People with mental illnesses are over-represented in jail and prison populations in the United States relative to the general population.
There are three times as many mentally ill people in jails and prisons than in hospitals in the United States. Mentally ill people are subjected to solitary confinement at disproportionate rates compared to the general prison population. There are a number of reasons for this over-representation of mentally ill people in jails and prisons, including the deinstitutionalization of mentally ill individuals in the mid-twentieth century, inadequate community treatment resources, and the criminalization of mental illness itself. Research has shown that mentally ill offenders have comparable rates of recidivism to non-mentally ill offenders.
The United States Supreme Court has upheld the right of inmates to mental health treatment. The majority of prisons in the United States attempt to employ a mental health providers. However, there is a severe shortage of staff to fill these vacancies and it is difficult to retain employees.
Prevalence
There is a broad scholarly consensus that mentally ill individuals are over-represented within the jail and prison populations of the United States.Torrey, et al. 1998, iv.
In a 2010 study, researchers concluded that, based on statistics from sources including the Bureau of Justice Statistics and the U.S. Department of Health and Human Services, there are currently three times more seriously mentally ill people in jails and prisons than in hospitals in the United States, with the ratio being nearly ten to one in Arizona and Nevada. "Serious mental illness" is defined here as schizophrenia, bipolar disorder, or major depression. Further, they found that 16% of the jail and prison population in the U.S. has a serious mental illness (compared to 6.4% in 1983), although this statistic does not reflect differences among individual states. For example, in North Dakota, they found that a person with a serious mental illness is equally likely to be in prison or jail versus a hospital. In contrast, in states such as Arizona, Nevada, and Texas, the imbalance is much more severe. Finally, they noted that a 1991 survey by the National Alliance for the Mentally Ill concluded that jail and/or prison are part of the life experiences of forty percent of these mentally ill individuals. In addition to mood and anxiety disorders, other psychopathologies have also been found in the US prison System. Antisocial personality disorder is found in less than 6% of the general American population, but seems to be found in anywhere between 12% and 64% of prison samples. Estimates of borderline personality disorder seem to make up around 1% to 2% of the general public, compared to 12% to 30% within prisons. Personality disorders, especially in the inmate population, are often found to be comorbid with other disorders.
A separate research study, The Prevalence of Mental Illness among Inmates in a Rural State, noted that national statistics like those previously mentioned primarily pull data from urban jails and prisons. To investigate possible differences in rural areas, researchers interviewed a random sample of inmates in both jails and prisons in a rural northeastern state. They found that in this rural setting, there was little evidence of high rates of mental illness within jails, "suggesting the criminalization of mental illness may not be as evident in rural settings as urban areas." However, high rates of serious mental illness were found among rural prison inmates.
2015 studies In 2015, lawyer and activist Bryan Stevenson claimed in his book Just Mercy that over 50% of inmates in jails and prisons in the United States had been diagnosed with a mental illness and that one in five jail inmates had had a serious mental illness. As for the gender, age, and racial demographics of mentally ill offenders, the 2017 Bureau of Justice Statistics report found that female inmates, when compared to male inmates, had statistically significantly higher rates of serious psychological distress (20.5% of female prisoners and 32.3% of female jail inmates had serious psychological distress, versus 14% of male prisoners and 25.5% of male jail inmates) and a history of a mental health problem (65.8% of female prisoners and 67.9% of female jail inmates compared to 34.8% of male prisoners and 40.8% of male jail inmates). Significant differences between race and ethnicity were also observed. White prisoners and jail inmates were more likely to have serious psychological distress or a history of mental health problems than black or Hispanic inmates. For example, in local jails, 31% of white inmates had serious psychological distress compared to 22.3% of black inmates and 23.2% of Hispanic inmates. Finally, regarding age, there were virtually no statistical differences between age groups and the percentage of those with serious psychological distress or a history of a mental health problem.
2017 studies A 2017 report issued by the Bureau of Justice Statistics used self-reported survey data from inmates to assess the prevalence of mental health problems among prisoners and jail inmates. They found that 14% of prisoners and 25% of jail inmates had experienced serious psychological distress in the past 30 days, compared to 5% of the general population. In addition, 37% of prisoners and 44% of jail inmates had a history of mental health problems.
Potential reasons for the high number of incarcerated people diagnosed with mental illnesses
Deinstitutionalization
Researchers commonly cite deinstitutionalization, or the emptying of state mental hospitals in the mid-twentieth century, as a direct cause of the rise of mentally ill people in prisons.Torrey, et al. 1998, 53. In the 2010 study "More mentally ill persons are in jails and prisons than hospitals: a survey of the states," researchers noted that, at least in part due to deinstitutionalization, it is increasingly difficult to find beds for mentally ill people who need hospitalization. Using data collected by the Department of Health and Human Services, they determined there was one psychiatric bed for every 3,000 Americans, compared to one for every 300 Americans in 1955. They also noted increased percentages of mentally ill people in prisons throughout the 1970s and 1980s and found a strong correlation between the number of mentally ill people in a state's jails and prisons and how much money the state spends on mental health services. In the book Criminalizing the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals, researchers note that while deinstitutionalization was carried out with good intentions, it was not accompanied by alternate avenues for mental health treatment for those with serious mental illnesses. According to the authors, Community Mental Health Centers focused their limited resources on individuals with less serious mental illnesses; federal training funds for mental health professionals resulted in lots more psychiatrists in wealthy areas but not in low-income areas; and a policy that made individuals eligible for federal programs and benefits only after they'd been discharged from state mental hospitals unintentionally incentivized discharging patients without follow-up.Torrey, et al. 1998, 53-54.
In the article Assessing the Contribution of the Deinstitutionalization of the Mentally Ill to Growth in the U.S. Incarceration Rate, researchers Steven Raphael and Michael A. Stoll discuss trans institutionalization, or how many patients released from mental hospitals in the mid-twentieth century ended up in jail or prison. Using U.S. census data collected between 1950 and 2000, they concluded that "those most likely to be incarcerated as of the 2000 census experienced pronounced increases in overall institutionalization between 1950 and 2000 (with particularly large increases for black males). Thus, the impression created by aggregate trends is somewhat misleading, as the 1950 demographic composition of the mental hospital population differs considerably from the 2000 demographic composition of prison and jail inmates." However, when estimating (using a panel data set) how many individuals incarcerated between 1980 and 2000 would have been institutionalized in years past, they found significant trans institutionalization rates for all men and women, with the largest rate for white men.
Accessibility A main contributing factor to the US's steady increase in those who are mentally ill within the prison system could be the lack of accessibility in various communities. Specifically, those who come from a lower-income background face these issues, in which there are few to no readily available resources for those experiencing ongoing difficulty with their mental health. The AMA Journal of Ethics discusses more specific factors contributing to the consistently high arrest rates of those with severe mental illness within certain communities, stating that the arrests of drug offenders, a lack of affordable housing, and a significant lack of funding for community treatments are the main contributors. With the introduction of Medicaid, many state-run mental health facilities closed due to a shared responsibility for funding with the federal government. Eventually, states would close a good portion of their facilities so that mentally ill patients could be treated at hospitals where they would be partially covered by Medicaid and the government. The National Council for Behavioral Health conducted a study in October 2018 that included survey results that confirmed "nearly six in 10 (56%) Americans [are] seeking or wanting to seek mental health services either for themselves or for a loved one..." These individuals are skewing younger and are more likely to be of lower income and military background”.
Criminalization
A related cause of the disproportionate number of mentally ill people in prisons is the criminalization of mental illness itself. In the 1984 study Criminalizing mental disorder: The comparative arrest rate of the mentally ill, researcher L. A. Taplin notes that in addition to a decline in federal support for mental illness resulting in more people being denied treatment, mentally ill people are often stereotyped as dangerous, making fear a factor in action taken against them. Bureaucratic and legal impediments to initiating mental health referrals mean arrest can be easier, and in Taplin's words, "Due to the lack of exclusionary criteria, the criminal justice system may have become the institution that cannot say no." Mentally ill people do indeed experience higher arrest rates than those without mental illness, but to investigate whether or not this was due to the criminalization of mental illness, researchers observed police officers over a period of time. As a result, they concluded that "within similar situations, persons exhibiting signs of mental disorder have a higher probability of being arrested than those who do not show such signs."