be moved to “community care” that offered higher quality at a lower cost. But, as Dart notes, the reality was far different:

“When these institutions close, the seriously ill patients end up on their own, often on the street with no support system to keep them stable or medicated. Inevitably, they suffer psychotic states and commit petty crimes that land them within the unyielding grip of the criminal justice system — caught in a revolving door between jail and the streets.”

The closures have “effectively criminalized” mental illness in Illinois, Dart writes. He calls the Cook County Jail that he oversees “the largest mental health hospital in Illinois” – at least one-third of the 10,000 inmates housed there have a mental illness.

Without the guarantee of care that had been provided by state facilities, people with mental illnesses often find themselves on the streets, committing petty crimes to get by. Without access to the prescription drugs they need to remain stable, many turn to hard narcotics to cope. Dart writes:

“The vast majority of these inmates are charged with low-level crimes of survival: prostitution, trespassing, disorderly conduct. Many are facing drug charges — for those unable to get medication to make the voices in their heads go away, heroin is often the next best solution. They are, for the most part, good people who suffer from an illness beyond their control and simply need their government to have its priorities straight.”

Dart also notes that taking proper care of people with mental illnesses isn’t just the right thing to do – it would also relieve state and local governments of the significant costs that go along with incarcerating people who should be in a hospital, not a jail cell:

“The fact is that doing right by the mentally ill will help address our state budget problems. Incarcerating just one seriously mentally ill inmate costs two to three times the rate of the average inmate, taking into account medications and enhanced security to protect against self-harm. For a fraction of that cost, we can empower new community health centers and establish comprehensive discharge planning. It's humane and fiscally prudent.”