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‘We need to ask why’: After falling into the criminal justice system with mental illness, woman now advocates for better treatment for others

Chicago Tribune - 7/16/2021

When the hallucinations started, Olachi Tiffany Etoh says she could see stars raining into her hands.

Then 24, college educated and working for a Fortune 500 company, she fled her office and began wandering streets on the city’s Northwest Side before winding up at O’Hare International Airport. Etoh had been battling mental health issues for years, somehow finding a way to function at a high level despite the relentless voices inside her head.

This time, however, was different.

While at O’Hare, she became completely untethered from reality and hallucinated that she was in the center of a mass shooting. Frantic, she grabbed a 2-year-old child near baggage claim and ran away with the toddler to shield him from imagined gunfire. She only made it a few feet before his mother took her son back.

Etoh was arrested on aggravated kidnapping charges, despite having no criminal history and obvious mental distress. She was sent to Cook County Jail, where she says her condition worsened and she felt demonized for her illness.

The case would make headlines across the city, even as Etoh’s parents urged compassion and understanding for their daughter. Records show they had reported her missing to Chicago police a week before the arrest, worried — correctly, as it turns out — that Etoh had stopped taking her medication and was living on the streets. Police, however, couldn’t do much because she was an adult.

“They couldn’t act until something happened,” Etoh said.

Etoh was found not guilty by reason of insanity in 2015 and sent to a state-run psychiatric hospital, where court records show she was treated for bipolar affective disorder with psychotic features, meaning she suffered from hallucinations and delusions.

Now on conditional release and living with her parents in Maryland, Etoh is fighting on behalf of other mentally ill people entangled with the legal system. She has been working with the National Alliance on Mental Illness, which recently released a report aimed at reducing society’s reliance on criminal courts for dealing with mentally ill people.

“To me, the fact that I ended up in jail during an episode of psychosis shows the extreme lack of compassion in the criminal justice system. A society without compassion will always seek to vilify, demonize and mercilessly persecute offenders without asking why,” Etoh said. “To create change, we need to ask why, and build compassionate answers.”

The NAMI report does not indict any specific branch of the criminal justice system, but rather points the finger at a society that has foisted the responsibility for mental health care onto prosecutors, police officers and judges instead of providing community-based support. In 2012, for example, then-Mayor Rahm Emanuel’s administration shuttered half of the city’s mental health clinics, leaving hundreds of at-risk patients without stable care. The void has meant many people’s first contact with mental health care takes place in police lockups, courtrooms or Cook County Jail, experts said.

In fact, the jail has long been identified as a place where those who need mental health care can be identified. Cook County Sheriff Tom Dart has been among those who raised an alarm about what the clinic closures could do to his jail population. And while no one has specifically tracked how many patients were directly affected by the closures may have turned up there, statistics show the percentage of inmates with psychiatric concerns has remained alarmingly high even as the overall number of inmates has dropped.

Cook County State’s Attorney Kim Foxx, whose office worked with NAMI on the report, says the shuttered mental health centers transferred responsibility for caring for these vulnerable residents to the justice system.

“It cannot be overstated that there was a devastating impact on our justice system when those mental services were shut down, particularly in communities that are overrepresented in the justice system on the South and West sides,” Foxx told the Tribune. “The criminal justice system, which was not built to deal with issues of mental health, has become a repository.”

At the time the report was written, NAMI researchers found that more than one-third of jail detainees have identified mental health issues. The number, however, has jumped to nearly 50% in the past year, Dart told the Tribune.

The U.S. Department of Justice estimates about 44% of people incarcerated in jails nationwide have been diagnosed with a mental health condition.

According the NAMI’s report, nearly 350 individuals are found not guilty by reason of insanity in Illinois each year and sent to psychiatric hospitals. The average stay at the state-run facility is about four years.

In Illinois, however, reform may be more challenging because the three institutions involved — the courts, hospitals and jails — are all run by different levels of government. Jail systems, for example, are operated by the local county governments, while state-operated hospitals are run by the Illinois Department of Human Services and courts are overseen by locally elected judges who ultimately are overseen by the Illinois Supreme Court.

“There is so much complexity and yet it’s so simple,” said Alexa James, chief executive of NAMI Chicago. “We have neglected mental health care, mental health access — especially in Black and brown communities — for too long. We really have not met people where they were in terms of what they needed. And, as result, 911 becomes the biggest mental health intake system in the city of Chicago.”

The Chicago Police Department recently announced plans to launch an initiative in which some 911 calls for mental health emergencies will be answered by trained mental health professionals paired with paramedics. The sheriff’s department also has instituted a program in which officers responding to 911 calls can connect a person suffering a mental health crisis to a mental health expert via a tablet to help defuse the situation.

Dart also has tried to address issues in the jail over the years by hiring additional mental health experts, retraining his staff and converting an old boot camp into a mental health center. He also pushed for better discharge planning, so people had a safe place to live, food to eat and counseling available when they leave custody.

“But at the end of the day, we’re not the right place to be doing it,” Dart said. “Nobody was doing it, so I had to pick up the responsibility. When NAMI and I talk about more funding for mental health centers in the community, that is the route to go.”

The report specifically praises the Cook County state’s attorney’s office for launching a diversion initiative that offers mental health support to misdemeanor offenders instead of a fitness evaluation. Foxx said she pushed the program after seeing some defendants spend more time in jail waiting for court-ordered mental health evaluations than what their actual sentence would entail.

The NAMI report says this program should be built upon throughout the state and expanded in Cook County. The idea has strong backing from Foxx and Dart.

“We must look to increase diversionary programs so we’re not prolonging entanglement in the system and we’re getting people treatment faster, which ultimately aids in recovery,” Foxx said.

Etoh spent four years in the Elgin Mental Health Center, where she was given medication that put her on the path toward stability. As her condition improved, she petitioned the courts to be released, but records show she was thwarted by a doctor who testified, in his opinion, it was possible she would stop going to therapy if allowed out.

Instead, she was given small slivers of freedom: an unsupervised walk on the hospital grounds, a supervised trip into town. Those privileges alone took three years to secure through the court system.

“The criminal justice system is not sure whether it functions to treat or incarcerate, so oftentimes you get both,” Etoh said. “Prosecutors often have a knee-jerk reaction to keeping people in a locked hospital setting, dismissing any treatment-oriented progress being made and relying instead on fear mongering in front of a judge of what ‘could’ happen upon release.”

The new NAMI study also takes a critical look at the state’s psychiatric hospitals, saying its “outdated and ineffective” laws reduce the likelihood individuals will recover and lead fulfilling lives. It points to states such as Virginia and Maryland, where conditional release practices are more common and boast low recidivism rates.

“I understand a punitive system, but I don’t understand a punitive system that would exacerbate someone’s health condition,” said Jen McGowan-Tomke, NAMI Chicago’s chief operating officer. “We need to invest in getting people out of state hospitals and jails and into community support. We need a safety net that’s not the court system.”

While NAMI has long advocated for additional community-based services, the report acknowledges that mental health does not exist in a vacuum. Investments in housing, nutrition access and other basic needs provide stability and act as positive mental health supports necessary for individuals to achieve and maintain recovery.

Etoh has enjoyed such support since a judge granted her permission to return to the East Coast and live with her close-knit family in 2020. With her life restored, she spends time with her nephews, explores ways to use her degree in international business from the University of Baltimore and has finished a memoir she hopes to publish. She also continues to take her medication and attend therapy.

As part of her work with NAMI to urge reforms, she spoke at the Illinois Mental Health Summit, hosted by the Illinois Supreme Court and participated mental health response training with the Chicago Police Department.

The most common question she gets from law enforcement involves what they should do when dealing with a mentally ill person. The answer, she says, is simple:

“Be compassionate, even if it’s hard,” she said. “Ask questions. And have real diversion programs in place — before we throw people who may be suffering into jails to waste away for a lifetime.”

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