Cook County Sheriff’s Office (Thomas J. Dart)
As a growing body of research documented evidence that disciplinary isolation exacerbated mental health problems and inflicted lasting harm and trauma, Sheriff Tom Dart, a nationally known advocate for mental health treatment in prisons and jails, ordered a halt to practices that confined people to their cells for 23 hours a day as punishment for serious offenses. New procedures, intensive staff training, and programming enhancements formed the basis of a new initiative at the Cook County Jail, first called the Special Management Unit and now the Rehabilitation Unit.
The goal of the Rehabilitation Unit is to provide a more humane and effective approach to disciplinary issues that produces better outcomes for both staff and detainees. Systems were designed to impose accountability, acknowledge mitigating mental health conditions, and provide detainees with more time out-of-cell to allow for positive interactions aimed at improving behaviors. The overall improvements in conditions in these units decreased the levels of violence in the Cook County Jail for both detainees and staff. Since 2016, the number of fights, batteries and Uses of Force on RU tiers have declined dramatically.
This reform grew out of Sheriff Tom Dart’s longstanding desire to use jail programming and practices to improve outcomes for detainees and eliminate solitary confinement and disciplinary segregation, measures that were proven to be ineffective in changing behavior. The effort coincided with oversight by the Department of Justice growing out of a 2010 consent decree to improve jail conditions. Conducing mental health assessments in determining disciplinary sanctions for detainees was among the consent decree goals, and Sheriff Dart broadened that goal to include achieving better outcomes by reducing in-cell time and providing structured socialization through programming abas well as interactions among detainees and between detainees and a consistent cadre of staff.
A multi-disciplinary committee including mental health care providers and jail officials was already meeting to discuss and review cases of concern. Early on, mental health officials were asked to provide assessments of individuals facing disciplinary proceedings to determine if mental status was a mitigating factor in the behavior. By 2014, mental health professionals were also determining if a persons’ mental health status should prevent their transfer to a disciplinary unit and whether the period of confinement there could extend beyond 14 days. This provided the groundwork for the subsequent iterations of the disciplinary units including the Special Management Unit in 2016 and then the Rehabilitation Unit in 2018.
There are three approaches to disciplinary housing, each tailored to meet the specific challenges of various populations and their mental health needs.
First, disciplinary actions lodged against detainees experiencing acute mental health conditions are held in abeyance. If their condition improves, decisions are made about whether to move forward, though commonly charges are dropped due to the mitigating mental health factors.
Second, those with serious, but not acute, mental health conditions (SMI) found guilty of disciplinary infractions are housed in special RUs in the Rehabilitation Treatment Unit (RTU), a jail division that provides higher levels of medical and mental health care. They are out of cell for socialization with staff and other detainees at least three hours a day in addition to time out for programming that includes group therapy, and movement for court and medical appointments.
Finally, there is the Rehabilitation Unit (RU) in Division 9, the compound’s maximum-security facility, where people not suffering from serious mental illness serve disciplinary time.
No one is placed in either RU without first being cleared by a mental health specialist.
For certain serious offenses—such as batteries against staff or others, sexual offenses, indecent exposures, or possession of weapons in the institution—detainees are automatically moved to the RU following clearance by mental health. A disciplinary hearing takes place usually within 72 hours. Others, facing less serious offenses, are not moved to the unit until guilt is determined and sanctions are imposed by the hearing board.
People in RU/Div. 9 are out of their cells for at least 4 hours a day in addition to time out for court or medical movement. Time out includes structured programming as well as unstructured activities like outdoor recreation. While in the dayroom, they interact with officers stationed there and other detainees. Out of cell time is also used for showers and phone calls. Roughly half of the unit is out at a time in groups of 6 to 10.
When out-of-cell, detainees are handcuffed and shackled to stationary objects—tables in Division 9 or floor holds in the RTU. Mental health professionals make rounds in the RUs several times a week and have the authority to remove individuals if they determine that the detainee’s mental health is being negatively impacted.
Other RU restrictions on both units include limitations on phone calls to 15 minutes a week, restricted visits, and commissary limited to personal hygiene products.
The maximum stay in RU is 29 consecutive days in Division 9 and 14 consecutive days in the RTU, per policy. People can be sanctioned for more than those limits, however, on the 14th or 29th day in the RU, the detainee must be released. They generally return to GP for a night before returning to the RU to serve the remainder of the sanction if approved by mental health.
The RU in Division 9 is staffed by the Special Management Team (SMT). Officers must meet certain qualifications and specifically apply for this assignment. They also must meet ongoing performance standards or face removal from the team.
Staff in the RU are specially trained to look for symptoms of mental health illness and have received Crisis Intervention Team (CIT) training.
The RU has seen promising results concerning the incarcerated population and staff. An analysis of the SMU/RU from January 1, 2017, to July 3, 2019, found that 58% of people assigned to RU never returned to RU during that booking, and another 17% only returned to the RU once. Violent incidents such as fights, batteries, and uses of force have also decreased on RU tiers since the implementation of these reforms in June 2016. In November of 2020, there was a single battery to staff per 100 RU people compared to 10 per 100 detainees prior to the implementation of reforms in 2016. In addition, Uses of Force stood at 2 in 2020 per 100 detainees compared with 11 in 2016. In 2020, flights reached a record low with no recorded incidents in a six-month period. The staff has also responded positively to the reforms—although they were resistant in its early stages—especially considering the increase in safety in these units.
Line staff plays a key role in the success of the RU. Their support for and commitment to the reforms were essential for the safety of all that live and work in these units during implementation. Replicating a unit like this at other jurisdictions requires cooperation from the staff at all levels of a facility and engaging key stakeholders who have a vested interest in the quality of working conditions in a facility—such as the corrections’ officer union. Departments should also invest time and resources in communicating the reforms and reasons for reform to staff and allow feedback during planning.