In Chicago, triage for mentally ill before jail

CHICAGO (AP) - One of the nation's most crowded jails may get relief later this year with the opening of a 24-hour triage center in Chicago where police can take people experiencing psychiatric or substance-abuse crises. The goal is to ease pressure on the county jail, where officials have long complained that about a fifth of the detainees are locked up because of mental health problems.

Based on successful models in other cities, the initiative comes as the Chicago Police Department and Mayor Rahm Emanuel try to deflect criticism over high-profile police shootings of young black men where mental health may have been a factor.

Advocates for the plan, which Cook County officials shared with The Associated Press ahead of an official announcement, say it will work only if officers are properly trained.

"In a perfect world, one would hope officers observing a person with a mental health problem would get them to a treatment center," said Dr. Jay Shannon, chief of Cook County Health & Hospitals System. "I don't think it's as simple as 'build it and they will come.'"

Nationally, as mental institutions closed in recent years, jails in large and small cities saw a surge in inmates with serious mental illnesses, most of them arrested for nonviolent crimes. This year, the county will spend $80 million for all health care, including mental health treatment, for adult and juvenile detainees.

Cities smaller than Chicago with triage centers have reaped savings in jail and hospital costs. San Antonio, Texas, documented annual savings of $2.4 million in jail costs tied to public intoxication, $1.5 million in jail costs for mental health and $1 million in emergency room costs. Minneapolis saved $2.16 for every dollar spent on its triage center. Salt Lake City reported emergency room use by mentally ill people in crisis fell by 90 percent.

"You can expect implementing a crisis triage unit will result in reduced use of the jail, which will make Sheriff (Tom) Dart happy, and also more cost-efficient use of the health care system and reduced pressure on emergency rooms," said Dan Abreu, an Albany, New York, researcher who provides technical assistance on jail diversion programs.

In 2012, Chicago closed half its mental health clinics and the state closed three mental health centers, including a psychiatric hospital in suburban Chicago. Dart, who has complained about the Cook County jail becoming a "dumping ground" for the mentally ill, told The AP he believes the triage center's success will hinge on whether police are well-trained.

"The concept is great. I'll never argue against more mental health services, but you have to think through the details," Dart said. Nearly all of his force has mental health crisis intervention training, he said, but Chicago and surrounding cities lag behind.

Shannon, the county's top health official, said two notable police shootings - Quintonio LeGrier and Laquan McDonald - might have been avoided with a functioning triage center and officer training.

LeGrier, a 19-year-old with mental health problems, had called 911 three times for help on Dec. 26. The officer who fatally shot him said LeGrier was coming at him with a bat. A police report said 17-year-old McDonald, who died after being shot by an officer 16 times, showed "irrational behavior," such as ignoring verbal directions and "growling." A medical examiner's report said the hallucinogen PCP was found in his system.

Spurred by the uproar over those shootings and others, Chicago is training more officers in de-escalation strategies to employ with people in crisis. By the end of the year, about 35 percent of street officers will have that training, said Chicago Police spokesman Anthony Guglielmi.

"We are excited and eager to start using the (triage) facility," he said.

A triage center "would save hundreds of thousands of dollars. It would save lives," said N'Dana Carter, who gets counseling at one of the city's remaining mental health clinics.

She and others affected by mental illness protested the closures and demanded more services recently outside Emanuel's office, and collected citizen comments to deliver to the embattled mayor in black trash bags they called "body bags."

The center would be located at an existing outpatient clinic on Chicago's South Side in an area that county data shows sends the most people with mental illness to the jail.

Cook County's health system has budgeted $3 million for its operation, including staffing with master's level therapists - though experts say that figure may need to grow. Community providers of mental health and substance abuse treatment would provide follow-up care.

"We treat any behavioral health need at any time," said Dr. Margie Balfour, chief clinical officer at Tucson's Crisis Response Center, which has a budget of $25 million in a county with one-fifth the population of Cook County. "No one is too acute or too violent. ... We never say no to the cops."

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Follow AP Medical Writer Carla K. Johnson at https://twitter.com/CarlaKJohnson