Mental Health and the U.S. Criminal Justice System
This paper examines the systemic failures of the U.S. criminal justice system in addressing the needs of individuals with mental illness. Drawing on a review of current literature, the paper traces the origins of the problem to the deinstitutionalization of psychiatric hospitals beginning in the 1960s, which shifted mentally ill individuals from treatment settings into the criminal justice system. The paper surveys current conditions — including overrepresentation of mentally ill persons in jails and prisons, the harmful effects of solitary confinement, and high recidivism rates linked to co-occurring substance use disorders — and projects future consequences if no reforms are enacted. Six concrete policy recommendations are proposed: revamping crisis response, establishing therapeutic diversion units, addressing dual-diagnosis recidivism, accounting for racial disparities, reducing unnecessary criminal justice contact, and prioritizing early intervention.
- Introduction: Framing the problem and defining mental illness
- Background: Deinstitutionalization and Criminalization: How hospital closures shifted mentally ill into prisons
- Current Issues in the Criminal Justice System: Overrepresentation, solitary confinement, recidivism, and crisis response failures
- Probable Future Concerns: Costs and consequences of maintaining the status quo
- Policy Recommendations: Six reforms to improve criminal justice mental health outcomes
- Conclusion: Call for stakeholder collaboration and systemic reform
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What makes this paper effective
- The paper grounds its argument in a clear definition of mental illness at the outset, ensuring analytical consistency throughout the discussion.
- It moves logically from historical context to current conditions to future projections before arriving at recommendations — a structure that makes the policy case compelling and well-supported.
- Each recommendation is tied directly back to evidence cited earlier in the paper, creating strong internal coherence between the problem analysis and the proposed solutions.
Key academic technique demonstrated
The paper effectively uses a problem-cause-consequence-solution framework. By first establishing the historical roots of the crisis (deinstitutionalization), then documenting its present-day manifestations with empirical sources, and finally projecting future costs of inaction, the author builds a layered evidential foundation that makes each policy recommendation feel both necessary and actionable. This technique is particularly useful in applied policy writing.
Structure breakdown
The paper opens with an abstract and introduction that frame the core problem and define key terms. A background section traces the historical origins of the issue. A current-issues section documents present conditions using peer-reviewed studies. A future-concerns section projects negative outcomes if the status quo continues. The recommendations section offers six labeled, discrete policy proposals supported by earlier evidence. The conclusion briefly synthesizes the argument and emphasizes stakeholder collaboration.
Introduction
Various researchers and analysts in the criminal justice realm have observed that a disproportionate percentage of mentally ill individuals are incarcerated in U.S. jails and prisons. Assessments of the country's criminal justice system further indicate that it fails to meet the treatment demands of mentally ill individuals who interact with the system at one point or another. What exists at this moment is a criminal justice system that is effectively rigged against persons with mental illness. With ineffective arrest and detention policies, a disproportionate number of mentally ill persons are sent to prison, only for their conditions to be worsened by an unconducive jail environment. When these persons are released, they lack access to treatment and therapeutic services that would decrease their chances of re-engaging with the criminal justice system — a dynamic that creates a vicious cycle. For this problem to be addressed effectively, there is a need not only to trace its genesis, but also to explore the current state of affairs and consider the consequences of inaction. Only then can meaningful recommendations be made to ensure that the criminal justice system is responsive to the unique needs of mentally ill persons.
From the outset, it is worth noting that symptoms associated with various mental health conditions are subject to interpretation by mental health experts. However, for purposes of this discussion, a concise and definitive definition of mental illness is necessary. As Remch et al. (2021) indicate, mental illness may be conceptualized as "any diagnosed mental disorder (excluding substance abuse disorders) currently associated with serious impairment in psychological, cognitive, or behavioral functioning that substantially interferes with the person's ability to meet the ordinary demands of living" (p. 621). This is the definition embraced throughout this discussion.
Background: Deinstitutionalization and Criminalization
Various theorists and experts have argued that the criminal justice system should treat offenders presenting with symptoms of mental illness differently than those who are mentally sound. For instance, as Scully (2021) — cited in a National Alliance on Mental Illness (NAMI) piece — notes, "in the mid-1800s, Dorothea Dix first advocated for the creation of a system of care for people with mental illness after she witnessed deplorable conditions in a Massachusetts jail." Previous studies have also demonstrated that incarceration can worsen mental health disorders (Remch et al., 2021).
Montross (2020) argues that various government decisions made over the past several decades have led to the current inappropriate handling of mentally ill persons by the criminal justice system. According to the author, the increase in the number of mentally ill persons in prison was originally triggered by the systematic closure of state psychiatric hospitals — a process that unfolded primarily during the 1960s, 1970s, and 1980s. To a large extent, this move was well-intentioned, as it followed findings that some long-term psychiatric institutions were notorious for cruel and egregious treatment of patients. It was established that asylums were in some instances worsening the very problem they were meant to solve, hence the decision to defund and close them and shift care to community settings. However, according to Montross (2020), the intended gains were never realized. Relevant social support systems were never established, and treatment and vocational training needs were never addressed as originally planned. As Montross (2020) observes, "without funds, without treatment, and suddenly also without housing, our nation's most vulnerable citizens fell out of health care and into the realm of the legal system… the criminalization of mental illness had begun."
Current Issues in the Criminal Justice System
Montross (2020) argues that the criminal justice system is not designed to address the unique needs of persons presenting with mental illnesses, and that the problem runs deep — from law enforcement policies to the incarceration environment itself. Montross (2020), who has served as a forensic evaluator for the courts, states that the criminal justice system "runs counter to every principle of human flourishing" she is aware of. In regard to law enforcement policies, she is categorical that police encounters often call for a high degree of attention and obedience. Failure to comply with police instructions can be interpreted as a deliberate attempt to obstruct justice or challenge law enforcement authority. Persons suffering from mental illness may be unable to follow police directions, which places them on a confrontational course with officers — significantly increasing their chances of being arrested, detained, and charged.
According to Scully (2021), a large percentage of persons incarcerated in U.S. prisons today are suffering from a mental illness, with some estimates as high as 37%. According to Remch et al. (2021), standard practice in the criminal justice system involves sending inmates who present with symptoms of mental illness to solitary confinement or other forms of restrictive housing — an approach that frequently aggravates their condition. As the authors note, "a recent study in Washington state correctional facilities found that people in restrictive housing had more symptoms of depression and anxiety and more psychiatric distress than peers in the general prison population" (Remch et al., 2021, p. 621).
Montross (2020) observes that in hospital settings, patients who are assaultive are not locked away in worse conditions; instead, more effective interventions are implemented to address hallucinations or delusions. In correctional facilities, however, inmates who assault peers or correctional officers are likely to incur additional felony charges — with some offenses attracting up to 15 additional years of incarceration. This further illustrates why the criminal justice system is so poorly suited to the needs of persons with mental illness.
According to Walker (2010), persons with mental illnesses who also engage in substance abuse are more likely to be rearrested following release from jail than those who have neither condition. It is important to note that mental illness alone is not the driver of high recidivism on this front — it must co-occur with substance abuse. In the words of Wilson, Draine, Hadley, Metraux, and Evans (2011), "substance use is a driving force behind the recidivism of people with mental illness leaving a U.S. urban jail" (p. 265). The authors attribute this dynamic in part to the failure to develop and implement interventions that address both co-occurring conditions among recently released persons.
One additional concern highlighted by Scully (2021) is a poor crisis response system. At present, the primary first responders in situations involving a person with symptoms of mental illness are police officers — largely because, unlike mental health response centers, which typically operate during business hours, police are available around the clock. This increases the likelihood that such individuals will be placed in custody rather than admitted to a mental health facility. Those who are economically disadvantaged are particularly vulnerable, as they may be unable to afford available psychiatric treatment. As Montross (2020) observes, "across the country, jail is now seen as a treatment option — and sometimes the lone treatment option — for disadvantaged citizens with mental illness." Montross (2020) raises a pointed question in this context: if we do not imprison persons with illnesses such as cancer or diabetes under the pretense of improving their condition, why should we imprison those who present with mental illness and cite their wellbeing as justification?
Conclusion
In the final analysis, the discussion above clearly indicates that the criminal justice system is rigged against persons presenting with various mental illnesses. Failure to take action would be akin to perpetuating the problem, and both short-term and long-term consequences could be catastrophic. It is important to note, however, that for the interventions outlined above to be effective, stakeholder collaboration is essential. This is especially true with regard to broad-based consultation, which is necessary to ensure that all relevant refinements are made and that the implementation process is well-coordinated. Reform is not only possible but necessary — the wellbeing of some of the nation's most vulnerable citizens depends on it.
References
Christiansen, M. J., & Levi, R. (2019). International practices of criminal justice: Social and legal perspectives. Routledge.
Joyce, P. (2013). Criminal justice: An introduction. Routledge.
Montross, C. (2020). We must change how our criminal justice system treats people with mental illness. Time.
Remch, M., Mautz, C., Burke, E. G., Proescholdbell, S., Marshall, S. W., & Naumann, R. B. (2021). Impact of a prison therapeutic diversion unit on mental and behavioral health outcomes. American Journal of Preventive Medicine, 61(5), 619–627.
Scully, S. (2021). Criminal justice reform means reforming the mental health system. National Alliance on Mental Illness.
Waldron, R. J., Quarles, C. L., & McElreath, D. H. (2017). The criminal justice system: An introduction. CRC Press.
Walker, S. (2010). Sense and nonsense about crime, drugs and communities. Cengage Learning.
Wilson, A. B., Draine, J., Hadley, T., Metraux, S., & Evans, A. (2011). Examining the impact of mental illness and substance use on recidivism in a county jail. International Journal of Law and Psychiatry, 34(4), 264–268.
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