Better Served In A Hospital, But Serving Time: Q&A With First Psychologist To Lead A Major US Jail

This article was originally published on The Psych Report before it became part of the Behavioral Scientist in 2017.

To say mental illness poses a significant challenge to jail and prison systems around the United States is an understatement. According to a 2014 report by the National Research Council, over half of inmates in the United States suffer from a mental health problem, with 10-25 percent of inmates dealing with severe illnesses like schizophrenia or bipolar disorder. But it’s not the case that mental illness leads to criminal behavior, a myth perpetuated in film and the media. While certain mental illnesses can cause people to act violently if left untreated, most people who suffer from mental illness are not violent. Yet, a lack of community psychiatric services, which were gravely reduced in the 1950s through the 1970s, means many who would be better served in a hospital are serving time in jail or prison.

This past week, an indication of just how entangled mental health and criminal justice have become, Chicago’s Cook County Jail announced that Dr. Nneka Jones Tapia, a clinical psychologist, will become the Executive Director of the jail. Jones Tapia began her career at Cook County Jail nine years ago, and for the past two years has served as the First Assistant Executive Director, overseeing the mental health initiatives at the jail. Jones Tapia will be the first mental health professional to lead a major jail in the United States.

As Executive Director, Jones Tapia will take over one of the largest jails in the United States. The Cook County Jail houses between eight and nine thousand detainees at a time, with more than a quarter of inmates diagnosed with a mental illness. Because of the number of inmates requiring mental health care, the Cook County Jail also qualifies as the largest mental health institution in the country.

We spoke with Jones Tapia to learn more about the reality of treating mental illness in a correctional facility, misconceptions surrounding mental health and incarceration, and the role of jails in the US.

Evan Nesterak: What role do you think jails currently serve in the US? And what role do you think they should serve?

Nneka Jones Tapia: I think many jails historically have just been hold ‘em and release ‘em facilities. We’re supposed to actually correct behavior though, and I’m not sure we’ve ever done that. With the set of circumstances that we’re under with the number of mentally ill people coming into most correctional institutions, we’re forced to now become an institution that corrects behavior. We’ve had great leadership in Sheriff Tom Dart in that he has been at the forefront of correcting behavior not just for the mentally ill, but for everyone that comes into the jail. Hopefully other facilities will take note and really develop programs for these individuals because they’re coming back to society one day. They will be our neighbors. They may very well be our family members. We want them to be as productive as possible when they return. The concept of hold ‘em and release ‘em can no longer be such. We have to do something different.

EN: Is there a story of an inmate that you think epitomizes the state of the jail and prison system as you see it?

NJT: I know of one young man. He was experiencing visual hallucinations. He was arrested for something to the effect of violation of an order of protection. As an aspect of his mental illness he didn’t quite understand that he couldn’t maintain contact with someone. He had these visual hallucinations of this individual that he couldn’t maintain contact with, and at a different correctional facility pulled out one of his eyes. That was his way to try to stop the hallucinations.

I think many jails historically have just been hold ‘em and release ‘em facilities. We’re supposed to actually correct behavior though, and I’m not sure we’ve ever done that.

While he was in our custody he attempted on several occasions to pull out the other eye. We had to go to a sports store and get a hockey mask to cover his face to protect the eyes as well as canvas mits that wouldn’t allow him to use his fingers, and we had to put an officer on him to monitor him constantly 24 hours a day, everyday, while he was in our custody. That’s someone who unfortunately ended up being sent to prison, but really could have been better served in a hospital to stabilize him and to get him the resources that he needed to be able to navigate society. It was a sad case. He’s going to be in prison for a while.

EN: If you could make one change to the environment in which the Cook County Jail resides—the community and city it serves—what would it be?

NJT: I would love to see community stabilization centers. If [local law-enforcement] identify someone with mental illness where the offense is more lower-level, there’s no true victim, [law enforcement] would have the ability to take them to this crisis stabilization unit. [There] they wouldn’t have to wait 8-10 hours like they have to do when [law enforcement takes] them to a local hospital to have someone assess and triage to determine that they would benefit from community treatment. [They would] have an individualized plan developed at that moment and engage community treatment at that moment so then they truly divert the person from coming into jail.

I’d like to see a process also where they can have social workers at local lock-ups. As symptoms start to arise, a community mental health professional is there at the lock-up to again catch the illness before it makes its way into the jail.

EN: What do you think is the biggest misconception surrounding inmates, incarceration, and mental health?

NJT: I think the common myth in society is that people with mental illness are dangerous, and that’s not the case. We know that’s not the case. What is dangerous is when we have someone with untreated mental illness and they may engage in behaviors that can become violent. So let’s start treatment early on and let’s not continue to misguide people into thinking mental illness in and of itself is dangerous, because when we portray those misconceptions to people they feel like those that have mental illness belong in a jail, belong in an institution where they’ll be locked away. But that’s quite the contrary. Get them treatment and they can be productive citizens like you and I.

EN: There seem to be two key aspects that the issues of mental health and incarceration share: prevention and treatment. How do you see prevention and treatment fitting into your vision for the Cook County Jail?

NJT: In my time that I’ve been with the Sheriff’s office we’ve learned that it’s really trifold. It’s prevention in the form of diversion, treatment while they’re in our custody, but then it’s also comprehensive release planning, so they do not return to our custody.

In my former role, as First Assistant Executive Director of Mental Health Strategy, we’ve engaged our community partners, including the courts with trying to divert people from coming into custody. Right now we have mental health professionals that provide an assessment of everyone coming into the jail prior to bond court. If we identify that they self-report mental illness, we relay that information to the public defenders office and the State’s Attorney’s office in hopes that in the bond court hearing the judge will divert them to community treatment. What we have found, unfortunately, is not many people are diverted and instead it results in more people being put in mental health court. So it helps in some sense, but they’re still coming into our custody, which is not what we wanted.

We’ve realized that the work that we do can not stop at our doors. It has to transcend into the community.

Because the demand is so high, we have developed some programs of our own. We’ve developed a mental health transition center where we bus over about 100 detainees to an offsite location of the jail. [We] provide them with cognitive behavioral therapy to help them start thinking about the world from a different perspective and how they go about their decision making. We give them educational skills. Most of them have not had their high school diploma or GED, so we provide GED programming, and encourage them to continue it post-release. We also provide job-training skills.

Since we opened in August of last year, about 40 of our detainees have been released from the jail, some were transitioned to the department of corrections for prison time on [the] charge that they we in for, but a number of them have gone out into the community and are gainfully employed or are continuing their education. We maintain regular contact with them, which is the third piece that we talked about in that comprehensive discharge planning. We’ve realized that the work that we do can not stop at our doors. It has to transcend into the community and that’s where we’ve developed quite a few connections with community partners that are committed to continuing the services that we start here at the jail. We are still lacking in the community, particularly with respect to psychiatric services, which is why we still have this revolving door, so we still hope to build those relationships to minimize those that continue to come in and out.