Pathway 3: Secure Inpatient Treatment

If the individual is found to need mental health services on an inpatient basis, the court shall remand the individual to IDHS. As outlined in the statue, the period of commitment:

The individual shall be placed in a secure setting and not be permitted outside the facility’s housing unit unless escorted or accompanied by IDHS personnel or with the prior approval of the court for unsupervised on-grounds privileges or supervised or unsupervised off grounds privileges.

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The facility director shall file a treatment plan report in writing with the court and forward a copy of the treatment plan report to the clerk of the court, the State’s Attorney, and the individual’s attorney, if the individual is represented by counsel. If the individual does not have counsel, a copy of the report should be sent to a person authorized by the individual under the Mental Health and Developmental Disabilities Confidentiality Act. 

The report shall include an opinion as to whether the individual is currently in need of mental health services on an inpatient basis or in need of mental health services on an outpatient basis. As outlined in the statute, the report shall summarize the basis for these findings and provide a current summary of the following items from the treatment plan:  

• An assessment of the individual’s treatment needs 
• A description of the services recommended for treatment 
• The goals of each type of element or service 
• An anticipated timetable for the accomplishment of the goals 
• A designation of the qualified professional responsible for the implementation of the plan 
• Recommendation for pass privileges if applicable  

The report may also include unsupervised on-grounds privileges, off-grounds privileges (with or without escort by personnel of the Department of Human Services), home visits and participation in work programs, but only where such privileges have been approved by specific court order, which order may include such conditions on the individual as the Court may deem appropriate and necessary to reasonably assure the individual’s satisfactory progress in treatment and the safety of the individual and others.  

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The treatment plan is reviewed every 90 days. In addition, an individual or anyone on his or her behalf may file a petition for a treatment plan review, pass privileges, conditional release, or discharge.

See Recipient Initiated Court Petitions for additional information. 

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Privileges are an essential tool to assess and mitigate an individual’s risk of harm to self or others. Privileges allow the team to observe the individual’s stability in increasingly less restrictive settings, mitigating risks by ensuring they can handle increasing levels of freedom.

Granting Privileges

• The hospital administrator, along with the treatment team, should recommend pass privileges they deem appropriate and necessary to reasonably ensure the individual’s satisfactory progress in risk mitigation treatment and the safety of the individual and others. 
• Once the court has approved the hospital administrator’s request for privileges, it is the responsibility of the treatment team and clinical staff to ensure that recipients are properly protected from harm to themselves and prevented from harming others.​ 
• Court approved privileges may be granted and, as necessary, indefinitely suspended by the treatment team (with notice to the court, State’s Attorney, and defense counsel), based on the treatment team’s independent clinical evaluation of the individual’s behavior. ​ 
• Court approved privileges may be temporarily suspended by hospital staff due to inclement weather or other conditions not related to behavior (without notice to the court, State’s Attorney, or defense counsel).

Principles Guiding Granting Privileges

• Individualized Assessment Over Arbitrary Timeframes 
  Progressive privileges are clinical tools used to assess treatment progress, risk mitigation, and readiness for less restrictive settings. They are not intended to function as administrative hurdles that delay access to less restrictive alternatives without clear clinical benefit. 
  • Progressive privileges must be guided by the forensic individual’s current clinical status, treatment progress, and dynamic risk factors—not by fixed timeframes (e.g., “must wait six months”). 
  • Arbitrary, “one-size-fits-all” waiting periods are not clinically justified and should not serve as a prerequisite for privilege consideration. 
  • Progression through privilege levels (e.g., on-grounds, off-grounds, supervised, unsupervised) is not a mandatory stepwise ladder that all patients must complete in a linear or exhaustive fashion.
  • Conditional release may be clinically appropriate even if intermediate privileges have not been exercised, as long as the treatment team has determined that the forensic individual’s current functioning, insight, and risk management strategies are sufficient to support a safe transition to a less restrictive setting.

• Risk-Informed, Trauma-Informed Clinical Judgment 
  Forensic treatment for NGRI focuses on individuals developing insight into the factors that influence their risk of physical harm to themselves or others and how they can be successful in community-based recovery. 
  • The treatment team must assess risk factors primarily associated with the index offense on an ongoing basis including protective factors, psychiatric stability, and behavioral insight prior to recommending privileges. 
  • Historical and contextual factors (e.g., index offense, history of violence, substance use, trauma exposure) must be integrated into the risk formulation. 

• Functional Milestones as Triggers
  Progressive privilege recommendations should be guided by functional treatment milestones. These milestones are not strict requirements but should be considered in the context of the individual’s clinical history and index offense. Examples include:
  • Consistent engagement in treatment planning and therapeutic groups, indicating motivation for recovery and capacity to benefit from a less structured environment.
  • Measurable progress in managing impulses and emotional responses, suggesting the ability to maintain safety and stability with reduced oversight. 
  • Behavioral compliance and respect for boundaries, reflecting readiness to follow community norms in a less restrictive setting.
  • Exhibiting understanding of their diagnosis, treatment needs, and legal circumstances, supporting informed decision-making and accountability outside of intensive supervision. 
  • Active participation in identifying personal risk factors and protective strategies, demonstrating the ability to apply these tools independently or with minimal support. 

• Clinical Documentation Standards 
  While the judge is responsible for approving privileges, she or he does so informed by clinical expertise documented in treatment plans and succinctly summarized on court reports. The treatment team must clearly document: 
  • The rationale for recommending or deferring progressive privileges, referencing risk factors, specifically those associated with the index offense and protective factors. 
  • The specific observable behaviors or other factors that inform the recommendation.
  • The individual’s progress on individualized treatment goals relevant to privilege readiness. 
  • Any conditions or supports required to manage risk. 

• Equity and Non-Discrimination
  • No patient shall be denied progressive privilege consideration based solely on demographic factors, the nature of their offense, or stigma associated with their diagnosis. 
  • All patients should be afforded an equal opportunity to be assessed for privileges based on treatment progress and clinical stability. 

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The facility director provides a written notice to the court, State’s Attorney, and defense attorney when an individual is no longer in need of mental health services on an inpatient basis and can be conditionally released for outpatient mental health services.  

An individual’s readiness for conditional release is contingent on the following: ​ 

• The individual remains in need of mental health services, but they do not require inpatient hospitalization​. 
• The individual is presumed capable of following the conditions of the release​. 
• Conditional release is not likely to present undue risk to the safety of the community​. 
• Appropriate outpatient supervision and treatment is available through a community service agency that is willing to provide progress reports to the court every 90 days (and as needed). 

Proposal Requirements for Requesting Conditional Release

If conditional release will be requested, the factors that are addressed may include:  

1. Whether the individual appreciates the harm caused by the individual to others and the community by his or her prior conduct that resulted in the finding of Not Guilty by Reason of Insanity;
2. Whether the individual appreciates the criminality of conduct similar to the conduct for which he or she was originally charged in this matter;
3. The current state of the individual’s illness; 
4. What, if any, medications the individual is taking to control her or his mental illness; 
5. What, if any, adverse physical side effects the medication has on the individual; 
6. The length of time it would take for the individual’s mental health to deteriorate if the individual stopped taking prescribed medication; 
7. The individual’s history or potential for alcohol and drug abuse;
8. The individual’s past criminal history; 
9. Any specialized physical or medical needs of the individual; 
10. Any family or support system participation or involvement expected; 
11. The individual’s potential to be a danger to himself, herself, or others; a written or oral statement made by the victim if applicable; 
12. Any other factor or factors the court deems

Additional factors may be included such as:

1. Availability of necessary treatment and monitoring services (if any required) in the community;​ 
2. Medication needs and how they will be addressed in the community (if any required); ​ 
3. Whether the individual is or is not able to provide for her or his basic needs;​ 
4. The individual’s need for mental health services on an outpatient basis; and ​ 
5. The individual’s housing needs, if any are required.  

If the conditional release involves referral to a community agency that has agreed to accept the individual, the Hospital Administrator or designee should obtain a written acknowledgment from the agency that it agrees to the conditions for monitoring and supervising the individual and this acknowledgment should be included in the report.​ 

A second opinion can be requested by the treatment team or Hospital Administrator or designee or both if clinically warranted.​ 

Approvals & Review Required for Conditional Release Petitions 

The Hospital Administrator or designee shall send the approved conditional release proposal to the DBHR Bureau of Forensic and Justice Services for final review and approval. The review panel includes the Statewide Forensic Medical Director, the Deputy Director of Forensic & Justice Services, the Forensic Court Services Administrator(s).

If approved by the Bureau of Forensic and Justice Services, the Hospital Administrator or designee shall submit the report to the court. Any proposal that is not ratified by the Hospital Administrator or approved by the Bureau of Forensic and Justice Services shall be returned to the treatment team for further action.

Implementing Conditional Release

When the court approves a request for Conditional Release of the individual to a designated service provider, the following shall occur:

1. The conditions of release and Thiem Date shall be clearly communicated in writing to the provider as well as the Forensic Community Services Administrator and shall include a copy of the court order and the discharge summary. 
2. The Forensic Community Services Administrator will make contact with the provider within 72 hours of placement to verify completion of admission and to confirm that the provider is both 
   • in receipt of the necessary documents and 
   • understands the conditions of release as well as IDHS’s monitoring functions. ​ 
3. IDHS shall advise the individual of his or her duty to register under the Sex Offender Registration Act or the Murderer and Violent Offender Against Youth Registration Act, as applicable. ​ 
4. Facility staff shall ensure that all necessary notices to courts, law enforcement, victims, and potential victims are delivered in accordance with current law. ​ 

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Should the individual no longer require mental health services, a request for discharge can be submitted to the court in the same manner as required for conditional release pursuant to 730 ILCS 5/5-2-4(d). 

Before the court orders that the individual be discharged or conditionally released, it shall order the facility director to establish a discharge plan that includes a plan for the individual’s shelter, support, and medication. If appropriate, the court shall order that the facility director establish a program to train the individual in self-medication under standards established by the Illinois Department of Human Services. 

Possible outcomes of the hearing:  

• If the court finds that the individual is no longer in need of mental health services, it shall order the facility director to discharge the individual.  
• If the court finds that the individual is in need of mental health services, and no longer in need of inpatient care, it shall order the facility director to release the individual under such conditions as the court deems appropriate and as provided by this 730 ILCS 5/5-2-4. Such conditional release shall be imposed for a period of 5 years (unless the Theim date is shorter) as provided in paragraph (D) of subsection (a-1) and shall be subject to later modification by the court as provided by this Section.
• If the court finds consistent with the provisions in this Section that the individual is in need of mental health services on an inpatient basis, it shall order the facility director not to discharge or release the individual in accordance with paragraph (b) 730 ILCS 5/5-2-4. 

When the court approves a request for discharge of the individual the Forensic Community Services Administrator, Treatment Team, or community mental health provider agency shall develop a discharge plan to ensure continuity of care, relapse prevention, and deterrence from future justice involvement. Implications of discharge shall also be explained to the individual in a manner that ensures that information is understood. 

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In preparation for discharge, IDHS shall advise the individual of her or his duty to register under the Sex Offender Registration Act or the Murderer and Violent Offender Against Youth Registration as explained in Illinois Offender Registration Acts.

Facility staff shall ensure that all necessary notices to courts, law enforcement, victims, and potential victims are delivered in accordance with current law.​ 

T. Civil Commitment Beyond Theim Date: 405 ILCS 5/1-100 et seq. By the Thiem Date, individuals must either be discharged or remain in the hospital under the conditions of the Mental Health Code:  

• Emergency pending an involuntary commitment procedure
• Voluntary inpatient 

At least one week prior to the Thiem Date, a letter signed by the Hospital Administrator, or designee, should be sent to the judge and both attorneys notifying them that on the Thiem Date, the patient will either be discharged as no longer subject to the jurisdiction of the criminal court, or, if not discharged, will remain under the conditions of the Mental Health Code.​ 

If the patient remains in inpatient treatment after the Thiem date, her or his legal status will be changed from forensic to civil and all applicable procedures will be followed. ​ 

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