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A large court system tackles a huge problem

March 1, 2007
by LISA BRAUDE, PHD and CARL ALAIMO, PSYD
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Stakeholders in an Illinois county work toward better outcomes for mentally ill offenders

“With such a large volume of people moving through our doors, we needed a system, not just a single courtroom.…”

—The Honorable Paul Biebel, Presiding Judge, Criminal Division, Cook County Circuit Court

The Cook County (Illinois) Criminal Justice System is the nation's largest unified court system. Each year it processes and admits more than 100,000 people to the Cook County Department of Corrections (CCDOC), more than 10,000 of whom have serious mental illnesses. Every day more than 1,000 detainees—of whom about 97% are awaiting the disposition of their felony cases—receive psychiatric services at CCDOC. Without clinical interventions, these individuals contribute to the backlog in court case processing and continue to cycle in and out of the jail and prison system.

Although some jurisdictions across the country have one problem-solving courtroom to meet the needs of people with serious mental illness, Cook County's sheer volume of cases would overwhelm a single specialized courtroom. Instead, Cook County's large, complex system required a much broader and systemic approach.

Additionally, Cook County and its partners recognized the challenges inherent in identifying individuals with mental health needs at a single point in time, which minimizes the efficacy of a “mental health courtroom.” For example, drug courts often are able to identify clients based on their charges. In contrast, mental health issues may emerge at any point in case processing, and criminal behavior may or may not be a symptom of a mental health disorder. Therefore, Cook County sought to allow for engagement in a specialized program for people with serious mental illness at any point in court or justice system involvement.

Program Model

From the beginning, a wide array of high-level officials, treatment providers, and client advocates shared equally in the conceptualization of and planning for the program, including:

  • chief judge of the Cook County Courts;

  • presiding judge of the Cook County Courts' Criminal Division;

  • administrators from Treatment Alternatives for Safe Communities, Inc. (TASC), a not-for-profit organization that provides behavioral health recovery management services for individuals with substance abuse and mental health disorders;

  • Cook County Adult Probation Department (Mental Health Unit);

  • Cook County State's Attorney's Office;

  • Cook County Public Defender's Office;

  • Cermak Health Services of Cook County, providing mental health services for detainees;

  • Illinois Department of Human Services' Division of Mental Health (DMH) and Division of Alcoholism and Substance Abuse (DASA);

  • Chicago Police Department;

  • Loyola University Chicago;

  • National Alliance for the Mentally Ill; and

  • community-based mental health treatment providers.

The Cook County Mental Health Program was implemented in April 2004 with a small federal planning grant and existing resources within Cook County to create a cohesive service system dedicated to the rehabilitation and recovery of offenders with mental illness. From its onset, the program's goal was to create a judicial system informed about therapeutic issues and characterized by equal treatment under the law, whereby equal offenses receive equal criminal processing.

In developing the program, stakeholders had a few primary goals. They aimed to identify eligible individuals early in their court involvement and link them to community-based treatment. They also wanted all criminal courts to have access to relevant information regarding treatment history and the extent to which mental illness might have contributed to criminal behavior. Ideally, judges in all Cook County criminal courtrooms would use the same legal standards to determine guilt or innocence, and sentencing would be informed by an understanding of appropriate therapeutic interventions. They hoped this information ultimately would lead to a reduction in the incidence of arrests, incarcerations, and hospitalizations among program participants with serious mental illness and co-occurring substance use disorders.

The program's core components were developed with a primary focus on sustainability and leveraging existing resources. The program's partners intended to develop a prototype for systemic change instead of an approach that relied on one courtroom, which would be limited in its ability to monitor clients' behaviors and to assist them in managing their illnesses. Therefore, identification of needs and appropriate interventions are built in at each stage on the Cook County criminal justice continuum (from arrest and incarceration through termination of community supervision).




Program participants are sentenced to probation with mandatory mental health treatment and other types of behavioral healthcare and social services. Mandated treatment for clients allows the judicial system to leverage the opportunity for stabilizing individuals through treatment and medication management and monitoring their progress. In turn, this theoretically reduces the likelihood of psychiatric and criminal recidivism.

In addition, the program takes advantage of case management strategies and client advocacy through TASC that have proved successful in criminal justice, mental health, and substance abuse systems. These strategies are designed to incorporate an intensive recovery management model, which promotes client responsibility and self-sufficiency by incorporating habilitation services in standard case management plans.

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