Too mentally ill for trial, she spent months in an Illinois jail as the state looked for a hospital bed. She died waiting.

Illustration by Kailey Ryan, Illinois Answers Project

Khayla Evans had an intellectual disability and a history of psychiatric issues. She was charged in summer 2022 with aggravated battery and child endangerment in Lake County, hundreds of miles from her Texas home.

She was too mentally ill for criminal proceedings to continue. A judge determined Evans, 24, was unfit for trial and needed to go to a state hospital.

There, she would undergo fitness restoration — with the goal of ensuring she was able to understand the legal process unfolding around her and help her lawyer craft a defense.

But there was a problem.

“There are no available beds right now for women,” Judge Christen Bishop said during the October 2022 fitness hearing. “Let’s hope that changes.”

So Evans waited at Lake County Jail, where her health declined. She regularly did not eat, drink or take her prescribed medications, jail records show. She complained of leg pain and was hospitalized. She was placed on suicide watch.

The deputy sheriff described Evans in an email to the Illinois Department of Human Services as one of “the worst we have had in a long time.”

“If there is anything I can do to expedite her getting a bed in IDHS please let me know,” then- Deputy Sheriff Nicholas Kalfas wrote in mid-December 2022.

Just one day later, Evans was dead. She waited for a bed for 67 days.

Following a change in state law in 2023, IDHS is required to admit people to a state hospital within 60 days when a person is found unfit and ordered to receive inpatient treatment. But an Illinois Answers Project investigation found hundreds of incidents in the last five years in which it exceeded this time period. Instead, the Department of Human Services relies on the law’s language that says the department can have an extension if it shows “good faith efforts at placement and a lack of bed and placement availability.”

The number of times defendants have been found unfit and in need of inpatient restoration has exploded in recent years, resulting in people having to wait longer for an available hospital bed.

They are often waiting in jail.

Illinois Answer Project’s investigation offers the fullest account to date of how many of those waiting for an IDHS placement are being detained longer in jail in part because of their mental illness. According to families, advocates and lawyers, the condition of those waiting deteriorates as each day passes. Meanwhile, judges have questioned if defendants’ constitutional rights to a speedy trial have been violated.

In rural Cass County, a judge said these delays were “bordering on the line” of cruel and unusual punishment.

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“And I think we’re over the line,” he said.

Defendants on average are waiting nearly twice as long as they did five years ago, analysis shows. In most cases, it’s more than three months. For some, it can be much longer.

IDHS officials said the department has struggled to keep up with the number of people being found unfit and referred to inpatient restoration. The state, in recent years, has added over a hundred beds and hired thousands of hospital workers to help combat these wait times.

A spokeswoman said the agency “has been working to gather a greater awareness and understanding in order to support solutions with key stakeholders.” Wait times did decrease slightly in fiscal year 2025, data shows.

The spokeswoman said 171 people are currently waiting to be placed in a hospital for fitness restoration, while 159 people are waiting to be assessed to determine the most appropriate place for fitness restoration.

A review of hundreds of pages of court records and transcripts shows a portrait of Illinois residents – some of whom have severe illnesses such as schizophrenia or bipolar disorder – landing in jail in the midst of mental health crises.

An unprecedented increase in people found unfit

A majority of counties have seen an increase in the number of times defendants are being found unfit, Illinois Answers found. Housing mentally ill detainees is challenging for the jails, which sheriffs said are not equipped to be mental health facilities.

In fiscal year 2023, when Evans entered jail, Illinois courts found people unfit to stand trial 433 times, a more than 80% increase from the previous year. The following year, that number rose to 1,072 – an increase of 450% from 2020 to 2024.

By the end of fiscal year 2025, the number dropped to 986.

In interviews, more than a dozen Illinois public defenders, sheriffs, forensic psychologists and national experts said the increase is a product of the lack of investment in mental health care – with the closing of mental health hospitals in recent decades, resulting in fewer beds and community resources.

In Illinois, four state psychiatric hospitals closed between 1997 and 2013.

An IDHS spokeswoman agreed, attributing the increase to several factors, including a lack of community-based resources and “insufficient wrap around supports” to help people adhere to their medication regimens.

The spokeswoman said there is “misunderstanding by some courts and attorneys that compulsory forensic care is one of the only means of treatment for this population.”

Fitness restoration is not mental health treatment, forensic psychologists said. It’s much more narrow in scope and focuses on stabilization and legal education.

Yet public defenders said they are ethically bound to bring up the issue of fitness if their clients can’t understand the proceedings. Some feel their hands are tied.

For LaTonya Burton, Evans’ defense attorney, she said it was clear her client had an intellectual disability. It felt like speaking with a child.

Evans was in Illinois in late June for a family reunion in the area. One day, she and another person were babysitting a cousin’s baby. Evans told a police officer she placed the child on the counter, “allowing him to fall off the counter and afterwards picking [redacted] up and striking him in the face.”

The mother pressed charges. The father described the baby’s eye to be “bloody and swollen,”in the police report.

He told police at the time that he wanted Evans to be “accountable for her actions and wants her to receive treatment for her mental health issues but expresses he does not want her to face time in jail or prison.”

Evans was arrested on June 30, 2022.

When Evans entered Lake County Jail, she began to get “progressively worse,” Elida Pulido, a nurse at the facility, told investigators after her death.

This nurse and several other jail employees said they knew Evans had a mental health condition, but not her diagnosis. In jail records, one correctional officer said Evans could be violent but said there was a period she would only “talk like a baby.”

Evans reported stomach pain throughout July, but she didn’t receive proper medical care, according to a 2023 lawsuit filed by her family against the county, the jail’s medical provider Wellpath and others.

In late November 2022, Evans was not able to move from the waist down, according to jail records.

She could not go to the bathroom by herself and was wearing a diaper, records show. Three staff members said in interviews following her death that she was taken to the hospital several times, including the week before she died.

She died of cardiac arrest, according to the lawsuit.  The family, in a statement provided by their lawyers, wrote that Evans’ death has left a “gaping hole” in their hearts and represents “a microcosm of what is happening in Illinois jails.”

“When the criminal justice system makes a choice to detain and house individuals who are disabled and vulnerable like Khayla, they have a corresponding, bare-minimum obligation to get people like Khayla the medical treatment and mental health treatment they need to survive,” the family said.

Illinois Is Turning to Local Jails to Treat Mentally Ill Defendants. Some Early Results Offer Hope — and Warnings

Christopher Covelli, deputy chief for Lake County Sheriff’s Office, also declined to comment on Evans’ death and the lawsuit due to pending litigation. He noted in an email that “[IDHS] placement is occurring much faster now.”

Prior to current regulations, sheriffs filed a lawsuit in summer 2022 arguing that the law at the time gave the state 20 days to transfer defendants to a state hospital for fitness restoration.  The Illinois Department of Human Services said that timeline was not a deadline but notification period.

But the lawsuit became moot after Illinois lawmakers in January 2023 passed legislation that set an initial deadline of 60 days.

The change would ultimately “enable more people with serious mental health issues to be moved from county jails faster and into IDHS facilities,” then state senator Ann Gillespie predicted as she voted for the legislation.

But the opposite occurred.

Not enough beds, as wait times increase

An Illinois Answers analysis of available data found that after January 2023, when the law went into effect, more than 85% of placement times for defendants exceeded 60 days.

The wait times – starting from when defendants were ordered to receive inpatient restoration to when they were admitted into the hospital – were getting longer. They nearly doubled from 43 days in fiscal year 2020 to 85 days in 2025.

At its peak, in 2024, the median wait time was 113 days, nearly four months.

The department has attributed long wait times to an inability to increase bed space at the same rate at which people are being found unfit. IDHS officials testified in court that there were times when the state had empty beds – but not enough staff to provide care. A spokeswoman told Illinois Answers that this has “not been an issue for several years.”

Wait times for inpatient fitness restoration have become a national problem, ranging from one week to over a year in different parts of the country. A number of states have longer wait times than Illinois for competency restoration, according to a 2024 report by the Treatment Advocacy Center.

Since 2021, the state has added 200 beds for people involved with the criminal justice system, an IDHS spokeswoman said. The state-operated Alton Mental Health Center is expected to add 100 forensic beds in 2026 after renovations to the southern Illinois facility. The state also partners with private hospitals, like University of Chicago Medicine Ingalls Memorial Hospital in Harvey and Lake Behavioral Hospital in Waukegan, for an additional 60 beds.

The Department of Human Services has said it hired more than 2,100 staff members in the first half of 2023. This helped the department increase the number of patients served by 10% in the latter part of that year.

Even with these gains, as of September 2025, dozens of people are waiting to be placed.

One of them is I.J, a 31-year-old diagnosed with schizophrenia, who was declared unfit after an April arrest on aggravated battery charges.

This is the second time in three years that he has been found unfit for trial. Illinois Answers is identifying him by his initials to protect his privacy.

I.J was once the kind of athlete who could excel at any sport, a University of Illinois graduate who dreamed up big career plans with his best friend and was always the favorite among his grandparents.

But he had begun to isolate himself from his family around the start of the COVID-19 pandemic, according to interviews with his mother and sister. He grew paranoid and barricaded himself in his room. His parents wouldn’t hear from him for weeks and, at times, were not sure where he was living.

By 2022, I.J. had been arrested and charged with retail theft, aggravated battery and burglary. He was found unfit – and waited for 229 days in Champaign County Jail.

Eventually, I.J. became fit for trial. He pleaded guilty to the burglary charge in early 2023, with the other charges getting dismissed. He received probation that required mental health treatment. But he didn’t get care.

His parents struggled to get him treatment. In April 2024, his family was able to have I.J. involuntarily committed to a Decatur hospital. He was then transferred to HSHS St. John’s Hospital in Springfield because he overdosed on Ibuprofen. The hospital released him and canceled the involuntary commitment petition.

In April, I.J. was arrested and charged again, this time in Macon County. He was found unfit again not longer after.

His family hoped he could be placed quickly this time, maybe by late summer. By September, his public defender said it could likely be by early October. Yet at a hearing in early October, I.J. remained in jail. There were no available beds.

I.J. was finally sent to a state hospital in late October, his sister said.

He waited for about 140 days.

‘This decompensation can be irreversible’ 

Last year, E.B., a 41-year-old woman with schizophrenia and bipolar disorder, was in DuPage County Jail for about three months as she waited for an IDHS hospital bed. She had been charged with violating a no-contact order – a misdemeanor that has a maximum penalty of 364 days in jail.

In the end, she was found not guilty.

“She basically should never have been charged,” Kristen Nevdal, her public defender, told Illinois Answers. “She suffered in our jail for months.”

Despite facing a lesser possible sentence, Illinois defendants with misdemeanor charges are on the same wait list as those facing felony charges. The median time these defendants waited for forensic admission increased from 45 to 78 days between 2020 to 2025.

Illinois Answers identified E.B.’s situation as one of over 100 cases in which people with misdemeanors waited more than 60 days in jail for a hospital bed in the last five years. Illinois Answers is identifying her by her initials in order to protect her and her family’s privacy.

Public defenders told Illinois Answers that they have seen clients spend a longer time in jail due to their mental illness.

“Not only are you seeing human suffering,” said Jennifer Maples, who is also a DuPage County public defender, “but some of this decompensation can be irreversible.”

IDHS tries to “expedite misdemeanor offenses, but that’s not the norm,” Dr. Agoritsa Barczak, forensic court services administrator for the department’s Division of Behavioral Health & Recovery, said in 2024 court testimony.

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The timing is based on clinical need and the date of the court order, an IDHS spokeswoman said, and evaluators also reassess people to determine when their admission should be prioritized.

E.B. complained of losing weight while being in jail. Her brother was shocked when he saw her enter the courtroom. Once a healthy woman, she was “skin and bones.”

According to court transcripts, Nevdal, her public defender, raised these concerns, noting E.B. had been placed on suicide watch and restrained due to her decompensation.

“These are due process violations,” Nevdal said in court.“This is an equal protection issue.”

More than three months after E.B. was found unfit, she was placed in state hospital. Updates to recent legislation require courts to prioritize outpatient restoration for people with misdemeanor charges, unless there is a specified need for inpatient treatment.

E.B. is currently undergoing inpatient psychiatric treatment and is doing much better, her brother told Illinois Answers. But the impact of the jail time has been “catastrophic,” he said.

For some, in the last five years, the outcome was far worse.

Renee Cook – a 42-year-old mother of three –  died in September 2023 in Tazewell County Jail while waiting to be placed by IDHS. She too faced misdemeanor charges.

Her family described her as a boisterous woman, who attended church services regularly and, every day, smoked two packs of Black & Milds and bought scratch-off lottery tickets.

Cook struggled with bipolar disorder and schizophrenia for most of her life, according to interviews with her family members. Though she went to therapy, took medication and prolifically journaled, her mental health began to worsen in 2023 following the high school graduation of her younger twin children. She had watched all three graduate high school, which she told her children was her “life goal” to witness.

Not long after, Cook began to have a series of run-ins with police for disorderly conduct. She was detained in jail for misdemeanor charges of battery and trespassing. She was found unfit for trial in late August 2023.

Jail records detail how Cook struggled in the days leading up to her death. She was on suicide watch for 10 days – including the day she died. She was put in a restraint chair and threatened with a taser. Tazewell County Jail officials did not respond to request for comment.

Cook continued to journal in jail, writing on different pieces of paper. Her handwriting was chaotic and messy, not like the neat entries in the journals before her incarceration, the ones her three children – ages 20 and 22 – keep as mementos in their rooms.

When Cook died, she had been waiting for a bed for about a month. Her death was due to complications of lymphocytic myocarditis, an inflammation of the heart, according to an investigation by the Illinois State Police.

Her children share a home in West Peoria, where a framed photo of the family at the twins’ high school graduation party in 2023 sits surrounded by candles next to Cook’s ashes.

On top of her ashes is a lottery scratch-off her son bought on the most recent anniversary of Cook’s death. Her children struggle to “heal,” knowing their mother was suffering in jail with a mental illness, her oldest daughter said.

“The conclusion that I’ve come to is, like, nobody deserves to die that way.”

Illinois Answers has identified at least four people, including Cook and Evans, who have died in jails since 2019 while awaiting a bed at a state psychiatric hospital. In the case of a DuPage County woman, who died after waiting for a bed for 85 days, her family sued and settled with the county for $11 million.

It’s unclear if there are more: An IDHS spokeswoman said the department “does not track incidents that occur while individuals are in the custody of a county sheriff.”

‘An exercise in futility’

The judge said he wracked his brain to think of the right words.

Seven Lake County defendants had been found unfit in August 2024. Now, more than 70 days later they were all still waiting in jail.

“I think the department’s efforts and arguments of placing these defendants can be summed up in three words: An ‘exercise in futility,’” said Lake County Judge Paul Novak.

“The department simply cannot place 350-plus people on their waiting list,” Novak said. “Efforts to improve bed space are simply putting a Band-Aid on a gapping [sic] wound.”

Novak gave this opinion in November 2024 as a result of “rule to show cause” petitions filed on the behalf of the seven defendants. Such petitions argue that a party has not followed a court order. If the judge agrees, the party is in indirect civil contempt, which could result in fines.

In this case, lawyers argued the Department of Human Services failed to comply with Novak’s August 2024 court orders to transfer seven defendants within 60 days and failed to show “good faith” efforts to do so.

Novak agreed. He found the department in indirect civil contempt and said IDHS would have to pay $1,000 per day per defendant until each was in a hospital.

Public defenders and state attorneys have increasingly filed such petitions, Illinois Answers found.

IDHS has been the target of 100 of these petitions in more than a dozen jurisdictions since 2022, according to data obtained through a public records request to the Illinois Attorney General.

Lake County, where Khayla Evans died, filed nearly two dozen petitions, the most of any Illinois county. It resulted in judges like Novak repeatedly finding IDHS in contempt, imposing daily fines until the respective defendants were sent to a hospital.

In all, IDHS paid the north suburban county more than $500,000 in fiscal year 2025. The state has filed appeals, including in Lake County, and had some success with a higher court overturning at least one ruling.

This May, IDHS and Lake County agreed to settle, with the court remitting more than $300,000 back to the department, which will go toward mental health care or forensic restoration in Lake County.

“It basically was the last straw,” Greg Ticsay, Lake County public defender, said of these filings. “There was very little refuge for us to pressure them to act faster. And quite frankly, in many ways it’s Pyrrhic, because the contempt fines didn’t necessarily get people admitted any faster.”

Several public defenders interviewed by Illinois Answers felt similarly, arguing these petitions were a waste of time. Yet others said anecdotally they found their clients were placed not long after the petitions were filed.

An IDHS spokeswoman said “the filing of a Petition for Rule to Show Cause does not accelerate placement.” The department, she said, has shown “good faith efforts” by expanding its bed capacity, both at state-operated and community hospitals.

Illinois Answers identified at least two judges who have raised concerns of constitutional violations regarding these wait times. Novak, the Lake County judge, addressed this on more than one occasion.

“There’s a lot of constitutional rights and statutory rights that are being infringed on because this defendant is waiting for a bed that the department’s in control of,” Novak said during a 2024 hearing.

In Cass County, Judge Timothy Wessel also expressed frustration at the lack of options for courts to help those found unfit.

This was in the 2022 case of a woman, with an unspecified psychotic disorder, who faced felony trespassing charges and waited more than 150 days in jail for a bed. Wessel said the lack of state funding was “ridiculous,” and “frankly, violates the constitutional rights” of the woman.

After she was finally admitted to a state hospital in early 2023, it became apparent to medical experts that she wouldn’t be able to regain fitness. The judge dismissed all three of her charges.

Wessel told her during the final hearing that she had served the “time that we can hold you.” She was free to go. She told the judge she planned to stay at a friend’s house.

“If you need help,” Wessel said, “don’t hesitate to ask, okay?”

Clarification: This story has been updated to clarify how many people are waiting to be placed in a state hospital for fitness restoration.

Story by Meredith Newman, for Illinois Answers Project

Contributing: Janelle O’Dea, Illinois Answers Project

This story was made possible by a grant from The Richard H. Driehaus Foundation to the Illinois Answers Project.

This article first appeared on Illinois Answers Project and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.