The United States prison system is the largest in the world. The United States continues to have one of the highest incarceration rates in the world, with 5 percent of the world population, but nearly 25 percent of the world’s prisoners. Over the last decade state prisons have experienced unprecedented growth and many demographic changes. Mental health disorders among prisoners have consistently exceeded rates of such disorders in the general population. According to a report from the Bureau of Justice Statistics, an estimated 16 percent of inmates in state and federal prisons have a serious mental illness. The mental health crisis is more pronounced among women prisoners. Increased incarceration rates in the United States have disproportionately affected racial and ethnic minority populations. Experts say jails and prisons have become the nation’s largest psychiatric facilities.
Mental Illness
Mental illness is a serious problem in the United States, and it is especially prevalent in jails and prisons. U.S. prisons and jails incarcerate a disproportionate amount of people who have a current or past mental health problem, and facilities are not meeting the demand for treatment. Mass incarceration, poverty, and a drug epidemic—coupled with a lack of access to treatment—have resulted in the criminalization of the mentally ill in a system often unprepared to properly deal with the problem.
The growth in the number of mentally ill inmates is mainly attributed to the gap between the need for treatment and the availability of mental health services in the community, especially for those who require in-patient care. Even when mental health concerns are known, disorders often go untreated. Most prisons lack the funds to offer adequate mental health treatment. This treatment discontinuity has the potential to affect both recidivism and health care costs on release from prison. Prisoners should have the same access to healthcare as everyone else.
Risk of Negative Consequences
A lack of access to mental health care, coupled with the stressors of prison life, can lead to a decline in mental health among inmates. Once incarcerated, individuals with mental illnesses tend to stay longer in jail and, upon release, are at a higher risk of returning to incarceration than people without these illnesses. Alone in that small space, they become even more distressed, have more psychotic symptoms, and are more likely to attempt suicide. Mental health services in prisons and jails are often inadequate, leading to further deterioration of mental health among inmates. A substantial portion of the prison population is not receiving treatment for mental health conditions.
Inmates with serious mental illnesses are at risk for several negative outcomes, including violence, self-harm, and recidivism. Being in prison makes them vulnerable to even more abuse. Mental health services in prisons and jails should be improved to better address the needs of inmates with mental illness.
Why Are So Many People With Mental Illness in Jail?
Incarceration disproportionately affects people with mental illness. In America, an estimated 2 million adults with serious mental illness are booked into jails each year. That’s nearly four times the number of people with mental illness in state prisons. Mental health problems are also more common among people in local jails than in the general population—a reality that has been amplified by the opioid epidemic and the resulting criminal justice responses to it.
There are several reasons why people with mental illness end up behind bars. People with mental illness are more likely to come into contact with police, due in part to behaviors related to their condition—for example, public disturbance or loitering charges stemming from auditory hallucinations or delusions. Once arrested, they are more likely to be held in pretrial detention because they cannot afford bail or lack stable housing or other support. In jail, they are less likely to have access to needed mental health treatment and more likely to experience violence. Mental health services provided in jails typically focus on identifying mental illness, crisis management (including suicide prevention), and short-term treatment.
The overrepresentation of people with mental illness in jails and prisons takes a toll on everyone involved—people with mental illness, their families and friends, corrections staff, and the general public. People with mental illness who are incarcerated are more likely to re-offend and end up back behind bars, further exacerbating the problem. The entire criminal justice system pays a price for this vicious cycle: Mental illness among people in jail or prison strains resources jeopardizes the safety and drives up costs.
Help for Prisoners with Mental Illness
There is no single solution to the problem of mental illness in the criminal justice system. But diversion programs that keep people with mental illness out of the justice system altogether are a promising start. Mental health courts, which connect people with mental illness to treatment and other services instead of jail time, are effective in reducing recidivism. Other diversion programs, like crisis intervention teams—teams of police officers specially trained in how to de-escalate encounters with people with mental illness—have also been successful in keeping people out of the justice system.
Both targeted programs and wholesale changes are sorely needed in how individuals with mental illness are processed in the criminal justice system. Addressing the overrepresentation of people with mental illness in our jails and prisons is not only the right thing to do, but it’s also the smart thing to do. Diversion programs that keep people with mental illness out of the justice system save money, improve public safety, and respect the dignity of people with mental illness.