Published on Wednesday, June 28, 2000 in the Washington Post
For Jailed Mentally Ill, A Way Out
by Kari Lydersen
CHICAGO –– After sleeping on this city's streets for 28 consecutive days, Ellene Price had had enough.

But she couldn't turn to homeless shelters for lodging. Several had barred her for bad behavior. A mental hospital where she was hearing voices released her after a week. With no havens available and the weather turning cold, Price decided to get arrested and sent to the Cook County Jail, where at least she would sleep indoors.

So, Price grabbed a female tourist by the neck and pushed her to the ground. She was arrested, pleaded guilty to battery and was sentenced to a year behind bars--joining more than a quarter of a million mentally ill people incarcerated in the country's prisons and jails.

For a while at least, jail was a relief. She had amenities she was unable to keep before because of her mental illness. "I had a clean uniform, a water fountain, a shower, a roof over my head," Price said.

"But then it started getting rough. The girls were fighting a lot, and I wanted to get out of there."

Jails are increasingly becoming the main psychiatric facilities for people with mental illness, according to mental health experts. In this city, the Cook County Jail houses the county's largest population of mentally ill people. In 1998, the latest year for which figures are available, 283,000 mentally ill people were incarcerated across the country in federal and state prisons and local jails, and almost 550,000 others were on probation, according to the Justice Department. About 16 percent of mentally ill people released from prison or jail are not ready to survive on their own, according to the Justice Department, and many of them are soon in jail or hospitalized again.

Price served less than one-quarter of her punishment. Officials from Thresholds, a unique national psychiatric rehabilitation center based in Chicago, went to her sentencing judge and got Price an early release. They enrolled her as a "member" in a program that offers intensive one-on-one counseling as well as assistance in meeting daily needs.

"People are released from jail with just a prescription and the address of a mental health facility, which might have a month-long waiting list," said John Fallon, director of the Thresholds Jail Program, which aims to reach mentally ill people caught up in the cycle of incarceration, hospitals and the streets. "It's almost guaranteed that they're going to fail the way things are set up now."

The Thresholds Jail Program was launched less than three years ago, serving 45 mentally ill people with funding coming primarily from Thresholds' own coffers. Last year, the program received $495,000 from the Illinois Department of Mental Health and expanded its staff from three to eight caseworkers.

"We're looking at people who are off the radar screen of mental health services," said Tom Simpatico, bureau chief of the Illinois Department of Mental Health. "These are highly recidivistic people who are not easily able to link up with community resources, so we need to find new solutions like this which can get them back in care."

Thresholds staffers hope their program can become a model for other states and receive enough government funding to serve the bulk of nonviolent mentally ill people in jail. The program costs about $26 a day per person, compared with about $70 a day to keep the same person locked up, or $400 daily to keep that person in a public mental hospital.

Thresholds identifies potential "members," as the patients are called, by working with personnel at the Cook County Jail. Members must be nonviolent offenders, and they must be willing to live on the north side of the city--where the program is based--upon their release. They also must have a mental illness, such as depression or schizophrenia, that responds to medication.

Thresholds caseworkers accompany members to their court dates and--as they did for Ellene Price--usually convince judges to release the inmates from jail early into the program's custody. Caseworkers helped get Price released Dec. 9 after only 11 weeks behind bars.

Thresholds workers then find affordable housing for the members, usually in hotels where others from the program live. The workers visit members at least once a day, giving them their medication, a $5 a day allowance and, for smokers, a daily allowance of cigarettes. They take members shopping or help them do their laundry. They go on group outings to the beach, baseball games or restaurants. Caseworkers are on call 24 hours a day and spend hours in the middle of the night visiting or looking for a member if necessary.

The services are available for as long as the client needs them.

So far the program has been a measurable success in at least one area: Since it started in September 1997, none of the 45 members has been rearrested.

Ronald Simmons, chief of adult forensic programs for the state of Illinois, said Thresholds "does an outstanding job of assertive case management. They have done an admirable job of keeping these people stable and functional in the community."

At a May banquet, most members gave testimonials about how they have avoided arrest and hospitalization since being in the program.

One success story is Richard Berry, a paranoid schizophrenic. Berry, a 43-year-old who has been arrested 137 times for minor offenses, has spent 11 of the past 20 years in mental hospitals, which he says are plagued by vampires and hair grease in the food. He has 13 brothers and sisters in the city but has no contact with them. Once, he was arrested for stabbing his mother with a pair of scissors.

But Berry hasn't been arrested or hospitalized since entering the program almost a year ago.

"Life is beautiful now," Berry said. "I have money, clean clothes, food to eat, a place to stay. I feel glad to be alive."

As she explained during a trip to Burger King with Berry, Price is also doing well. She hasn't been arrested in the six months since her release, she has a stable home and a boyfriend, and she is looking for work.

"If I didn't have Thresholds, I would still be in jail and who knows what would have happened after that," Price said. "I'd probably be somewhere deceased."

Prison and the Mentally Ill

Almost 300,000 mentally ill people are incarcerated in the nation's prisons and jails. Of those, about half are receiving treatment. They are more likely than the overall prison population to have suffered physical or sexual abuse in their lifetimes and are more likely to have committed a violent offense.

Estimated percent of population that is mentally ill

State prison 16.2%

Federal prison 7.4%

Jail 16.3%

Probation 16.0%

Percent of mentally ill inmates receiving treatment

State prison 60.5%

Jail 40.9%

SOURCE: Bureau of Justice Statistics, 1998 survey

© 2000 The Washington Post Company