Inside The Massive Jail That Doubles As Chicago’s Largest Mental Health Facility

Since drastic budget cuts left thousands of Chicagoans without access to reliable mental health care, all too many are getting their only real treatment when they land behind bars.


man bound hand and foot struggles to sit upright and hollers, “This is inhumane!”

Another pulls his knees to his chin and, wide-eyed, whispers about telekinesis and the CIA.

“Someone cut off all my toes,” a third man with scars streaking his face says quietly. “I’m so glad I’m finally in the hospital.”

But this isn’t a hospital.

The Cook County Department of Corrections in Chicago is one of the largest single-site pre-detention facilities in the world, with an average daily population hovering around 9,000 inmates. It is estimated that 35 percent of this population is mentally ill.

Milton in the mental health division of Cook County Jail.
Cook County

According to a May 2015 report by the National Alliance on Mental Illness, Illinois cut $113.7 million in funding for mental health services between 2009 and 2012. Two state-operated inpatient facilities and six City of Chicago mental health clinics have shut down since 2009. The report goes on to detail that Governor Bruce Rauner’s 2016 budget proposal to slash $87 million of funding for mental health services could cause an estimated 16,533 adults to lose access to care.

Emergency room visits for patients having a psychiatric crisis increased by 19 percent from 2009 to 2012. A 2013 report by Illinois mental health care provider Thresholds found that the increase in ER visits and hospitalizations resulting from the $113 million budget cuts cost Illinois $131 million—almost $18 million more than the original “savings.

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Now more patients than ever are being treated in jail rather than at a mental health facility. Cook County Jail has become one of the largest, if not the largest, mental health care provider in the United States. The Cook County Sheriff’s Office estimates that it costs $143 per day to house a general population inmate. But when taking into account the treatment, medication, and security required to incarcerate a mentally ill person, the daily cost doubles or even triples.

When people are arrested—even before they visit bond court—within hours they are interviewed by social worker Elli Petacque-Montgomery and her team to screen for mental illness, a procedure unique to Cook County. Among the 60 people screened for mental illness on November 10 of last year after their arrest, 63 percent of women and 37 percent of men were considered mentally ill. Five had previously been involved with the Department of Children and Family Services, often indicating childhood abuse or neglect.

Petacque-Montgomery’s team quickly assesses crisis situations and immediately places acutely psychotic, violent, or suicidal arrestees in single cells away from other inmates. People who are psychotic are then sent to CERMAK, the jail’s division for physically ill and acutely mentally ill patients. Those with minor mental illness are sent to Division Two, Dorm Two, where they live in dormitory-style bunk beds instead of cells and receive therapy and medication.

After being diagnosed with mental illnesses when they were arrested, the four men interviewed below—Milton, Daniel, Tommy, and Andrew—were all serving time and receiving treatment in Dorm Two.

Tommy: Serving time for driving on a revoked/suspended license, driving under the influence


This would be my 11th time in Cook County. Why am I here? They say because anxiety. So I take anxiety pills…they help; they help a lot. I used to be a lot more antsy…I think this was diagnosed when I first came in. I think, but I’m not even sure, you know? I wasn’t even paying attention to what they were asking. I was just answering them, and I ended up here.

Our counselor has been very helpful. She’s very professional, very attentive to every single one of us. From day one she tells us this is a family and everybody gets treated as a family…. I thank God for her.

Growing up in Chicago…we go through a little phase I would say trying this, trying that…but I never really stuck to drugs. Alcohol, oh, that’s everywhere, so I just had a little bad luck getting caught driving a little intoxicated….

This program…everybody’s trying to go home, everybody’s trying to work on their problems, their behaviors. They’re giving you the help, so the last thing on everybody’s mind is going back to your old behaviors

Underground Tunnel

I get real frustrated real quick, but now I know what the problem is. So when I get out of here I’m going to go to the doctor and continue my pills because it helps me a lot….I thank God that Cook County has this opportunity where we can take our pills.

Being in jail, the littlest thing would get me frustrated—like commissary wouldn’t come on time; stupid things, like why is that officer screaming? I know it’s her job, but little things, you know? Like why can’t I watch this TV show? But as you get older you start to notice you can’t have it your way and this program here teaches us that. Before, I would break things, like a dummy, break things or scream out, lash out. And that would get me into trouble….But now, I’m OK. Thank God I got diagnosed.

This division of the jail, this is Hotel California right here—you can’t get no sweeter than this. This is the best one here. Other parts of the jail…you got some people who think they can handle everything by pushing people around…so if you don’t know anything about that you tend to get taken advantage of….A lot of people here, this is their first time in jail and they think this is Cook County. It’s not. I try to tell them, you think this is bad? Make this your last because this is nothing, this is the tip of the iceberg.

Daniel: Serving time for possession of heroin