Courts as conveners and leaders

10/8/2024

"Judges are in a unique position to gather stakeholders and facilitate cross-system change."

State Courts' Responsibility to Convene, Collaborate, and Identify Individuals Across Systems

The primary goal of the convening was to explore shared policy and practice commitments to improve mental health, financial, and justice outcomes across the Competency to Stand Trial and Competency Restoration process. Attendees included judges, attorneys, sheriffs, mental health providers, policy makers, and advocates. The meeting concluded with a summary of activities emphasizing the need for collaboration among all stakeholders to address system pressures. Planned court-driven activities include, but are not limited to, increased multidisciplinary training events, identifying and implementing processes to capture data which is critical for policymakers and courts to make informed decisions about what is working well and where changes are needed in the competency to stand trial process, and statewide implementation of the Competency to Stand Trial Court System Assessment Tool, which was designed for judges and court personnel to examine the status of practices, policies, and resources in their jurisdiction, relating to competency to stand trial and related behavioral health systems.

Furthermore, Illinois Department of Human Services (IDHS) provides the following update on the challenges, efforts, and progress of the Forensic and Justice Services Bureau.

Post-COVID, the number of individuals being referred to IDHS for forensic treatment has increased at an alarming rate. Since 2020, the number of forensic referrals from the courts has doubled and as a result, we are seeing an unprecedented number of individuals waiting for inpatient admission. The current landscape has created critical challenges for the Department, even as we work feverishly to maximize internal capacity, expand diversion alternatives, and develop demonstration pilots to meet the needs of the forensic population. The following are some of our efforts and progress:

IDHS is acutely aware of the increasing numbers of affected individuals in jail custody throughout the State. Our forensic staff is working diligently to assess IDHS referrals promptly and to monitor their condition biweekly, at a minimum, for decompensation. In accordance with the least restrictive setting mandate, the Department is also looking for opportunities to redirect forensic referrals to outpatient treatment - wherever appropriate. Our forensic evaluators maintain contact with jail staff and regularly communicate with the courts regarding a detainee's expected admission date, in accordance with 725 ILCS 5/104-17(b).

We have also shifted our process to prioritizing admissions to the first available bed, regardless of catchment area, in an effort to expedite these placements. In addition to adding another 12 beds to our contract with Ingalls Memorial Hospital in Harvey, IL, bringing it to 24 beds, we have operationalized the 12-bed, Kankakee County jail-based mental health services pilot, which is designed to house detainees from smaller jails and provide contracted mental health treatment services to justice-involved individuals waiting for an inpatient bed at IDHS. Although these efforts have impacted our overall system positively, the Department remains challenged by the overwhelming number of referrals it continues to receive statewide.

Notably, IDHS has increased its overall inpatient capacity by 125 beds over the last two years. Unfortunately, since the pandemic, the courts have dramatically increased forensic referrals from a monthly average of roughly 50 prior to 2020, to, most recently, a high-water mark of 120 in May. The bottom line is that despite the Department's efforts to increase capacity and reduce wait times, it is simply unable to keep up with the pace of referrals by the courts. IDHS has also enhanced its outpatient treatment provider network and continues to maximize the use of outpatient restoration wherever appropriate. On top of this, the Department continues to implore the courts to return to the Sheriff individuals whom the Department has reported as fit, in order to make room for new admissions. In the end, our goal remains the same: to comply with State law and to admit individuals to inpatient treatment in 60 days or less. To that end, we have our staff working diligently to find capacity anywhere in can and as soon as operationally possible.

The Department's staffing challenges, reflective of national trends that are causing shortages of healthcare workers around the country, have also impacted its ability to keep pace with the courts' ever-increasing forensic remands. Although the Department has engaged in considerable recruitment efforts, which include salary increases and the engagement of contract staff, it is nevertheless unable to consistently staff every bed in the system. This has caused some courts to conclude that the Department has not done enough to resolve the staffing crisis when nothing could be further from the truth. All providers across the nation are feeling the crunch, and that includes county jails that struggle to attract and retain staff. The Department is acutely aware of this crisis and is working diligently to resolve it.

Other DHS efforts that will impact the entire forensic system include refurbishing the Willow building on Alton MHC's campus. Through a renovation project handled by the Capital Development Board, this project, upon completion, will add an additional 100 beds of inpatient forensic capacity to the system. The current estimate is that the project will be completed and ready for occupancy at the end of 2025. Through our strategic plan and in working with the Institute of Healthcare Delivery Design, we are also implementing strategies to find inpatient candidates who are suitable for community placement and may be appropriate for step-down to lesser restrictive settings. All of these efforts are geared towards providing additional capacity for the admission of forensic individuals and reducing wait times for individuals in jails.

Finally, IDHS is looking for opportunities to further expand housing resources in areas across the State, and in Southern Illinois in particular, which would help stabilize those released into the community and further reduce recidivism. We are optimistic that our continued and combined efforts will not only improve the admissions timeframe for all IDHS-referred detainees, but also reduce the number of justice-involved individuals who are re-entering the system after a prior admission.

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