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What is Forensic Treatment?
Each day in Illinois and in the nation, many people with mental illness and intellectual disabilities come into contact with the criminal justice system. Forensic Treatment represents the critical intersection of the legal and behavioral health systems, encompassing the evaluation, treatment, and case management of individuals with mental illness or intellectual disabilities who are involved in criminal proceedings. It is important for courts, attorneys, law enforcement, correctional facilities, administrators, and other community partners to understand the specialized services required by law at this intersection—including evaluations, fitness restoration for individuals who have been found Unfit to Stand Trial (UST), and risk mitigation for individuals acquitted as Not Guilty by Reason of Insanity (NGRI) in preparation for reintegration into the community.
Historical Context
Across the United States, the number of state psychiatric hospital beds for the severely mentally ill (SMI) has steadily declined since the 1950s as part of the broader movement toward deinstitutionalization. This transition was driven by important reforms aimed at addressing poor hospital conditions, protecting human rights, and expanding community-based treatment alongside advances in antipsychotic drugs. Many individuals benefited from greater independence and community supports; however, over time, the reduction in inpatient psychiatric capacity outpaced the development of sufficient community resources for many living with SMI.
As a result, states across the country have experienced increasing pressure on psychiatric systems. Nationally, psychiatric bed availability reached a historic low in recent years, while demand for forensic services has continued to grow.
Illinois has also experienced these challenges and taken deliberate steps to respond to them through multiple initiatives designed to improve access to care. These efforts include partnering with community-based hospitals to increase inpatient treatment options, expanding outpatient forensic service capacity, improving internal processes to have more efficient movement through the system, evaluating how existing state-operated hospitals resources can be utilized more effectively, and investing in future capacity at existing locations. While no single initiative can resolve the national psychiatric bed shortage, Illinois is working through these collective efforts to move its forensic system in a positive direction and create a foundation for continued improvement.
Illinois Department of Human Services (IDHS), Forensic and Justice Services
The Forensic and Justice Services Bureau serves as the primary administrative authority for forensic treatment in Illinois and operates within the Division of Behavioral Health & Recovery (DBHR), a division of the Illinois Department of Human Services (IDHS).
Under Illinois statute, individuals involved in the forensic system are remanded to IDHS, not DBHR nor any specific division. This distinction is important. While DBHR administers and coordinates many forensic treatment services, it does so as a part of the broader IDHS system. Within that system, multiple divisions have responsibility for forensic populations, including the Division of Developmental Disabilities (DD). Certain individuals and services fall under DD, even though DBHR may coordinate or help triage aspects of that work.
DBHR, through the Bureau of Forensic and Justice Services, manages the infrastructure supporting court-ordered evaluation and treatment, secure placement, and continuity of care for individuals transitioning back into the community through conditional release. This management includes a statewide system of State Operated Psychiatric Hospitals (SOPHs), partner inpatient programs, and contracts with outpatient providers. Understanding this structure helps clarify roles, set appropriate expectations, and ensure the right parts of the system are engaged in supporting individuals across the continuum of care.
Civil Treatment Services vs Forensic Treatment Services
Forensic treatment is distinct from civil behavioral health care in that it considers how a person’s mental health or intellectual disability affects their legal situation. Forensic individuals are those who the criminal court has remanded for inpatient or outpatient treatment because of their involvement with the criminal justice system. Forensic treatment stabilizes an individual to return to their court proceedings or to continue recovery in the community. Individuals who require inpatient psychiatric treatment and are not involved with the criminal justice system can be treated in State Operated Psychiatric Hospitals as civil patients.
| System | Civil Treatment | Forensic Treatment |
|---|---|---|
|
Focus |
Stabilizing acute psychiatric illness and preparing for recovery in the community |
Understanding how mental health or intellectual disability affects a legal case, and what care is required as a result |
|
Entry Points |
Voluntary (self admission) or involuntary if someone is a danger to themselves or others |
Court ordered |
|
Exit |
Discharged by IDHS (on rare occasions by mental health court if civil courts are involved) |
Discharged at the criminal court discretion |
Populations the Forensic Mental Health System Serves
The Forensic System serves criminal justice-involved individuals who have one of the following legal statuses:
Unfit to Stand Trial (UST):
“a defendant, who due to mental disorder, illness, or cognitive impairment, cannot understand the nature/consequences of court proceedings or cannot rationally assist in their own defense.” 725 ILCS 5/104
Not Guilty by Reason of Insanity (NGRI)
“a legal defense in criminal cases where a defendant is acquitted because a severe mental disease or defect made them unable to understand the wrongfulness of their actions at the time of the offense.” 730 ILCS 5/5-2-4
Sexually Violent Persons (SVP):
“a person who has been convicted of a sexually violent offense, has been adjudicated delinquent for a sexually violent offense, or has been found not guilty of a sexually violent offense by reason of insanity and who is dangerous because he or she suffers from a mental disorder that makes it substantially probable that the person will engage in acts of sexual violence.” 725 ILCS 207/5(f)