On October 20, 2020, The National Judicial Task Force to Examine State Courts’ Response to Mental Illness and the State Justice Institute hosted the fourth of five virtual sessions to support the Illinois Supreme Court’s continuing efforts focused on coordinating solutions for individuals living with mental illness. The session began with welcoming remarks provided by Sara Feigenholtz, who represents the sixth district in the Illinois Senate, and Heidi Mueller, director of the Illinois Department of Juvenile Justice (IDJJ).

Senator Feigenholtz, who has focused on healthcare access and delivery issues during her legislative tenure, stated that while Illinois has made some progress regarding policy and funding to address mental healthcare delivery and access, it still has a long way to go. She said that historically mental health treatment has been provided in clinical settings, but that health care policies are being contoured to deliver treatment in more effective ways. Sen. Feigenholtz described the combination of the COVID-19 virus and the death of George Floyd as game-changers, bringing trauma center stage and amplifying not only the gaps in mental health care access, but the intersection of racial injustice and inequality. These recent events have made it clear to policymakers that regressive laws and policies need to be viewed and approached with a different lens—especially for youth. She emphasized the need for a paradigm shift aimed at rehabilitation that addresses, not exacerbates, trauma, promotes a culture of stability and non-violence and provides alternative policies for when individuals experience the criminal justice system.

Director Mueller remarked that, like mental health, trauma is a public health issue. She compared trauma to a virus that requires inoculation and mitigation. She stated that IDJJ has observed the fall-out of the failure to address the issue of trauma among the youth they serve. Seventy-five percent of boys and 95 percent of girls in IDJJ custody have experienced two or more significant traumas in their lifetime. Ninety-five percent of these youth have at least one diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, and 76 percent have three or more such diagnoses. Seventy percent have experienced the impact of ongoing generational systemic racism. Director Mueller noted that IDJJ’s transformation model recognizes the need to utilize instruments of healing such as love, compassion, hope, and connectivity rather than isolation, fear and loathing.

The first keynote speaker was former U.S. Rep. Patrick J. Kennedy, who has gone on to found The Kennedy Forum and co-found the One Mind Campaign. During his 1995 to 2011 tenure in the U.S. House of Representatives, he was the primary sponsor of major mental health and addiction equity legislation. He noted the historic lack of prevention in the juvenile justice system and the failure to recognize the role that trauma plays in determining whether youth enter the criminal justice system, particularly in minority communities. Although this failure rendered the civil and human rights of these individuals incomplete, for many years politicians at the highest levels were content with doing nothing. Kennedy stated that the criminal justice system is not working and is too costly in terms of money and human justice. He explained that reform must occur in tandem with real recovery and chronic disease management using a series of treatment modalities, which will require policy changes to mental health and education systems.

Congressman Kennedy observed that with the convergence of the COVID-19 pandemic and the Black Lives Matter movement, people understand what it is like to be second class Americans and are primed for change. Anxiety and depression are not treated the same as other illnesses and often go untreated until Stage Four. The life expectancy plateau is thus going down, resulting in many preventable deaths. Due to the interrelationship of criminal justice, education and mental health, Kennedy stated that we need to support the mental health of youth in schools and their families. This will require embedding social-emotional learning and stress management skills in school curricula. Currently, teachers have no skills to help these youth.

Kennedy closed by observing that we have an historic opportunity for change in the criminal justice system and a need to build advocacy across systems. He emphasized the need to reduce the time spent on police response, adjudication, sentencing and parole and invest and reallocate dollars to achieve a more effective and meaningful outcome. Using advocacy groups to get the message across to mandate recovery and help others to become self-advocates is critical to achieving this change.
The second keynote speaker was Sarah Y. Vinson, M.D., a board-certified adult, child and forensic psychiatrist and author. Dr. Vinson began her presentation by providing definitions of key terms and concepts, including mental illness, social justice, racism, health inequities and structural trauma and outlining the principles of social injustice. Dr. Vinson stated that everyone is on a continuum between mental illness and mental health and that everyone can go one direction or the other on that continuum based on certain risk factors and the impact of biological, psychological and social considerations.

With respect to trauma, Dr. Vinson explained how the development of a child’s positive sense of self is dependent on the caregiver’s benign use of power. A solid foundation for this development is comprised of a true home, reliable caregiver, educational opportunity and access to health care. Dr. Vinson stated that poverty is a poor foundation for this development due to the lack of a true home (due to housing instability and food insecurity), impaired caregivers (who are poorly supported, have low wages and lack mental health treatment), unmet educational needs (which are often segregated and under-resourced) and limited access to health care (due to gaps in coverage and capacity that translate into untreated illness). Dr. Vinson stated that 15 million children in the U.S. are living in poverty. Forty-three percent of children in the U.S. are in low income families, and the majority of children living in poverty are white.

Dr. Vinson discussed the impact of early trauma on children as evidenced by the experiences of justice-involved youth. Ninety percent of those youth have had at least one incident of trauma and 80 percent are low income. Seventy percent of those youth have a mental illness. However, she said that racial and structural trauma are not counted when diagnosing those youth and not counted in the instruments used to assess and evaluate them. This lack translates into problems in our courts and produces reliably racist outcomes. Eighty percent of state judges are white. The majority of people in jail are black or brown and their sentencing outcomes often differ. They are less likely to be referred for a mental health evaluation or a diversion program.

Dr. Vinson noted that similar racial inequities exist in our healthcare system. A study done in 2018 revealed that 69 percent of black adults with mental illness and 42 percent of black adults with serious mental illness were untreated. Sixty-seven percent of LatinX adults with mental illness and 44 percent of LatinX adults with serious mental illness were untreated. Eighty-nine percent of LatinX adults with substance abuse problems and 88 percent of black adults with substance abuse problems received no treatment. Dr. Vinson stated that cost was the most cited reason for not seeking treatment, meaning that the system is not accessible.

Dr. Vinson stated that to judge everyone by the same (race neutral) criteria is ineffective because society is not race neutral and people of color do not have equal access to tools and opportunities. She stated that to effectuate meaningful reform we must develop a knowledge base, understand injustice and our role in addressing it and respond to injustice. To underscore that point, Dr. Vinson closed her presentation with a quote from James Baldwin: “Ignorance allied with power is the most ferocious enemy.”

This session was informative, thought-provoking, timely and worthy of review. It is available on-demand online at www.ncsc.org/mentalhealth (along with the other four sessions).

Cheryl Jansen is a public policy director, Equip for Equality in Springfield.