32 United States The EconomistAugust 10th 2019
W
hen it comesto the treatment of
mentally ill people, says Tom Dart,
“in future people will look back and call us
evil.” Mr Dart, who serves Cook County in
Illinois, may be the most interesting sher-
iff in the country. America locks up the
mentally frail “out of indifference”, he says.
Behind bars, with few officers trained to
help, the sick grow more troubled and like-
ly to reoffend.
In Chicago Rahm Emanuel, the previ-
ous mayor, closed six of 12 public-health
clinics in 2012. Sheriff Dart thinks that re-
sulted in more ill people losing their way,
going off medication, getting arrested and
being dumped in his gargantuan, crum-
bling jail on the city’s South Side. His staff
say that of nearly 40,000 people who pass
through yearly, 37% (as of mid-July) suffer
some form of mental ailment.
Early in his term (he was first elected in
2006) the sheriff, a former Illinois lawmak-
er, tried raising awareness. He calls the ne-
glect of mental health chronic, inhumane
and costly. Imagine if we treated diabetes
by locking sufferers in a small room, he
says. But as Alisa Roth writes in “Insane”,
published last year, the prison system has
been known as a warehouse for the mental-
ly ill for decades. She cites a federal study
that suggests 75% of female detainees suf-
fer mental illness.
The sheriff’s response has been to try
making his jail “the best mental-health
hospital” possible. He has done away with
solitary confinement, a practice which has
long been known to cause and worsen
mental woes. (Doing so has also cut staff
assaults, he says). He appointed psycholo-
gists as jail directors and hired medically
trained staff in place of some guards. In-
mates can take courses in yoga, chess and
other activities intended to rehabilitate.
Spend a day in his jail and much appears
unusual for a place of detention. In a damp
and gloomy basement, prison workers
hand out questionnaires to men arrested
the night before. They scramble to see in-
mates before they go before a bail judge
(who will release most the same day), to get
a chance to diagnose the mentally ill, see
who gets treatment and offer care.
For those kept inside—the jail holds
some 6,000 detainees at a time, many for
three-to-six months—further diagnosis
and treatment follows. Staff in a beige hos-
pital building distinguish between 1,600
inmates, currently, who are “higher-func-tioning” for example with depression, 382
of “marginal stability”, perhaps with
schizophrenia, and 80 who suffer the most
acute psychosis. The last are the hardest to
manage, let alone release safely.
Treatment includes antidepressants
and other medical care, getting sober, and
counselling to address low self-esteem.
“We diagnose, prescribe and treat, offer
therapeutic classes, hotlines for families,
and have a discharge plan like a hospital,”
says Mr Dart. In one cell block a psychia-
trist leads 40 women in blue jail smocks in
a lively, if scripted, discussion of how to
seek self-forgiveness. The women read po-
etry, talk of betrayal and of shaking off ad-
diction. Over half are hooked on heroin,
says an official. A gaunt detainee tells how
she struggles with anger, “but I don’t think
I’m the same person as when I came in, I
used to lash out at every little thing.”
Therapy sessions for male detainees
bring forth stories of isolation, absent par-
ents, addiction, violence, fear and arrests.
A 25-year-old, Jesus Saenz, says he has been
to the county jail 30 times. He laments
years lost to cocaine and pcp, gangs, de-
pression and bi-polar disorder. After medi-
cal care and months of counselling he now
vows to stay clean and get a job. “They
helped me stop my bullshit, hurting other
people,” he says.
What chance does Mr Dart have of suc-ceeding? Some anecdotes are cheering, but
measurement is tricky beyond looking at
rates of rearrests. Reoffending in the first
ten days of release is down sharply, says the
sheriff. A pilot project gives the most vul-
nerable help to find housing, food and
clothing on release. Some are driven home,
not just dumped outside the jailhouse
door. But longer-term rates of rearrest are
not yet noticeably down, he concedes.
The jail population has shrunk by half
since Sheriff Dart came in. That is ex-
plained by many things, including general-
ly lower rates of arrest by police in the past
three years. Bond reform, passed in 2017, is
also a factor. Bail is rarely set at thousands
of dollars, so fewer are jailed merely for be-
ing poor. This has freed up resources for
better health care, as did closing a military-
style boot camp in the jail. Mr Dart is con-
vinced data will eventually show overall
benefits, once experts from the University
of Chicago and elsewhere have had time to
track outcomes.What’s in a badge
Beyond the jail walls he is trying other ex-
periments, rethinking the role of the sher-
iff’s office and deploying his nearly 7,000
staff in ways his predecessors never imag-
ined. There are over 3,000 sheriffs across
America, law officers whose duties are lim-
ited mostly to policing and enforcing court
orders. Under Mr Dart’s expansive view, the
office can be a form of alternative govern-
ment. His mandate is so nebulous, he ar-
gues, it amounts to “outrageously broad
powers” for a willing sheriff, especially be-
yond city borders (his county includes 130
towns and villages outside Chicago). He
tries what he calls “wildly different
stuff...to make my job more bizarre.”
Examples include his office helping the
mayor of a depopulated, crime-ridden and
poor town, Ford Heights, to fix its public
lighting and water, build a baseball dia-
mond and replace a defunct police force.
Elsewhere he has clashed with banks, by
refusing to evict homeowners who are be-
hind on mortgages. He resisted even facing
threats of contempt orders against him
personally. He called the evictions unjust
for a “thoughtful society”.
Mr Dart campaigned to close Backpage-
.com, a website shuttered by federal au-
thorities for hosting adverts for human
trafficking and prostitution. And in Chica-
go he deployed officers to promote com-
munity policing—to build trust among res-
idents in especially violent areas—even
when city police, at first, seemed reluctant
to accept help. Not all these efforts succeed.
But through his willingness to try new
things until someone stops him, and his
enthusiasm for clashing with Democratic
power-brokers in Springfield like the
House Speaker, Mike Madigan, Mr Dart has
reimagined what a sheriff can be. 7CHICAGO
What happens when a radical sheriff comes to townTom DartBull’s-eye
The Dart arts