THRESHOLDS JAIL PROGRAM (IL)

Program Description
Founded in 1959, Thresholds is one of the nation's largest psychiatric rehabilitation centers. The organization strives to provide services that create opportunities for people with mental illness to live with dignity and independence. It annually serves over 5,000 people with severe and persistent mental illness in Chicago and neighboring northern suburbs. Services include a comprehensive program of psychiatric care, educational development, housing, and vocational training and placement. The Thresholds treatment and rehabilitation model has been recognized by the American Psychiatric Association and U. S. Department of Labor and has been replicated by many organizations across the country.

The Thresholds Jail Program is one of several specialized programs the organization offers the community. Established in 1997, the Jail Program has been successful in reducing time in jail and psychiatric hospitals for its mentally ill clients from Cook County Jail by utilizing a unique and cost-effective model of home-visiting and intensive case management. The project team includes a consulting psychiatrist, ten direct care staff, a weekend case manager, an administrative support person, nurse, and program supervisor. Jail Program staff make initial contacts with potential clients at Cook County Jail upon request from the jail social workers. Program staff may get involved with the individual's case before release, but most services are provided upon release. Jail Program clients typically have long histories of hospitalizations and involvement in the criminal justice system. The average Jail Program client has been hospitalized in a psychiatric facility an average of 12 times and arrested an average of 35 times.

In an effort to help stabilize the lives of its clients, the program provides a range of comprehensive services upon release from jail including intensive case management, medication monitoring, housing placement, mental and physical health care, and regular home visits. Program staff are available 24 hours a day, seven days a week.

Program Goals
The Thresholds Jail Program seeks to reduce psychiatric hospitalizations, arrests, and incarceration of individuals with severe and persistent mental illness by providing the necessary support services and case management.

Networking, Partnering & Collaboration
Ongoing development and implementation of the program is fostered by the Public Psychiatry Task Force, a collaborative body with members from a variety of public and private stakeholder agencies. On a daily basis, the Jail Program team works closely with the courts, police, probation, other mental health agencies, and substance abuse programs. The program also works closely with rooming houses, single room occupancy hotels, and family members to house program clients. The program has developed a network of community members such as business owners, landlords, and friends that assist the program team in watching clients in the community, giving feedback, and helping program participants to create stable lives in the community. Thresholds has received funding for the program from a number of government sources and private community foundations. The organization is working to leverage support
for expanding the program to include development of a mental health court and similar aftercare project in a prison setting.

Outcomes
Independent researchers at Loyola University, under the direction of Dr. Arthur Lurigio, have found an approximate 80 percent reduction in the use of state and county mental health institutions among program participants. In addition, more than 90 percent of the program clients are housed in the community, some for the first time in decades.

The Loyola study compared the number of jail days and arrests for each participant, days spent in the hospital, and incidents of psychiatric hospitalization before and after program participation. The number of jail days for the first 30 people accepted into the program dropped from 2, 741 days in the year prior to 469 days during the treatment year (an 82 percent reduction). Additionally, the number of days spent in psychiatric hospitals dropped from 2,153 to 321 days (an 83 percent reduction) over the same period.

Despite the relatively small number of program participants (the program currently serves 68 clients), the cost savings are potentially significant compared to the costs of incarceration and hospitalization. It costs approximately $70 a day to house an individual in jail; one day in a public mental hospital costs taxpayers about $500. The Thresholds program, by contrast, costs about $26 a day per client. In the one-year study involving 30 clients, the total jail savings were estimated at $157,000 and the total hospital savings were estimated at $917,000.

The Thresholds Jail Program recently received the prestigious American Psychiatric Association's Gold Achievement Award.

Additional Reading

• Arthur Lurigio, John Fallon and Jerry Dincin. 2000. "Helping the Mentally Ill in Jails Adjust to Community Life: A Description of a Postrelease ACT Program and its Clients." International Journal of Offender Therapy and Comparative Criminology 44 (5): 532-548.
  
• "Helping Mentally Ill People Break the Cycle of Jail and Homelessness." 2001. Psychiatric Services 52 (10): 1380-1382.

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