However, a monthslong investigation by the Lee Enterprises Public Service Journalism Team and The Pantagraph show that many of these deaths — whether they are the result of withdrawal, chronic medical conditions or mental health complications — could be prevented.
Jail officials have pointed to a lack of both a sustainable funding source for inmate services and a skilled workforce trained to recognize and respond to medical and mental health emergencies.
Without these assets, the pressure falls more on community-based resources, which the Illinois Legislature has attempted to expand in previous sessions to provide a sufficient level of care for at-risk detainees.
Gov. JB Pritzker said in January that he has attempted to build up mental health care and substance abuse treatment since taking office in 2019. And even if someone is serving time in jail or awaiting a sentencing, it is not right that those individuals be denied access to mental health care.
“The question I think that we're asking and that we want to have answered in the appropriate way is should people who have a substance use problem be serving in jail, or they should they be getting care from the appropriate kind of professionals,” Pritzker said.
One such effort was legislation from Rep. Maurice West , D- Chicago , and Sen. Elgie Sims , D- Chicago , in 2024 that would appropriate $15 million via Illinois Department of Human Services grants for community-based pretrial services, including mental health and substance use disorder treatment. However, this was one of several bills related to jail health care that couldn’t make it out of committee last year.
“I wish it was happening faster, but we're doing the best we can with the available resources we have,” Pritzker said.
But even if those outpatient services were to expand, mental health and substance abuse programs may not accept insurance because insurance doesn't offer a high enough reimbursement rate for services.
“Many providers just don't take insurance period because it doesn't reimburse high enough and the paperwork is too much,” said Rep. Lindsey LaPointe , D- Chicago . “But that is most acute when we're talking about Medicaid.”
This year, LaPointe reintroduced legislation seeking to establish more parity between behavioral health and physical health care coverage. This bill would get signed into law on Dec. 12 .
“Both our behavioral health care providers, who do the essential work of keeping our communities safe and healthy, as well as the average Illinoisan looking for care deserve to be heard and seen,” LaPointe in a news release.
She also said additional funding streams and special programs are a useful temporary solution but the focus should be on ensuring that people have access to health care and are connected with a larger network of resources.
"Whether you touch the criminal justice system or not, we've let our (health care) systems erode," LaPointe said.
Staffing Incentives
Without additional funding, nursing and medical staff positions in correctional settings are unable to remain competitive with other private health care opportunities.
But according to some jail administrators, incentive programs meant to level the playing field don’t always work. Macon County Jail Administrator Jamie Belcher said he’s been advised by the jail’s health care contractor, Quality Correctional Health Care, that signing bonuses and other incentives offered by the company have been unsuccessful across all seven states where they represent jails.
A number of incentive programs are available to recruit medical and behavioral health professionals into underserved regions and facilities, including the National Health Services Corps at the federal level and the Community Behavioral Health Care Professional Loan Repayment Program at the state level.
Although many of these programs are aimed to recruit these individuals to work in Illinois' prisons, jails aren't always seen as eligible institutions by these programs.
In 2023, U.S. Sen. Dick Durbin , D- Illinois , called for the Health Resources and Services Administration to include Cook County Jail as an eligible site under the National Health Services Corps . He was joined by Sen. Mark Kelly of Arizona , who wished to make Maricopa County Correctional Health an eligible site.
The NHSC offers scholarship opportunities and loan repayment options for doctors, nurses, dentists and behavioral health care providers willing to work in underserved institutions such as prisons and community mental health centers.
“Given the unique circumstances and challenges associated with providing health care in a correctional facility, county-run jails face significant barriers to recruitment of qualified health professionals," Durbin and Kelly wrote. "While federal and state correctional facilities are eligible for the scholarship and loan repayment incentives afforded by the NHSC, a 1989 federal regulation narrowed eligibility to exclude county jails."
A funding bill that passed out of the Senate Appropriations Committee last year included language directing HRSA to brief the committee on how to develop a process to provide county correctional facilities the opportunity to participate in the NHSC if they meet program requirements.
But as of October, no county jail is eligible as a NHSC site.
The state's Community Behavioral Health Care Professional Loan Repayment Program offers loan repayment assistance to qualified mental health and substance abuse professionals working in community mental health centers.
Although the list of eligible workplaces expanded starting in fiscal 2025, Lynne Baker , managing director of communications for the Illinois Student Assistance Commission , said county jails still are not on the list of facilities that meet the requirements of a community health center under this program.
Richard Forbus , vice president of program development for the National Commission on Correctional Healthcare , said that even if these incentives were available to county jail employees, there isn't an avenue to provide these benefits to health care employees from outside contractors.
"The problem with those programs is it's typically limited to a public employee or it's a program offered at the state or federal level for offering those incentives," Forbus said. "So that's why I don't think you see it as much in the jails, because I would tend to think on my end, you're going to see more county jails using contractors than county employees."
Melissa Caldwell , president of behavioral health services for Freedom Behavioral Health , which originally operated under Advanced Correctional Healthcare , said her company offers incentives to recruit behavioral health professionals but cannot apply for federal programs.
"I've worked in prison systems where the workers were eligible for federal loan repayment," Caldwell said. "And unfortunately, private health care providers such as the one that I work in are not eligible and we're explicitly denied eligibility."
In response, Caldwell said her organization is exploring the expansion of incentives for county jails, even if private health care contractors are not the direct recipients.
CCBHC and Community Resources
In 2023, the Department of Human Services was tasked with submitting a strategic plan to improve access to and overall capacity of state-operated psychiatric hospitals in Illinois .
One of the top priorities of this plan was to expand patient options and capacity beyond that of the state's four main mental health centers. In order to accomplish this, DHS would need to simplify the processes required for local providers to take on patients in existing state-operated programs and make it easier for those providers to receive funding for the creation of new services.
Some jails offer programs that attempt to restore detainees with severe mental health issues or substance use disorders without intervention from the state.
McLean County , in particular, coordinates with the Inmate Services Bureau to provide medication and treatment to individuals unfit to stand trial. This has allowed the McLean County Jail to restore multiple detainees deemed unfit to stand trial to be restored to a level of competency without the need to be transferred to an inpatient facility. Several other detainees found not guilty by reason of insanity were able to be connected to community-based treatment with an inpatient transfer to a state psychiatric facility.
But for smaller counties like Woodford , which have no diversion programs or community partnerships to support at-risk detainees, it may be difficult to establish a state-funded framework for mental health care.
"Most counties are just like us," Tipsword said. "We have no services for them so until we start dealing with the mental health issue outside of jail, this is where everybody's going to end up."
Otwell said DHS continues to work with its partners in law enforcement, the courts, mental health advocates, and community providers to identify and implement solutions to this forensic challenge.
One possible community-driven avenue is the piloting and establishment of Certified Community Behavioral Health Clinics.
Last year, the McLean County Center for Human Services was one of a handful of facilities across the state to receive a four-year grant from the Substance Abuse Mental Health Services Administration .
The money is meant to help implement substance abuse and mental health services that could help local recipients become Certified Community Behavioral Health Clinics . With this designation, community-based treatment centers are eligible for an enhanced Medicaid reimbursement rate based on the anticipated cost of these expanded services.
Kim Freymann , chief clinical officer for the Center for Human Services , said there are nine core services a CCBHC must provide, including outpatient mental health and substance abuse services and psychiatric rehabilitation.
But if these services were expanded to inmates deemed unfit to stand trial, Freymann said she has a concern that is shared by numerous jail administrators: the inability to force a patient to follow a court-ordered medication or treatment regimen.
"We certainly can set somebody up with our prescriber and prescribe medications," Freymann said. "But if somebody doesn't come in to take their medications or pick up their medications or they don't take their medications, there's nothing that we can do about that except report that back to the courts."
However, CHS works closely with the McLean County Jail to complete a screening for detainees in need of mental health services once they’re released whether it be psychiatry, case management or counseling services.
“Also, if there’s ever an issue with a crisis that’s going on in the jail with one of their inmates, then they’re able to notify our crisis team or mobile crisis team,” Freymann said. “And then they’re able to provide those services to them as needed.”
But as a certified clinic, Freymann said CHS will be able to expand substance abuse services and address behavioral health care as a whole.
Freymann added that she hopes to use a portion of the funding to hire an internship coordinator who can collaborate with local universities to provide internship opportunities at CHS that could grow into full-time employment.
Illinois is one of ten states participating in the CCBHC Medicaid Demonstration Program. As part of this, the state has provisionally certified 19 locations that were determined to be ready to implement all state and federal CCBHC requirements.
Included in this list is Chestnut Health Systems , which is seeking state and federal certification at its facilities in Madison and St. Clair counties.
Certification processes at the state and federal level are similar, according to Chestnut's Chief Clinical Officer Matt Mollenhauer , but states are empowered to add more criteria.
Mollenhauer said the reason it won't be seeking state certification at its McLean County facilities is because they wouldn't fulfill all nine CCBHC criteria. Therefore, it would require a collaborative agreement between agencies like the Center for Human Services to gain CCBHC status.
Chestnut Health Systems is on the fourth year of its federal CCBHC grant. Mollenhauer said once the federal grant elapses, Chestnut will make determinations on how to proceed with the state certification process in other regions.
"What is, I think, a little misunderstood when you get a federal grant for CCBHC is that it's really not improving volume of care," Mollenhauer said. "It's about helping you build the infrastructure so that care can be more efficient."
Potential Consequences
Behavioral health workforce shortages not only leave jails short-handed but also bleed into certain community-based measures that prevent law enforcement agencies from getting involved with non-violent mental health crises.
In 2021, Gov. JB Pritzker signed into law the Community Emergency Services Support Act, or CESSA.
This law requires emergency response operators to refer calls seeking mental or behavioral health support to a service that can dispatch a team of mental health professionals as opposed to police. Law enforcement is also integrated into this process to divert offenders who commit low-level, non-violent misdemeanors to proper resources.
CESSA’s implementation deadline was 2025. However, Senate Bill 2500, which was signed into law in August, extended the implementation deadline to July 1, 2027 .
Rock Island County Sheriff Darren Hart said the issue he is having is finding enough staff to offer this kind of assistance.
"Every day, I get a blotter and a blog that comes through and shows me all the incidents that my staff are going to and domestics and individuals who are suffering from mental health challenges (or a) mental health crisis," Hart said. "Those are rising and they have continued to rise throughout my career.”
A reliable funding source is also a concern.
"When you put these types of responsibilities on law enforcement, there has to be a funding mechanism for us to keep up with this from the training aspect (and) from the medical aspect," Hart said. " The Rock Island County Sheriff's Office is a very large expenditure to the citizens here in Rock Island County ."
"My budget is nearly $15 million and it will never decrease," he added. "It will continue to go up with the level of care we're trying to provide and these medical services."
IDHS pretested the scripts and protocols 911 call centers will use to assess a situation in August. These protocols will then be piloted by the three IT vendors that will help to handle calls.
“Each set of pilots will include metrics to evaluate the response, the adequacy of training of the telecommunicators, and any other unexpected issues that arise,” said Daisy Contreras , DHS deputy director of communications. “The overall goal of this testing is to ensure that the systems work correctly, that the training is effective, and that individuals in need of care receive the appropriate response.”
But for a smaller county like Woodford that lacks practicing behavioral health professionals, Tipsword said law enforcement will have to call on support from Peoria or Bloomington . And as counties get smaller and more rural, that challenge escalates.
"Often times we try to legislate to one specific problem that happens somewhere," Tipsword said. "It may be absolutely valid and it's fixed but when you're painting with such a broad brush for the entire state, those downstream unintended consequences for everybody else sometimes is too much to overcome."
Jud DeLoss , chief executive officer of the Illinois Association of Behavioral Health , said one of his organization's concerns with CESSA was the removal of community crisis workers’ ability to petition for involuntary commitment. This course of action is not one that behavioral health professionals incentivize or prioritize but it may be necessary to ensure an individual’s safety and the safety of others, he added.
“If mobile crisis responders’ hands are tied, what happens to the individual if no one is able to step up and petition for involuntary commitment?” DeLoss asked. “Law enforcement can respond but if they didn’t witness the danger or potential danger of the situation, they may not want to step up.”
State law further limits involuntary commitment by preventing inpatient or outpatient referrals for individuals charged with a felony.
Mark Heyrman , director of the national nonprofit Mental Health America , said this has been in effect since the 1970s to prevent jails from furloughing their inmate populations to state-operated mental health facilities, which offered thousands of beds for at-risk patients at the time.
But as funding and staffing at these facilities have deteriorated over the past 50 years, the opposite has happened: inmates in need of mental health treatment are stuck in jails that are unequipped to help them for months until one of the roughly 1,000 IDHS beds becomes available.
However, involuntary commitments do occur under special circumstances. McLean County Jail Superintendent Diane Hughes said the Inmate Services Bureau has worked with courts, when appropriate, to divert someone to a local hospital on an involuntary petition for inpatient mental health treatment.
But even with the limited legislative change that has occurred, law enforcement officials say there is no universal solution to addressing jail health care.
“I think if any of us had the magic answer, we would all use it today. And we would solve this problem,” Hart said.
Tens of thousands fewer women were incarcerated in the U.S. between 2019 and 2020 due to COVID-19, but as prison populations creep back to pre-pandemic norms, more children are being separated from their mothers, putting them at greater risk of health and behavioral problems, and making them vulnerable to abuse and displacement. Black and Hispanic women are more likely to be imprisoned than their white counterparts and are disproportionately affected by family separation due to incarceration. Rare programs like the Reunification Ride, a donation-dependent initiative that buses prisoners’ family members from Chicago to Illinois' largest women's prison every month so they can spend time with their mothers and grandmothers, are a crucial lifeline for families, prisoners say.
©2026 the Billings Gazette, Distributed by Tribune Content Agency, LLC.
