Illinois Mental Health Courts Offer Treatment Over Prison. Is it Working?

We also pored over financial documents, public records, arrest records and watched courtroom proceedings to thoroughly examine the programs, which aim to reduce interactions between those with mental health and substance abuse issues and the criminal justice system.

In today’s newsletter, we also take a look at how emergency rooms are triaging children in mental distress.

Let’s get into it…

Mixed results and uneven access: A look at Illinois mental health courts

Shayla Woodworth struggled with mental illness and addiction since she was a teen and spent time in jail in three states. She’d heard of mental health courts before but didn’t know much about them, and assumed they were a joke.

Then, in 2023, she and her husband stole a car, drove it to the parking lot of a Love’s gas station and fell asleep. They woke up to flashing lights, surrounded by police officers shouting at them with guns drawn. Officers took them to McLean County Jail.

Suddenly, mental health court seemed like it might not be such a bad idea, after all — a way to stay out of prison, change her life and even get her children back.

“I really had to sit with myself and make a decision,” Woodworth said. “I knew that if I went to prison … I was going to keep repeating the same thing.”

Mental health courts have proliferated across the U.S. in recent decades, promising to end vicious and expensive cycles of incarceration by diverting people with mental illness into community-based supervision and treatment. The courts aim to reduce recidivism, increase compliance with treatment and improve quality of life. But the process can be long and arduous for participants who are often navigating poverty, housing instability and social isolation.

When it works it can be life-changing for the people involved. But as our investigation shows, many people who might benefit don’t have the opportunity to participate and those who do face a difficult road to completion. 

Read the full investigation here.

Reforming how we triage kids

When patients come to a crowded emergency department (ED), staff members, usually nurses, need to make quick decisions: Does this person have a serious condition and need prompt attention, or can they wait a little while so the more serious cases can be addressed first? This is the process called triage.

When ED staffers triage children with symptoms of mental health conditions, how good a job do they do? Not very good, according to a recent study in JAMA Pediatrics.  

Only about a third of the cases were triaged appropriately and the majority – about 57% – were “overtriaged,” meaning the condition of a patient was initially judged to be more serious than the treatment they ended up receiving. Just 8% of the entire group was “undertriaged” – meaning their condition was initially judged to be more minor – and that was more likely to happen to Hispanic and Black children than white children.

The study reviewed the cases of more than 74,500 pediatric visits at 15 different emergency departments around the country from 2021 through 2023. It found that younger children were more likely to be overtriaged, said Dr. Jennifer Hoffman, an author of the study.

“Over-triaging typically leads to the patient being roomed earlier, when they actually were safe to wait in the waiting room. This can pull resources away from other children who actually need urgent attention,” Hoffman told MindSite News.

Under-triaging can also have harmful effects for patients, she said.

“If a child who is at risk of harming themselves or another person is in the waiting room for a long time, there is a risk of elopement, which means that they might leave before they’re seen and evaluated by a provider. There’s also a risk of the child becoming escalated while they’re in the waiting room, which could potentially be harmful to other patients and families waiting.”

The findings suggest that triaging behavioral health visits in the emergency department changed based on the patient’s race, age and language spoken, highlighting the need  to improve the assessment process.

While the study didn’t explore solutions — only identify the problem — Hoffman pointed to updating the tools nurses are using to assess patients, providing more guidance on how to assign scores for the assessment and improving nurse education on applying criteria or updating the criteria as ways to improve the process.

Another possible option to consider, Hoffman says: Artificial Intelligence.

“If AI tools are thoughtfully designed and implemented, there is potential for some of that data to be used to help make more objective decisions, instead of relying on subjective judgment, which is more prone to bias,” she said.

(Unless, of course, we build that same bias into the AI model. Just sayin’…)

Until next month,

Josh McGhee

P.S. I’m just back from a short trip to Arizona, where Isabelle Senechal and I accepted a first-place Katherine Schneider Journalism Award for Excellence in Disability Reporting on behalf of MindSite News, Invisible Institute, South Side Weekly and Medill Investigative Lab-Chicago. Reread the award-winning series – “Policing the Vulnerable” – here.