Cook County Jail in Chicago has been described by academics, journalists, and Sheriff Tom Dart himself as the largest mental health facility in the United States — not by design, but by default. On any given day, an estimated 30–35% of the jail's population has a serious mental illness: schizophrenia, bipolar disorder, major depression, or another condition that, in a different system, might be treated in a hospital or community setting.
How the Jail Became a De Facto Psychiatric Hospital
The roots go back to the deinstitutionalization movement of the 1960s–1980s, when state psychiatric hospitals were closed across the country — including in Illinois — without adequate community mental health infrastructure to replace them. People who would previously have been treated in hospitals ended up cycling through emergency rooms, homeless shelters, and jails. Cook County, as the hub of Illinois's largest metropolitan area, absorbs a disproportionate share of this population.
Sheriff Dart's Response: NAMI Partnership and Mental Health Unit
Sheriff Tom Dart, who has held office since 2006, has been unusually vocal about the problem and has pursued in-jail mental health programming as a partial response. The jail partners with the National Alliance on Mental Illness (NAMI) Cook County to provide peer support, family education (the NAMI Family-to-Family program), and navigation services for people leaving the jail who need to connect with community treatment.
The jail operates dedicated psychiatric and mental health tiers staffed by Cermak Health Services, the Cook County Bureau of Health Services division that provides all medical and mental health care inside the jail. Cermak employs psychiatrists, psychiatric nurses, and counselors. Medication continuity — ensuring that people who enter the jail on psychiatric medications continue receiving them — is a core focus, because abrupt discontinuation can trigger psychiatric crises.
Limitations and Criticism
Critics, including the MacArthur Foundation's Safety and Justice Challenge (which has funded Cook County reform efforts), note that jails are structurally ill-suited to treat serious mental illness. The coercive environment, noise, isolation, and instability of jail contradict the environmental conditions that mental health treatment requires. The Cook County Public Defender's Mental Health Unit advocates for diversion to community treatment as an alternative to incarceration for many clients.
Diversion Options
Cook County has developed several pre-arrest and post-arrest diversion programs. The Crisis Assistance Response and Engagement (CARE) program deploys mental health clinicians with police to non-violent mental health calls. The Behavioral Health Leadership Office coordinates post-booking diversion for people with mental health diagnoses into treatment courts and community services.