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Meet Cook County Sheriff Tom Dart, the Man Who Runs America's Largest Mental Healthcare Provider

When Sheriff Dart took over the Cook County Jail, he didn’t expect that he would eventually be responsible for administering what has become the largest mental healthcare provider in the country.
Photo by Eric Fernandez/VICE News

Tom Dart has been the sheriff of Cook County for the last nine years and oversees Chicago's Cook County Jail, the largest single-site correctional facility in the United States. Over the last few years, following the closure of half of the city's 12 mental health facilities in 2012, he has seen a tremendous rise in the number of inmates who are mentally ill.

Dart estimates that roughly 30 percent of the 9,000 inmates at the jail have some form of mental illness. When he took over the jail in 2006, he didn't expect that he would eventually be responsible for administering what has become the largest mental healthcare provider in the country.


Recognizing the desperate need for reform in the mental healthcare system, Dart is now an outspoken advocate for the mentally ill population housed at his jail. He spoke with VICE News about the difficulty posed by steep budget cuts as well as his office's efforts to help inmates with mental disorders.

VICE News: We're sitting in an area of the jail that you've been able to be shut down because there aren't enough prisoners, but meanwhile another segment of the jail has filled up…
Tom Dart: If for some reason people doubt what I've been saying about how the jails throughout the country — prisons as well — if they doubt that they have not become dumping grounds for the mentally ill, then I would suggest they come here. They would see that the divisions for people without mental illnesses are either empty or half-filled. The ones for people with mental illness are filled to capacity, and the areas where we have the most acutely mentally ill people are always over capacity. I don't make the numbers up, that's just what we have here. And if that doesn't provide the hard evidence that people need to know that jails have been converted from being holding locations for people awaiting their trial to locations where we dump the mentally ill, nothing's going to convince them otherwise.

To what do you attribute this increase in mentally ill inmates?
Our state, unfortunately, has been leading the country in its devastating cuts of mental illness programs and programs for the mentally ill. I mean, they've just been destroyed. In the course of the last five to six years, we've been seeing shutdowns of health clinics in the city of Chicago. They went from having 12 mental health clinics spread throughout the city down to six with no explanation. There was no study done, there was no reaching out to people who are intimately involved with the system to get our input….


They've just cut all these services because they want to save money. The mentally ill are, by and large, a population that is darn close to voiceless other than some great advocacy groups that are really all that's left. But when you think about it, it's the perfect population if you're a hard-nosed budget cutter and you're looking, "We're going to cut and save money," it's the perfect population to go after. They, by and large, have burned through their family connections because of all the different issues they've had over the years. They don't have a sustained lobbying effort, so they aren't filling people's pockets with money. They're a group of people who have been shunned by society for a myriad of reasons, and so when you're looking to where you can make cuts where you're going to get the least pushback, they're the perfect group, and that's what happened here.

The irony is that it actually costs a lot to house these people here, doesn't it?
I would say morally and ethically it's wrong, but then I would say fiscally, this isn't even a sustainable model. This is people being reckless at best, and if a child was doing this, the child would be disciplined, the child would be held back a grade, the child would go sit in the corner. But adults, when they do it, we're all on board or we just ignore it…. This is the reason why people hate government. I mean, there's no thought behind this. And in the end, not only is it hurting people — which it objectively is — but you see that you have an unsustainable financial model where you have people cycling into a system where they don't get any better. They're there for an undefined period of time for no particular reason. It's not like a doctor said, "This person needs this for 120 days." No, no. They're there for just however long it takes, and then they're shot back out into the street, no support mechanisms or whatever. And they come right back in — and all the numbers show that, so this isn't me coming up with some grand theory. All the numbers lay that out. So they come back in and they do it over and over and over and over again, and it costs outrageous amounts of money. And so, what CEO of what company would say that's a really good business model? A CEO that's about to be fired, probably.


It's a vicious cycle.
It's horrible. I mean, honestly. I just can't think to myself that a thoughtful society would agree that this is how we should treat people. I come from such a unique perspective, having been a former prosecutor, that I'm not being confused with someone who is thinking that there are no bad people. I tried and succeeded in putting people behind bars for extended periods of time — their life, at times. There are bad people out there. There are bad people we need to keep away from the rest of society because they'll hurt them. I completely understand that. Boy, do I understand that. But this much larger group is being held in a criminal justice system that was never set up for them, and they don't belong in it. And a thoughtful society would not allow this stuff to go on.

(Photo by Eric Fernandez/VICE News)

How have the 2012 mental health facility cuts affected this jail?
We found countless detainees here waiting on their trial who would come to me and tell me over and over again, you know, "Where am I going to go? What am I going to do? I mean, that was my clinic — I don't know what to do." I try not to lead by anecdote around here. Numbers are a little bit tricky at times to come by because you'd be really hard-pressed to say, "Because that clinic closed, so-and-so is in my custody." That would be really trying to extrapolate something that I don't need to go down. All I need to be able to say is, the cuts were done with no plan, no thought at all, and real people were horribly impacted by them. I've talked to countless people that this has happened to. When you actually sit and talk to these detainees, you'll figure out why it is so devastating….


One of the guys, telling me, was like, "I developed a relationship with my counselor. I've had it for years. We worked together really well." And I'll look at his background and say, yeah, he hasn't been in a lot, and he said, "That was my connection." He's gone now, and the next closest clinic is three bus rides away, transfers. Having to go through different territory of different gangs and things like that. All the different things that a person wouldn't normally think of, but that's the population that would be going to these clinics. They aren't coming in from some well-to-do suburb and having their family drop them off, or they drive there themselves in their BMW. These are folks that are on the edge as it is. And then all of a sudden, to remove the one stabilizing thing that they had, is hard — especially when there was no plan in place, there was no thought.

Now we hear that the new governor's going to cut even more money from the mental healthcare budget.
We've got a new governor in place and everyone always tells me that he's walked into a fiscal disaster in our state, so that's the truth. It's going to require a lot of different strategies to try and address it, so I understand that…. His plan to date has been just across the board cuts to everything, and we had an income tax increase that they allowed to sunset. So that removed a large chunk of money, so that's gone, and the governor said he's not putting that back on the books. They have just talked across the board cuts, and one of the things, as usual, that's high on the list, is the mental health system. And so, that's looking to sustain, I believe, an 80 — I believe it's an $86 million cut. I don't know how the system could sustain that. I mean, the providers that I deal with, the people that I hand folks off to who leave the jail, with the notion that we put a plan together for them to have them leave here and to have a support network in the community so they don't come back. Those providers, I don't know how they're going to be able to survive. They don't have any money.


Isn't that just going to end up being more expensive in the long run, when these people are coming back to the jail — when more people need treatment here?
I can't tell you how many times I sit there and say, am I talking calculus to folks?

It's absurd.
It is. I often, I just think to myself, my five-year-old would get this. Why is it that adults don't get it? And I keep going back to it: It's because they don't care. If they cared, then they would. I mean, they would sit there and say, "Okay. Money doesn't fall from the sky, so we got to figure out a way to make this work." But how can we make this work? You have our governor, he goes and puts together some goofy task force that's going to study the criminal justice system…. Well, two things. One, the criminal justice system's been studied ad nauseam and no one ever implements anything that comes out of the study, and we all know that. I was in the legislature, you've seen this happen a billion times. And two, he puts the group together [and] doesn't include me, who is the largest provider of the criminal justice system. So where do you think that train wreck is going? And yet, that's the reason why everyone's supposed to sit around and wait and wait and wait. "We'll have this grand plan…"

What do you think will come of the study?
I sincerely doubt that the plan will ever come, but more importantly, the way we operate here is that the folks here are real people. Their lives matter. They're real folks. And their stories, when you sit down and talk to them, are heartbreaking stories. Nine times out of ten, they do not deny that they have horribly let their families down. They've hurt their families; their families were great; they burnt them out; they've made mistakes. They're objectively mentally ill, though, and yet you hear these stories and yet we're supposed to treat them like a number? And we're supposed to wait?

We have about 200-some people leave this jail every day, and what am I supposed to do? As they're leaving, say, "Hey, you wait. We're going to get around to a study, we're going to get this thing taken care of in the next 20 or 30 years. You just hang in there, okay?"

What can be done in the meanwhile?
We've put together plans and processes here that are real. That when people leave here, we're giving them pathways to places to go, we help them with housing issues, we help them even with trying to get jobs. We try, more than anything else, to get them to cycle down from the jail setting to get ready to go into communities, and we'll continue to do that. We've often told people that it is by far not a perfect plan — it's not a complete plan yet — but it is a plan, and it is a plan that's thoughtful and is one that's happening immediately. I'm not waiting for some goofy study to come about from the governor's office.

Follow Danny Gold on Twitter: @DGisSERIOUS