Submitted by IDHS - Division of Mental Health
Mental health and justice professionals across the nation have noted that the system managing forensic consumers, both those adjudicated Unfit to Stand Trial (UST) and Not Guilty by Reason of Insanity (NGRI), is in crisis. State mental health services often are inundated with court referrals and are challenged to address them in a timely manner, resulting in waits for fitness restoration services for people in jail. Despite a directed and sustained effort to increase both community and inpatient services, a severe staffing shortage is currently causing Illinois to experience this crisis.
Historically, the Illinois Department of Human Services, which provides forensic services, has endured significant challenges. Bed capacity, obtaining and retaining critical staff, and limited resources in the community to provide alternatives to justice involvement have been concerns for many years. The perfect storm of the COVID pandemic in early 2020 and the backlog of cases that resulted and an unprecedented workforce crisis, have significantly complicated an already challenging situation. Additionally, although fluid, the number of persons waiting for inpatient forensic treatment has recently increased to levels not previously seen. This has caused a strain on resources not only for the State’s mental health system and the staff that work there, but for jails and the courts alike.
The current challenges to the forensic system in Illinois are complex. Although the State’s mental health authority may reasonably be expected to address the increased number of referrals, there are a number of external factors at work that are outside of the control of the Department. For IDHS’ part, it has implemented several forensic initiatives to help “right-size” the system and divert non-violent consumers from more restrictive levels of care - where appropriate. Between 2020 and the present, the IDHS expanded its Outpatient Fitness Restoration programs from 2 to 17 community providers. This has allowed over 100 consumers to be treated in the community and preserved the State’s inpatient beds for individuals who require a higher/more secure level of care. Further, additional funding was provided to 5 Supervised Residential Programs to add capacity for long-term consumers in NGRI legal status to facilitate step downs into a community level of care on a plan of court-ordered conditional release. A Forensic Work Group was also convened with stakeholders around the state to provide transparency and to collaborate on solutions that can help to manage and resolve the issues that drive individuals into forensic care.
These strategies, while not a panacea, have helped to build a network of community mental health professionals, sheriffs, judiciary, State’s Attorneys, Public Defenders, and advocacy groups, all working together to arrive at solutions. Recommendations for improving the system have been generated amongst the group and have assisted IDHS with developing strategies for long-term system change.
IDHS is also working on several internal strategies to add additional, inpatient bed capacity for forensic services. Those key plans include the reopening off-line units, repurposing existing capacity into forensic units and reclaiming units previously utilized by the Illinois Department of Corrections. Securing and retaining the requisite staff is key to opening those beds for use and will have a very significant impact in accelerating inpatient admissions. IDHS is considering all available options to increasing capacity through the use of other State facilities and utilizing contract vendors where needed to fill the gap in staffing. All of these efforts are strongly supported by both the Governor’s Office and IDHS Secretary’s office.
However, despite its best efforts and available funding to support these efforts, the Department faces challenges outside of its control. For example, IDHS has noted a 37% increase in the number of forensic referrals in the last 12 months. This comes at a time when the Department is struggling to hire and retain staff that are already weary from the ongoing effects of the COVID-19 pandemic. Although new hires have occurred, they have generally not kept pace with attrition – which can result in mandated overtime at our 24/7 facilities.
The Department also relies on the courts to help facilitate inpatient admissions. For example, once the Department reports a defendant fit to stand trial, it requests that the Court issue an Immediate Transport Order (“ITO”) to remand the Defendant back to the custody of the Sheriff. When there are delays in entering these orders, defendants end up waiting at the “back door” of an IDHS facility for transport to the jail. While waiting, they continue to occupy a bed that would otherwise be available for a new admission – further exacerbating the “front door” problem.
Lastly, some litigants (whether representing State’s Attorney’s Offices or Public Defender Offices) and some courts, sua sponte, have resorted to the use of rules to show cause and contempt proceedings to compel the Department to admit individuals in advance of other defendants who have been waiting for an admission. IDHS understands and shares the frustration and the care for the mental health of the affected defendants that underly these proceedings. IDHS works diligently to triage admissions based upon: (1) most critical need; and (2) length of time waiting for an admission. The pace of admissions is not, by any means, a lack of will or deliberate noncompliance, but a current lack of available staffed and open beds which, as detailed above, IDHS is working hard to increase to meet the increased need. All estimates for admission are based upon these assessments. When an order ends up advancing one admission over another, the admission dates of other defendants are disrupted, including the admission dates of defendants who have been waiting for an admission and/or may have higher clinical needs.
In conclusion, IDHS continues to work collaboratively with all system stakeholders to address the nationwide crisis that is affecting forensic admissions. Our ultimate goal is to provide defendants with the mental health care they need in a timely manner and in the least restrictive and most therapeutically appropriate setting possible. It is important that our stakeholders know the challenges we face and, we hope, work collaboratively with us towards positive solutions that improve the system. We want others to know that IDHS takes its responsibility seriously, not just as a statutory obligation to provide care, but also as a moral one. The Department is committed to improving the system that provides much needed mental health services to some of our state’s must vulnerable citizens We are asking for the patience and help of the courts while we work to address these system challenges and overcome the considerable hurdles that are presently impacting our admissions.