Protecting the Unprotected

Joe Monahan’s ongoing campaign for mental health and people with disabilities

Published in 2023 Illinois Super Lawyers magazine

By Taylor Kuether on January 20, 2023

In 1978, Joe Monahan was running a child welfare agency that handled everything from foster care to counseling and school interventions. Right after starting the job, he pitched a new group home for troubled youth.

“I remember the first night I walked into the town, they had an emergency board meeting because the neighbors were all upset, and they protested to not permit us to open,” he recalls.

So Monahan suggested another location, then another.

“The last place the board of directors chose was on the outskirts of town, at the end of an airstrip, and the neighbors went, ‘How are you going to bring these delinquent kids into our neighborhood?’ We were trying to explain that these are kids who don’t have a mother or a father, we’re trying to provide a home, we’re going to have 24-hour care,” says Monahan.

It didn’t work.

“Ultimately, I went back to the funders and said, ‘What if, instead of having one group home that served eight kids, we funded foster care?’ So we used the dollars that were going to go into the group home and expanded our foster care network. And that turned out good for that community. They, today, still do not have a group home.”

Situations like these—two steps forward, one step back—are common in the field, and they emboldened Monahan to enter law school and try to effect change at a higher level as an advocate for people with disabilities and the professionals who serve them. Thirty-five years later, he still has the same passion for the people he’s hoping to protect, and while major problems remain, there are reasons for optimism.

“I had a client who was going to start a group home for persons with autism. I went into the suburban neighborhood all ready to make the legal arguments, prepared for this outpouring of negativity,” Monahan recalls. “I went in front of the village board and, as I stood up, the village president said, ‘We don’t need your arguments, we’ve considered this, we have an ordinance that permits you in our community, you are welcome with open arms.’”

Early in his social work career, Monahan often crossed paths with lawyers.

“On the legislative front, we were involved in a lot of advocacy and the people I was running into were the lawyers writing the laws, the lawyers interpreting the laws, the lawyers pushing the laws through the House and the Senate in Illinois,” he says. “That’s when I started thinking, as an advocate, I would be able to be more effective.”

After grad school, he ran the comprehensive child welfare agency, which offered everything from foster care to counseling. Once again, every time Monahan turned around, he was calling a lawyer. “It was interesting, as a director of an agency, the number of legal issues I was running into,” he says.

Then he went to law school, where he stumbled upon a class-action suit brought by Patrick Murphy, representing children who were wards of the state placed in institutions. “It’s ironic now, 30-some years later, the same issues are on the front page of the newspapers,” he says.

Murphy’s work inspired Monahan to join the Illinois Guardianship & Advocacy Commission representing individuals in mental health court, and, later, to start his own firm in 1988. Today, Monahan Law Group counsels hospitals, mental health clinics, child welfare agencies, social service agencies and people in administrative and judicial proceedings.

“We really see all sides of the issue: the institutional point of view, the parent point of view, the sibling point of view, the consumer point of view for individuals seeking services,” Monahan says.

It’s brought his career full circle. “I started out as a law student trying to get kids out of psychiatric hospitals that didn’t need to be in there, and now today those same issues are confronting the entire health care system for kids, who are placed in psychiatric hospitals and there’s no place for them to go when they’re discharged. It’s something that I’ve been interested in for a long time.”

Julia Lynch, an in-house attorney at Northwestern Medical Center, can attest to Monahan’s passion for the work.

“First and foremost, Joe is totally dedicated to helping hospitals help our most vulnerable,” says Lynch. “Joe has helped us with some of these sad situations involving troubled minors who’ve been locked out of their homes and left in hospitals. We’ve asked Joe for help in securing living arrangements for our developmentally disabled patients who’ve been left in hospitals, and his team is really helpful in helping us with patients who are experiencing mental health crises. He always tries to find creative ways to get these vulnerable patients into appropriate situations.”

Monahan and his team also assist in situations where people have been discharged by a hospital and need to find an appropriate living situation, says Lynch. “Joe’s office manages multiple guardianship cases for Northwestern Medicine every year. He and his lawyers come in and help us make sure these patients’ rights are protected and they have a safe discharge plan. His depth of knowledge about the Illinois mental health code makes Joe and his team indispensable. He is just so committed to the rights of mental health patients and committed to the code that protects those patients’ rights.”

It can be an emotionally draining area of law. As Monahan tells his 14-lawyer firm, “‘We are changing people’s lives with our work. People come to us when they can’t figure out their problems. You are going to hear the most unbelievable stories and you’re going to have people who call you who are very upset. Understand why they’re upset and try to be empathetic towards them.’

“We try to treat each other that way within the firm as well.”

Monahan’s empathy stems in part from his own tragedy.

“I have a wonderful wife who is with me all the way. I have four children and two grandchildren, and we’re a very close family,” he says. “One of my sons, my oldest son, died at an early age of an undiagnosed heart condition, so it gives me some empathy. I understand parents and families that are going through the horrible of horribles. That sensitivity has allowed me to listen more carefully to those who are in pain.”

Mental health, and the stigma associated with it, is a particular interest of Monahan’s.

“A person with a diagnosis of cancer can access cancer care; a person with a heart condition can access health care. A person with a diagnosis of a mental health issue should have that same right of access,” he says.

What makes access particularly tough these days, he says, is the structure of health care. “Everything is done to get people out of the hospital as quickly as possible,” Monahan says. “It’s the same with mental health issues, but we don’t have the infrastructure for something less than hospitalization.” 

In the 1920s, ’30s and ’40s, states built huge institutions to house people, Monahan says, only to find that it’s extremely expensive to do so. There were once 35,000 to 40,000 state hospital beds for people with mental illness in Illinois state institutions. “Today, we have about 1,200 beds,” Monahan says.

So where are they? “Sheriff [Tom] Dart will tell you that the largest mental health facility in the United States is Cook County Jail,” Monahan says. “Jailers in L.A. will tell you the Los Angeles County Jail is the biggest. But whether it’s first or second, the point is that a lot of people who are in jail have mental health issues.

“When Sheriff Dart hired a new head of Cook County Jail, he hired a psychologist,” Monahan continues. “He said, back then, ‘One out of three people going into the jail had serious mental illness.’ Now it’s up to about 37 percent.”

For children, the mental health statistic is even worse. “The state of Illinois has zero state hospital beds for minors in its state system. Zero,” Monahan says.

But the issue is deeper than just a lack of beds. Monahan advocates for what he calls the three-legged stool of mental health treatment. 

“First, we want to get them into the hospital to get them stabilized. Second is getting them on the proper medication,” he says. “But the third leg, which we often ignore, is post-hospitalization. What treatment, what services, what support can we have in the community so they don’t come out, stop taking their medication, and then need to go into the hospital again? … It’s this revolving door.”

Monahan says he’s experienced patients who have had five, 10, even 20 hospitalizations over the course of a couple of years. “It’s because we don’t have the infrastructure, the outpatient care. We hear about people spending days in the emergency rooms because they can’t get access to care; all the psychiatric beds are full, particularly in the city,” says Monahan. “Access to care is important. I think a spotlight on mental health at the national and state levels could net more resources so that people have access to them.” 

Unfortunately, says Monahan, the current national narrative about mental health is about shooters.

“A person with a diagnosed mental health issue is more likely to be a victim than a perpetrator of violence,” Monahan says. “That gets lost in the headlines of these horrific shootings. It’s something I try to impart upon my students: We need to get good health care policy.”

For example, there were situations in which patients refuse medication or treatment, leaving practitioners and families little recourse. “So myself and a couple of others sat down and tried to figure out a system,” Monahan recalls. “When we were rewriting the statute, we made it so that all people can go through the state’s attorney and were allowed access to the courts, so all people could get court orders for involuntary treatment when it was appropriate.”

In 2021, Monahan took a case to address the issue of when a state’s attorney has access to a woman’s medical record when she’s a victim of sexual assault.

“We worked with organizations to clarify the law—that in order to get medical records, one had to get a court order,” he says. “It went up to the appellate court, and we were successful; it went to the [state] supreme court, and we were successful. Those were important victories.”

Because of such victories, the National Association of Social Workers Foundation honored Monahan with the Social Work Pioneer award in 2020. His sister, Mary Jo—a social worker, advocate, and nonprofit leader—received the honor in 2021. With COVID delaying ceremonies, they collected their awards together in October 2022.

On Oct. 15, 2022, the National Association of Social Workers Foundation honored Joe and his sister Mary Jo with Social Work Pioneer awards in Washington, D.C.

The pandemic also brought its own battles.

“Joe helped Northwestern when we were faced with patients who sued us—or threatened to sue us—over ivermectin,” Lynch recalls. “Specifically, [it was] lawyers seeking court intervention to force Northwestern hospitals and doctors to administer ivermectin to treat COVID-19, despite the drug not being indicated or approved for such use—and despite the treating physicians’ medical opinions that the drug was not indicated or medically appropriate under the circumstances. Joe dropped everything to defend Northwestern Medicine and our physicians in one such case, and we prevailed thanks to his excellent advocacy.”

Monahan has been teaching mental health law at Loyola for many years, and he always tells his students that it doesn’t matter what type of law they’re involved in, they’re going to be involved in issues concerning mental health.

Joe with his son, Colin, at Guaranteed Rate Field in October 2021 for the American League Division Series against the Houston Astros.

“My first lecture every semester is ‘Why did you take this class?’ Most people say, ‘Oh, I think it’s interesting,’ only for me to find out later they may have a family member with a mental health issue or they got an undergraduate degree in psychology or social work, or they’re interested in the field, which always warms my soul,” Monahan says.

“What I try to impart upon my students is a real understanding that mental health issues impact so many people and we see it everywhere. What’s important to me is that they get a clear understanding and a broad overview of the mental health system. I want them to know the history. I want them to know how to get somebody into the hospital and out of the hospital. I want them to understand what their legal and ethical obligations are when working with a person with a disability. I want them to understand who their client is.”

It’s common for young attorneys to be appointed to represent someone in a criminal or civil matter, and the client may have a mental health issue, Monahan says. “How do they deal with that when that’s interfering with their client’s ability to understand? What are their ethical obligations? How do they treat a person with a mental health issue? What do they do?

“I’ve tried hundreds of cases in the guardianship arena, but what I’ve tried to do with each and every one of my clients is to treat them with the ultimate respect and give them the ultimate advocacy,” he says. “I’ve tried to do my very best.”