Mental Illness and Incarceration: Causes and Solutions
This paper examines the growing crisis of mentally ill individuals being incarcerated in U.S. jails and prisons rather than receiving appropriate psychiatric care. It traces the problem to deinstitutionalization policies initiated in the 1950s, which closed state psychiatric hospitals without establishing adequate community treatment alternatives. Drawing on national prevalence data, the paper documents the high proportion of inmates with serious mental disorders, then details the consequences: elevated recidivism, higher taxpayer costs, management difficulties, and increased rates of suicide and abuse. The paper concludes by proposing a range of policy reforms — including expanded use of assisted outpatient treatment, mental health courts, staff training, Medicaid funding reform, and revised treatment laws — aimed at shifting the system's focus from punishment toward treatment.
- Introduction: Thesis: mentally ill people belong in treatment, not prisons
- Statistics: The Criminalization of Mentally Ill People: Prevalence data on psychiatric disorders across U.S. jails
- Deinstitutionalization: 1950s hospital closures pushed mentally ill into criminal system
- Problems Associated with Incarcerating Mentally Ill Persons: Recidivism, costs, management difficulties, suicide risk
- Possible Solutions: Six policy reforms to shift focus toward treatment
- Conclusion: Deinstitutionalization caused harm; treatment frameworks urgently needed
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What makes this paper effective
- Grounds its argument in specific, concrete statistics — percentages of inmates with psychiatric disorders, daily housing cost comparisons, recidivism rates — which give the policy claims quantitative weight.
- Uses vivid, well-chosen anecdotes (the Mississippi Hinds County Jail inmate, Linda Kraige in Virginia) to humanize the data without displacing it.
- Balances problem identification with an equally detailed solutions section, giving the paper a practical, policy-oriented shape rather than stopping at critique.
Key academic technique demonstrated
The paper demonstrates effective use of a problem-cause-effect-solution structure. It defines key terms precisely at the outset, traces a single root cause (deinstitutionalization) through multiple downstream effects, and then maps each effect onto a corresponding policy remedy. This parallel architecture makes the argument easy to follow and shows that proposed solutions are directly responsive to identified problems rather than generic recommendations.
Structure breakdown
The paper opens with a thesis-driven introduction and a brief glossary of key terms. The second section establishes the statistical scope of the problem. The third section identifies deinstitutionalization as the principal cause. The fourth section details four major categories of harm caused by incarcerating mentally ill persons. The fifth section proposes six specific policy interventions. The conclusion synthesizes the argument and reaffirms the call for a treatment-centered approach.
Introduction
Mental illnesses are among the most serious health concerns facing administrators and policymakers in America today. With the declining availability of both mental health community treatment programs and inpatient psychiatry beds in the few facilities that remain, more and more mentally ill persons are going without treatment and the essential services needed to help them cope effectively with their conditions. Police are often the first responders whenever a mentally ill patient experiences a relapse and acts out due to symptoms of their condition; worryingly, however, rather than being taken to mental health facilities for treatment, most of these individuals end up in jails and prisons.
From the very outset, prison and correctional systems were not designed to respond to the needs of people with mental health problems. When such people are housed there, they become more vulnerable to abuse, fail to receive necessary treatment and care, and end up costing the taxpayer significantly more in medical expenses than the average prisoner. Owing to the unfavorable prison environment, their symptoms worsen, and despite this, their chances of reconnecting with essential services such as Medicaid upon release are very minimal. Worsening symptoms, coupled with frustration, mean a higher risk of recidivism and increased danger to the community.
Since one of the core purposes of the criminal justice system is to ensure the successful reintegration of offenders into the community, there is a need to reorganize the current arrangement so that it focuses more on treatment and less on punishment in the handling of mentally ill persons. Achieving that will, however, require first acknowledging that the closure of state psychiatric hospitals is responsible for the rising numbers of incarcerated mentally ill individuals, that it is directly related to the rising rate of violent crime, and that it imposes a heavier burden on the taxpayer — costing twice as much as assertive community treatment programs.
Before proceeding to the main discussion, it is prudent to define a number of key terms used throughout this paper.
Mental illness: a condition that impairs a person's normal functioning, feelings, moods, thinking, and relational ability (Busfield, 2011). Studies have found major depression, bipolar disorder, and schizophrenia to be the most common mental illnesses and psychiatric disorders affecting prisoners in the American jail system (Treatment Advocacy Center, 2007; Torrey et al., 2010).
Incarceration: the confinement of a person in prison or jail.
Deinstitutionalization: the policy of emptying state psychiatric institutions and then closing them to minimize overcrowding, prevent the deterioration of care, save federal funds, or simply "liberate" persons who have been confined (Torrey et al., 2010).
Statistics: The Criminalization of Mentally Ill People
Researchers have differed on the exact proportion of inmates with serious mental conditions in the U.S. prison system. These discrepancies are partly due to the fact that prison staff — the primary source of such information — may be unwilling to reveal confidential patient information or may not be available for interviews, forcing researchers to rely on online sources that are often outdated. Nonetheless, there is consensus that between 10 and 16% of prisoners (up from 6.4% in 1983) in the system today have some form of severe psychiatric disorder (Treatment Advocacy Center, 2007; Torrey et al., 2010). This implies that approximately 218,000 individuals who ought to be receiving treatment in psychiatric institutions are locked up in jails and prisons with either no or very limited access to such treatment (Treatment Advocacy Center, 2007).
In her study assessing the prevalence of severe mental conditions in Chicago's Cook County Jail, Linda Teplin (as cited in Torrey et al., 2010) found approximately 10% of inmates with psychiatric conditions to have major depression, bipolar disorder, or schizophrenia. The American Psychiatric Association (APA) estimates that on any given day, 2.1 to 4.3% of prisoners in state facilities suffer from bipolar disorder, 13.1 to 18.6% from major depression, and 2.3 to 3.9% from schizophrenia. Two commonly cited examples are the Maine Hancock County Jail, where almost 50% of inmates are on psychotropic medication, and the Ohio State Prison, which reported an astonishing 285% increase in inmates with mental conditions between 1990 and 1996 (Torrey et al., 2010). It is estimated that if this trend continues and the rate of incarceration remains unchanged, 63% of male inmates and 75% of female inmates in jails, and 75% of females and 50% of males in state prisons, will require psychiatric services every year (Aufderheide, 2014).
The situation is no different in juvenile facilities. According to the National Alliance on Mental Illness (NAMI), 74% of girls and 66% of boys in the juvenile justice system suffer from some form of psychiatric disorder (NAMI, n.d.). These figures are a clear indication that the prison system is fast transforming into a large psychiatric institution lacking the requisite treatment and response facilities. In fact, not one of the 3,139 counties in the United States has a psychiatric facility matching the number of mentally ill individuals in its county jail (Treatment Advocacy Center, 2007). The trend is alarming — but what, or who, is to blame for it?
Deinstitutionalization
The deinstitutionalization policy was initiated in the 1950s as a way to reduce overcrowding in state mental health facilities whose quality of care had been compromised by the rising numbers of patients seeking low-cost treatment. It involved shutting down or emptying state psychiatric facilities and had the support of both civil society groups — which believed that mentally ill people had a right to enjoy their freedom — and fiscal conservatives, who interpreted it as a way of saving federal funds (Torrey et al., 2010).
As it turns out, however, the policy has had the effect of channeling mentally ill persons into the criminal justice system, which was never designed to handle such cases. Torrey and his colleagues (2010) point out that due to deinstitutionalization, it is ten times more difficult for a severely ill mental patient to secure a bed in a psychiatric institution than it was in 1955. This lack of treatment causes a worsening of symptoms, a situation made worse by the fact that most of these patients do not have medical insurance to cover the cost of care (Torrey et al., 2010).
Conclusion
Studies have shown that the number of mentally ill patients in prisons has risen substantially since the second half of the twentieth century. Deinstitutionalization has been identified as one of the fundamental reasons for this trend. Despite being initiated with the best of intentions, deinstitutionalization has done more harm than good, particularly because it did not establish adequate frameworks to ensure that mentally ill patients continue to receive treatment after being discharged from hospital. Incarcerating mentally ill patients carries a number of serious disadvantages, including raising the cost of running prisons and increasing the incidence of jail suicide. There is, therefore, an urgent need to establish sufficient frameworks ensuring that mentally ill persons have adequate access to treatment facilities in this post-deinstitutionalization era.
References
Aufderheide, D. (2014). Mental illness in America's jails and prisons: Towards a public safety/public health model. Health Affairs.
Busfield, J. (2011). Mental illness. Cambridge, UK: Polity Press.
Mitchell, A. (2013). Medicaid disproportionate share hospital payments. Congressional Research Service.
NAMI. (n.d.). Criminalization of people with mental illnesses is a significant problem. National Alliance on Mental Illness.
Rosenbaum, S. (2002). An analysis of the Medicaid IMD exclusion. The George Washington University.
Torrey, E. F., Kennard, A. D., Eslinger, D., Lamb, R., & Pavle, J. (2010). More mentally ill persons are in jails and prisons than hospitals: A survey of the states. Treatment Advocacy Center.
Treatment Advocacy Center. (2007). Criminalization of individuals with severe psychiatric disorders. Treatment Advocacy Center.
WHO. (2007). Mental health and prisons. Mental Health, Human Rights and Legislation Information Sheet (Sheet 4). World Health Organization.
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