Round-the-clock commitment keeps the mentally ill out of jail.
John Fallon (B.S. '83, psychology) first met Kathy Powell at 7:30 p.m. on a brisk April evening. She was standing outside the front doors of the psychiatric treatment center where he works, holding a bundle of clothes and clutching a card with the name of the center—Thresholds. She had been released from Cook County Jail a day earlier than expected, which meant that Fallon had to miss his son's soccer game and rush back into the city to meet her. Waiting until the morning wasn't an option.
Because Kathy is schizophrenic, Fallon knew that every hour counted. When she is on medication, she is able to recall the names of her grandchildren and dream about a future. If her treatment lapses, she becomes disordered, hears voices, and falls prey to the pattern of behavior that landed her in jail in the first place.
"My job is to get people like Kathy to take their medication," says Fallon. "Then, during that short interval when they see the world as the rest of us do, I try to make that world a good one so that they'll stay in it."
Prior to the 1950s, the mentally ill were locked away in institutions such as the gothic-looking state mental health facility in Manteno, IL. Mainstreaming gained favor in the 1960s as the first wave of pharmaceuticals demonstrated that many otherwise disruptive behaviors often could be controlled with medication. Controlled, however, does not mean cured, and therein lies the problem that Fallon is addressing.
"Mental illness happens
seven days a week.
Care has to be the same."
Fallon, 42, is project leader for an innovative program run by Thresholds, a large private psychiatric facility on Chicago's north side. This project provides aftercare to persons coming from Cook County Jail. Called the Thresholds Jail Program, it is trying to break the cycle of drug abuse, incarceration, hospitalization, and homelessness into which many of the mentally ill fall.
At any given time, nearly a quarter of a million mentally ill adults are incarcerated in the country's prisons and jails. While there, they usually receive good care. Problems start, however, when they are released.
"Once they leave custody, there is little or no follow-up, no assurances they will take or can even pay for their medication," says Fallon. "They are let go on a darkened street in the middle of the night with no money, with only the name and phone number of a treatment center scrawled on a piece of paper, and no guarantees that the center has room for them. They are expected to fend for themselves."
Fallon is a long-time advocate of residential and community-based care. While still at UI, he worked as a live-in counselor at a home for runaway teens. When his father died, he dropped out for a year to be a houseparent at a home for emotionally disturbed youth. These experiences, plus the strong background he got at UI in psycho-social behavior, convinced him that caring for the mentally ill, like parenthood, meant being available when needed.
Believing that society pays now or pays later, Fallon and Thresholds try to "be there" for the jailed mentally ill. Participants are recommended to Thresholds by doctors at Cook County Jail. Like Kathy, all participants are nonviolent and responsive to medication even though they may have been arrested and/or psychiatrically hospitalized more than 100 times. Caseworkers meet them at the jail when they are released and find them an apartment in one of the residential hotels near Thresholds so that assistance is readily available. They are given an allowance and taught how to care for themselves and how to hold a job. A caseworker visits every day—including holidays—to ensure that they are taking their medication. The daily contact usually lasts a year but will continue as long as necessary. Fallon has talked with one "member," as Thresholds calls program participants, every day for two years. All caseworkers are on-call 24 hours a day.
This open-ended commitment is a big reason the program seems to be working. During the program's five years, it has helped more than a hundred men and women stay out of jail. Initial results far surpassed anyone's expectations. Incarceration among participants is down more than 80 percent, and hospitalization is down more than 80 percent. These results were so surprising that the American Psychiatric Association gave the program its prestigious Gold Achievement Award for 2002 as the nation's top small community-based program. These results are only achieved one person at a time.
On Kathy's first night out of jail, Fallon found her a room, took her shopping for necessities, and bought her a small radio. She still has the radio even though she bought a larger one last winter with money she earned at her new job.
"Mental illness happens seven days a week," says Fallon. "Care has to be the same."
By Holly Korab