The prevalence and treatment of mental illness in the criminal legal system
Below, we’ve curated virtually all of the research about the relationship between mental health and the criminal justice system available online.
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. Police are also often used to respond to mental health crises, despite their involvement frequently resulting in violence or incarceration. The research below expands on mental health policies, practices, and inequities affecting justice-involved people. You can also see a selection of our other research on health in prisons on our Health page.
Share of Adult Suicides After Recent Jail ReleaseTed R. Miller, Lauren M. Weinstock, Brian K. Ahmedani, et al., May, 2024“Among 7 million adults released from incarceration in 2019, nearly 20% of suicides occurred among those who were released from jail in the past year and 7% were by those in their second year of jail release.”
Elements of State and Federal Prison Suicide Prevention and Response PoliciesChristine Tartaro & Emily Alas, February, 2024“Results revealed that corrections department policies for suicide prevention and response contain about half of the recommended elements, and that most departments' suicide prevention policies are not included in departmental policy documents.”
Prevention Over Punishment: Finding the Right Balance of Civil and Forensic State Psychiatric Hospital Beds Treatment Advocacy Center, January, 2024“The number of state hospital beds for adults with serious mental illness (SMI) has been declining and reached a historic low of 10.8 beds per 100,000 people in 2023, with 52% of those beds occupied by people committed through the criminal legal system.”
"You Send Yourselves to Jail": Coercive Diversion in the Allegheny County Mental Health Court Abolitionist Law Center, December, 2023“As a plea-dependent court, [the mental health court] subjects people to most traditional carceral processes and leaves them with a permanent record.”
Barriers to access to psychiatric medications in Missouri county jailsJessica K Burval, Courtney A Iuppa, Carrie R Kriz, Shelby E Lang, Leigh Anne Nelson, Nicole A Gramlich, Ellie S R Elliott, & Roger W Sommi, October, 2023“Of the 51 jails surveyed, only 57% of jails were able to provide long-acting injectable antipsychotics, 22% charged a fee for administration of medications, and 31% would not adjust medication times based on food requirements.”
Racial Differences in Self-Report of Mental Illness and Mental Illness Treatment in the Community: An Analysis of Jail Intake Data Narcissa Plummer, Rubeen Guardado, Yvane Ngassa, et al., September, 2023“In a Massachusetts jail, Hispanic, Black (NH), Asian/Pacific Islander (NH), other race/ethnicity people were less likely to report a history of mental illness at jail intake, and less likely to report receiving psychiatric medications in the community.”
Involuntary Civil Commitment as Mass IncarcerationTristan Campbell, September, 2023“Despite civil commitment often mirroring--and sometimes substituting for--incarceration, there is almost no data in comparison.”
"All carrots and no stick": Perceived impacts, changes in practices, and attitudes among law enforcement following drug decriminalization in Oregon Paywall :(Hope M. Smiley-McDonald, Peyton R. Attaway, Lynn D. Wenger, Kathryn Greenwell, Barrot H. Lambdin, and Alex H. Kral, August, 2023“Law enforcement interviewees expressed frustration that they could not use drug possession as a "tool" for investigations to pursue and build cases, establish probable cause, and impose what they believed necessary for social order.”
Inequities in Mental Health Services: A 16-Year Longitudinal Study of Youth in the Justice System Maria Jose Luna, Karen M. Abram, David A. Aaby, Leah J. Welty, & Linda A. Teplin, June, 2023“Among a random sample of youth experiencing detention in Chicago in 1995, less than 20% of youth who needed mental health services received them in the following 20 years.”
Calculating TortureSolitary Watch and Unlock the Box Campaign, May, 2023“State and federal prisons and local and federal jails in the U.S. have reported on a given day locking a combined total of more than 122,000 people in solitary confinement for 22 or more hours.”
Lifetime and Jail-Specific Suicidal Ideation: Prevalence and Correlates in a Sample of People in Jail in the United States Bryce E. Stoliker, Haile Wangler, Frances P. Abderhalden, and Lisa M. Jewell, April, 2023“Approximately 45% of the 196 people sampled reported a lifetime history of suicidal ideation (SI) & 30% reported SI during the current incarceration... Those who identified as non-men reported a higher prevalence than men on lifetime and jail-specific SI”
Banning Torture: Legislative Trends and Policy Solutions for Restricting and Ending Solitary Confinement throughout the United States Unlock the Box Campaign, January, 2023“Given that even a brief time in solitary can cause devastating harm--without any benefit--policymakers should finally and fully end solitary confinement for all people, other than for periods of minutes or hours for purposes of emergency de-escalation.”
Mental Health of Incarcerated Veterans and Civilians: Latent Class Analysis of the 2016 Survey of Prison Inmates Paywall :(Emily R. Edwards et al, September, 2022“Classes were compared on Veteran status, military service-related variables, and treatment-related variables...Results attest to the importance of person-centered mental health care within correctional settings.”
Mental health disparities in solitary confinementPaywall :(Jessica T. Simes, Bruce Western, and Angela Lee, July, 2022“Disparities by mental health status result from the cumulative effects of prison misconduct charges and disciplinary hearings. We estimate that those with serious mental illness spend three times longer in solitary [than those without mental illness].”
Working in "a meat grinder": A research roundup showing prison and jail jobs aren't all that states promise they will be Prison Policy Initiative, May, 2022“A 2016 paper studying correctional officers in Michigan estimated that 34% of participants had PTSD, 36% had depression, and 25% had both.”
Punishment of People with Serious Mental Illness in New York State Prisons: An Analysis of 2017-19 Disciplinary Data in Prison Residential Mental Health Treatment Units #HALTSolitary and Mental Health Alternatives to Solitary Confinement, May, 2022“Of the 399 people disciplined in a Residential Mental Health Treatment Unit during the 29-month review period, 99% were sanctioned with segregated confinement and 85% received at least six months or more of additional segregation time,”
Autism and the Criminal Justice System: Policy Opportunities and Challenges International Society for Autism Research, April, 2022“Inclusive research practices that meaningfully involve and partner with neurodiverse minority groups are needed to generate policy change in the criminal justice system, which excessively and disparately harms minority communities.”
Parole, Power, and Punishment: The Massachusetts Parole Board's Discriminatory Treatment of People with Mental Health Disabilities Northeastern University School of Law and Mental Health Legal Advisors Committee (MHLAC), March, 2022“The Board's Handbook lists factors that Board members can consider. No regulation, however, requires [their consideration]...the Board's largely arbitrary decision-making process allows for implicit bias that directly impacts those with disabilities.”
Incarceration and subsequent risk of suicide: A statewide cohort study Paywall :(Erin Renee Morgan et al, January, 2022“Suicide risk was 62% higher among previously incarcerated individuals compared with the general population.”
Research roundup: The positive impacts of family contact for incarcerated people and their families Prison Policy Initiative, December, 2021“As with visitation, family phone calls are shown to reduce the likelihood of recidivism; more consistent and/or frequent phone calls were linked to the lowest odds of returning to prison.”
Prisons and Mental Health: Violence, Organizational Support, and the Effects of Correctional Work Paywall :(Amy E. Lerman, Jessie Harney, Meredith Sadin, September, 2021“Correctional workers have a high likelihood of exposure to violence in the workplace. However, empirical literature has largely neglected the mental health consequences of prison work.”
"Every Thought and Dream a Nightmare": Violence and Trauma Among Formerly Imprisoned Gang Members Paywall :(Shytierra Gaston, Faraneh Shamserad, and Beth M. Huebner, August, 2021“Although direct involvement in violence dissipated after prison, exposure to vicarious victimization was substantial and ongoing.”
Certified Community Behavioral Health Clinics and the Justice SystemsNational Council for Mental Wellbeing, August, 2021“CCBHCs are required to deliver a comprehensive scope of services to meet clients' full [mental health/substance use] needs while integrating services with primary care.”
Reforming solitary confinement: the development, implementation, and processes of a restrictive housing step down reentry program in Oregon Ryan M. Labrecque, Jennifer J. Tostlebe, Bert Useem and David C. Pyrooz, August, 2021“We focus on the task set forth by the Oregon Department of Corrections (DOC) to create a new unit that is committed to rehabilitative programming, increased socialization opportunities, and blunting some of the harsher conditions of restrictive housing.”
Unjust Isolation: The Diminishing Returns of Solitary Confinement of Pregnant Women and California's Need to Regulate It Richard Lee, July, 2021“When all the risk factors of pregnant prisoners intersect, it puts them in an especially ill-equipped position to protect themselves mentally against the potential harms of solitary confinement.”
Building exits off the highway to mass incarceration: Diversion programs explained Prison Policy Initiative, July, 2021“We envision the criminal justice system as a highway where people are heading toward the possibility of incarceration; depending on the state or county, this highway may have exit ramps in the form of diversion programs and alternatives to incarceration.”
The Revelatory Nature of COVID-19 Compassionate Release in an Age of Mass Incarceration, Crime Victim Rights, and Mental Health Reform Jennifer A. Brobst, July, 2021“Early COVID-19 compassionate release decisions reveal that courts continue to base early release decisions primarily on an assessment of public safety risk from crime, not community impact, crime victim impact, or even prisoner health.”
Family member incarceration and mental health: Results from a nationally representative survey Kristin Turney, June, 2021“The stressor of incarceration proliferates to have reverberating mental health consequences for those connected to the incarcerated, via pathways such as destabilized family economic wellbeing or impaired relationships between family members.”
Decoupling Crisis Response from Policing -- A Step Toward Equitable Psychiatric Emergency Services New England Journal of Medicine, May, 2021“Police responses to psychiatric crises harm patients far too often, especially in minority communities, where a long history of institutional racism informs warranted distrust of law enforcement.”
Proliferation or adaptation? Differences across race and sex in the relationship between time served in prison and mental health symptoms Paywall :(Lauren C. Porter, Meghan Kozlowski-Serra, and Hedwig Lee, May, 2021“Drawing on data from the Survey of Inmates in State Correctional Facilities in 2004 (N = 12,118), our findings suggest that time served is correlated with mental health symptoms, but that the association differs across race and sex.”
Defund the Police - Invest in Community Care: A Guide to Alternative Mental Health Responses Interrupting Criminalization, May, 2021“This guide highlights considerations for real, meaningful shifts away from law enforcement and towards autonomous, self-determined community-based resources and responses to unmet mental health needs.”
Adequacy of Healthcare Provided In Louisiana State PrisonsLoyola University, Louisiana State University, VOTE (Voices of the Experienced), May, 2021“The real-world minimum wage equivalent of [medical co-pays] for incarcerated people who earn incentive wages of $.02/per hour is: $1,087.5 for a routine visit, $2,175 for an emergency visit, and $725 for a prescription.”
Mortality in State and Federal Prisons, 2001-2018 - Statistical TablesBureau of Justice Statistics, April, 2021“In 2018, a total of 4,135 state prisoners died in publicly or privately operated prisons, and an additional 378 federal prisoners died in facilities operated by the Federal Bureau of Prisons (BOP).”
The Impacts of Solitary ConfinementVera Institute of Justice, April, 2021“The widespread use of solitary does not achieve its intended purpose--it does not make prisons, jails, or the community safer, and may actually make them less safe.”
Prevalence, Comorbidity, and Continuity of Psychiatric Disorders in a 15-Year Longitudinal Study of Youths Involved in the Juvenile Justice System Teplin, Linda et al., April, 2021“Among participants with a [psychiatric] disorder at baseline, 64.3% of males and 34.8% of females had a disorder 15 years later. Compared with females, males had 3.37 times the odds of persisting with a psychiatric disorder 15 years after baseline.”
Harm Reduction at The Center of IncarcerationDr. Nneka Jones Tapia, April, 2021“Even when the reality of trauma in correctional institutions is fully appreciated, policies often only focus on programs for people who are incarcerated, as if they are the problem, instead of on the system itself.”
Policing and public health calls for service in PhiladelphiaJerry H. Ratcliffe, March, 2021“In Philadelphia, at least in a relatively normal (i.e. non-COVID-19) year, calls to the police that start or result in some form of medical/public health connection comprise about 8% of the police activity that originates from the public.”
Risk factors for suicide in prisons: a systematic review and meta-analysis Shaoling Zhong et al., February, 2021“Single risk factors are not sufficient to identify individuals at high risk of suicide.”
Behavioral Health Crisis Alternatives: Shifting from Police to Community Responses Vera Institute of Justice, November, 2020“Communities must pursue new approaches that minimize trauma and distress, promote dignity and autonomy, and reduce repeat encounters with police for people who experience behavioral health crises.”
Investigation of the Massachusetts Department of CorrectionUnited States Attorney's Office District of Massachusetts, November, 2020“The conditions in Massachusetts Department of Correction's prisons (MDOC) violate the Eighth Amendment to the U.S. Constitution.”
The Community Responder Model: How Cities Can Send the Right Responder to Every 911 Call Center for American Progress, October, 2020“Estimates for the share of calls that could be handled by [community responders] range from a low of 21 percent of calls in Detroit to a high of 38 percent in Seattle and Portland.”
"Defunding the Police" and People With Mental IllnessBazelon Center for Mental Health Law, August, 2020“We should dramatically reduce the role of the police in the lives of people with mental illness. As the same time, mental health services should be expanded and racial disparities in their delivery eliminated.”
Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies National Association of State Mental Health Program Directors, August, 2020“Individuals [in behavioral health crisis] account for a quarter of police shootings and over 2 million jail bookings per year. Explicit and implicit bias magnify these problems for people of color.”
Suicide in North Carolina JailsDisability Rights North Carolina, June, 2020“While the total deaths [in North Carolina jails] increased by 6% (from 46 to 49) between 2018 and 2019, jail suicides increased by 67% (from 12 to 20). In 2019, 41% of all jail deaths were deaths by suicide.”
Trauma and Loss During Reentry: Early Findings from a Multi-State Trial Florida State University Institute for Justice Research and Development, May, 2020“47% of our participants experienced at least one traumatic event in the 8 months after their release from incarceration.”
Psychological Distress in Solitary Confinement: Symptoms, Severity, and Prevalence in the United States, 2017-2018 Keramet Reiter et al, January, 2020“Serious mental illness rates, typically estimated at 10% to 15% of prison populations, are measured at 9% in Washington's general prison population but 20% in our intensive management unit [(i.e. solitary confinement)] sample.”
Diversion to What? Evidence-Based Mental Health Services that Prevent Needless Incarceration Bazelon Center for Mental Health Law, September, 2019“Investing in community-based mental health services provides numerous benefits, including a reduction in law enforcement intervention and incarceration.”
ISOLATED: ICE Confines Some Detainees with Mental Illness in Solitary for Months Project On Government Oversight, August, 2019“About 40 percent of the records show detainees placed in solitary have mental illness. At some detention centers, the percentage is much higher.”
Police-Mental Health Collaborations: A Framework for Implementing Effective Law Enforcement Responses for People Who Have Mental Health Needs Council of State Governments, July, 2019“Increasingly, officers are called on to be the first--and often the only--responders to calls involving people experiencing a mental health crisis.”
The Effectiveness of Mental Health Courts in Reducing Recidivism and Police Contact: A Systematic Review Desmond Loong, Sarah Bonato, Jan Barnsley, Carolyn S. Dewa, June, 2019(The results suggest there is some evidence that mental health courts help to reduce recidivism rates, but the effect on police contact is less clear. Results also suggest case managers or access to vocational and housing may be important components.)
The Treatment of People with Mental Illness in the Criminal Justice System: The Example of Oneida County, New York Alexander Black, Kylie Davis, Kenneth Gray, Connor O'Shea, Alexander Scheuer, June, 2019“The sub-standard condition of inpatient psychiatric facilities, due to deinstitutionalization and capital flight, means that there are not nearly enough beds or psych wards to house, let alone care for, all individuals with severe mental health issues.”
Road Runners: The Role and Impact of Law Enforcement in Transporting Individuals with Severe Mental Illness Treatment Advocacy Center, May, 2019“Approximately one-third of individuals with severe mental illness have their first contact with mental health treatment through a law enforcement encounter.”
Managing Mental Illness in Jails: Sheriffs Are Finding Promising New Approaches Police Executive Research Forum, September, 2018“The mental health crisis in the United States has been thrust upon America's correctional agencies.”
The Psychological Effects of Solitary Confinement: A Systematic Critique Craig Haney, March, 2018“Solitary confinement not only is a common form of mistreatment to which prisoners of war have been subjected and been adversely affected, but is also associated with "higher levels of later life disability" among returnees.”
"Don't Look Around": A Window into Inhumane Conditions for Youth at NORCOR Disability Rights Oregon, December, 2017“A lack of oversight and accountability has allowed Northern Oregon Regional Correctional Facility (NORCOR) to neglect the basic mental health and social development needs of kids in custody.”
Police Contact and Mental HealthAmanda Geller, Jeffrey Fagan, and Tom R. Tyler, December, 2017“Recent police contact is associated with increased levels of anxiety symptoms, and both quantity and intensity of recent stop experience are significantly associated with increased PTSD symptoms.”
Forensic Patients in State Psychiatric Hospitals: 1999-2016 National Association of State Mental Health Program Directors, September, 2017“The results from this study indicate that, over a little less than two decades, states have seen an increase in the number of forensic patients who are present in their state hospitals.”
Police, courts, jails, and prisons all fail disabled peoplePrison Policy Initiative, August, 2017“In 2015, police shot 124 people experiencing a mental health crisis. In 36% of those cases, the officers were called to help the person get medical treatment, and shot them instead.”
Review of the Federal Bureau of Prisons' Use of Restrictive Housing for Inmates with Mental Illness U.S. Department of Justice, July, 2017“BOP Policies Do Not Adequately Address the Confinement of Inmates with Mental Illness in RHUs, and the BOP Does Not Sufficiently Track or Monitor Such Inmates”
Indicators of Mental Health Problems Reported by Prisoners & Jail Inmates: 2011-12 Bureau of Justice Statistics, June, 2017“About 1 in 7 state and federal prisoners (14%) and 1 in 4 jail inmates (26%) reported experiences that met the threshold for serious psychological distress (SPD) in the 30 days prior to a survey that was conducted between February 2011 and May 2012.”
Confronting California's Continuing Prison Crisis: The Prevalence And Severity Of Mental Illness Among California Prisoners On The Rise Stanford Justice Advocacy Project, May, 2017“While the overall state prison population has decreased dramatically, the percentage of state prisoners with mental illness has increased by 77 percent.”
Using Time to Reduce Crime: Federal Prisoner Survey Results Show Ways to Reduce Recidivism Families Against Mandatory Minimums, May, 2017“An estimated 45 percent of federal prisoners have mental health and behavioral problems...Two-thirds of prisoners who responded to our survey said they had not received mental or behavioral health counseling while in federal prison.”
When did prisons become acceptable mental healthcare facilities?Stanford Law School Three Strikes Project, May, 2017“While the overall state prison population has decreased dramatically, the number of prisoners with mental illness continues to climb and is expected grow in the years ahead.”
Era of Mass Expansion: Why State Officials Should Fight Jail Growth Prison Policy Initiative, May, 2017“In most states over the last three decades, the number of people in jails has outpaced population growth by 2, 3 or even 4 times. In 12 states, the jail population has grown more than 3 times faster than the general population.”
Gender and Trauma, Somatic Interventions for Girls in Juvenile Justice: Implications for Policy and Practice Rebecca Epstein and Thalia González, Georgetown Law Center on Poverty and Inequality, April, 2017“Trauma-informed, gender-responsive, and culturally competent somatic interventions can serve as a critical component of physical and mental health approaches for system-involved girls.”
A Crisis in Search of Data: The Revolving Door of Serious Mental Illness in Super Utilization Treatment Advocacy Center, April, 2017“National or state-level data that quantify the role and cost of individuals with serious mental illness on law enforcement, corrections, emergency medical or homelessness services do not exist. ”
Unlocking solitary confinement: Ending Extreme Isolation in Nevada State Prisons The ACLU of Nevada, Solitary Watch, Nevada Disability Advocacy & Law Center, February, 2017“In this report, we found that solitary confinement is, in fact, widely used in the state of Nevada, often for prolonged periods of time, and that many of the people held there are denied basic human needs like daily exercise and sufficient medical care.”
The Death Penalty in Five Florida Counties: Disproportionately Used Against Persons with Significant Mental Impairments Fair Punishment Project, January, 2017“These findings have raised a legitimate question as to whether Florida's capital punishment scheme-even one with a unanimous jury requirement- is capable of limiting application of the death penalty to the most culpable offenders.”
Emptying the 'New Asylums': A Beds Capacity Model to Reduce Mental Illness Behind Bars Treatment Advocacy Center, January, 2017“In Texas, reducing the average hospital stay from 189 days to 186 days would reduce forensic bed waits from an average of two months to three days.”
Creating a Culture of Safety: Sentinel Event Reviews for Suicide and Self-Harm in Correctional Facilities Vera Institute of Justice, December, 2016“Investigating the feasibility of using a sentinel events approach to review and learn from errors in the criminal justice system such as wrongful convictions, eyewitness misidentifications, or incidents of suicide and self-harm in custody.”
Beyond Bars: Keeping Young People Safe at Home and Out of Youth Prisons The National Collaboration for Youth, December, 2016“The youth prison is the signature feature of nearly every state juvenile justice system even though it is harmful, ineffective and expensive.”
Preventable Tragedies: How to Reduce Mental-Health Related Deaths in Texas Jails The University of Texas School of Law Civil Rights Clinic, November, 2016“In Texas, state health officials estimate that 30 percent of jail inmates have one or more serious mental illnesses.”
The Future of Youth Justice: A Community-Based Alternative to the Youth Prison Model Patrick McCarthy, Vincent Schiraldi, and Miriam Shark, October, 2016“Closing these failed institutions requires a clear-headed, common-sense, bipartisan policy approach, and a commitment to replace these facilities with effective alternatives that are already available.”
Responsible Prison Project: Reshaping The Texas Prison System for Greater Public Safety Aaron Flaherty, David Graham, Michael Smith, William D Jones, and Vondre Cash, October, 2016“It has often been said that those who are closest to a problem are closest to its solution. That is no less true for those who are in prison.”
Locked Up and Locked Down: Segregation of Inmates with Mental Illness Anna Guy, Amplifying Voices of Inmates with Disabilities Prison Project, September, 2016“[Protection and Advocacy Agencies] have received countless reports of abuse and neglect of inmates in segregation, including prolonged isolation, deplorable conditions, inadequate care, increased self-harm and suicide attempts, and even death.”
Individuals With Serious Mental Illnesses in County Jails: A Survey of Jail Staff's Perspectives Public Citizen's Health Research Group and The Treatment Advocacy Center, July, 2016(This report uses data from 230 sheriff's departments in 39 states to examine how correctional staffs understand and deal with inmates struggling with serious mental illnesses.)
Disabled Behind Bars: The Mass Incarceration of People With Disabilities in America's Jails and Prisons Center for American Progress, July, 2016“This report highlights steps policymakers can take to combat inappropriate and unjust incarceration and criminalization of people with disabilities, as well as steps to ensure appropriate and humane treatment of people with disabilities[.]”
Individuals With Serious Mental Illnesses in County Jails: A Survey of Jail Staff's Perspectives Public Citizen's Health Research Group, The Treatment Advocacy Center, July, 2016“The purpose of our survey was to understand the perspectives of county jail sheriffs, deputies, and other staff with respect to individuals with serious mental illnesses in jails.”
Raising Cain: The Role of Serious Mental Illness in Family Homicides Treatment Advocacy Center, June, 2016“[T]his is the first study of the role of serious mental illness in all family homicides.”
Administrative Segregation in U.S. PrisonsNational Institute of Justice, March, 2016“Across the political spectrum, there is growing concern about the efficacy and utility of administrative segregation practices[.]”
InCorrect Care: A Prison Profiteer Turns Care into Confinement Grassroots Leadership, February, 2016“This report’s in-depth analysis of GEO Group, GEO Care and now Correct Care Solutions’ involvement in operating mental health hospitals and civil commitment centers exposes serious concerns.”
The Human Toll of Jail Fact SheetVera Institute of Justice, February, 2016“Today, about 14.5 percent of men and 31 percent of women in jails have a serious mental illness, compared to 3.2 and 4.9 percent respectively in the general population.”
First-Episode Incarceration: Creating a Recovery-Informed Framework for Integrated Mental Health and Criminal Justice Responses Vera Institute of Justice, January, 2016(This report outlines a new integrated framework that encourages the mental health and criminal justice fields to collaborate on developing programs based on early intervention.)
Report and Recommendations Concerning the Use of Restrictive HousingU.S. Department of Justice, January, 2016“At its worst, and when applied without regard to basic standards of decency, restrictive housing can cause serious, long-lasting harm. It is the responsibility of all governments to ensure that this practice is used only as necessary.”
Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters Treatment Advocacy Center, December, 2015“The risk of being killed while being approached or stopped by law enforcement in the community is 16 times higher for individuals with untreated serious mental illness than for other civilians.”
First Do No Harm: Advancing Public Health in Policing Practices Vera Institute of Justice, November, 2015(This report details the cultural divide among system actors that amplify and sustain these problems and offers recommendations on how law enforcement policymakers and practitioners can enhance both public safety and community health.)
Community-Based Responses to Justice-Involved Young AdultsHarvard Kennedy School Program in Criminal Justice, September, 2015“[T]oday’s neurobiological and developmental research suggests that young people ages 18-24 are more developmentally akin to juveniles than fully mature adults.”
Callous and Cruel: Use of Force against Inmates with Mental Disabilities in US Jails and Prisons Human Rights Watch, May, 2015“This 127-page report details incidents in which correctional staff have deluged prisoners with painful chemical sprays, shocked them with powerful electric stun weapons, and strapped them for days in restraining chairs or beds.”
Behind the Eleventh Door: Solitary Confinement of Individuals with Mental Illness in Oregon's State Penitentiary Behavioral Health Unit Disability Rights Oregon, May, 2015(This report looks at case studies from the Behavioral Health Unit (BHU) of the Oregon State Penitentiary (OSP) to determine the detrimental effects on mentally ill patients in solitary confinement.)
The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System: A Scan of Practice and Background Analysis Urban Institute, March, 2015“An estimated 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates have a mental health problem.”
Bridging the Gap: Improving the Health of Justice-Involved People through Information Technology Vera Institute of Justice, March, 2015“Aims to address the problems of disconnected justice and health systems and to develop solutions by describing barriers, benefits, and best practices for connecting community providers and correctional facilities using health information technology (HITs)”
Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails Community Oriented Policing Services, U.S. Department of Justice, 2015“This report identifies successful practices that local law enforcement can employ to reduce the arrest and incarceration of people living with mental illness in their jurisdictions.”
Designed to Break You: Human Rights Violations on Texas' Death Row Human Rights Clinic at the University of Texas School of Law, 2015“Every individual on Texas’ death row thus spends approximately 23 hours a day in complete isolation for the entire duration of their sentence, which, on average, lasts more than a decade.”
Federal Bureau of Prisons: Special Housing Unit Review and Assessment CNA, December, 2014“As of November 2013, approximately 5 percent of the entire Bureau’s prisoner population was being housed in one of these restrictive housing populations with the vast majority in the SHU status.”
Impact of Disproportionate Incarceration of and Violence Against Black People with Mental Health Conditions In the World's Largest Jail System Dignity and Power Now, August, 2014“Nationwide, people with mental health conditions constitute 64% of the jail population, according to the Federal Bureau of Prison Statistics.”
Medicaid Prior Authorization Policies and Imprisonment Among Patients With Schizophrenia American Journal of Managed Care, July, 2014“As the total costs in the United States that are associated with severe psychiatric disorders in jails are very high, new policies on how to treat incarcerated individuals with schizophrenia, particularly nonviolent offenders, are warranted.”
Worse Than Second-Class: Solitary Confinement of Women in the United States American Civil Liberties Union, April, 2014“...solitary is often used on the most vulnerable: pregnant women, individuals with mental illness, transgender women, and - in a particularly disturbing trend - victims of sexual assault by prison guards.”
Solitary Confinement and Risk of Self-Harm Among Jail InmatesAmerican Journal of Public Health, March, 2014“Inmates ...assigned to solitary confinement were 3.2 times as likely to commit an act of self-harm per 1000 days at some time during their incarceration as those never assigned to solitary.”
Investigation of the Pennsylvania Department of Corrections' Use of Solitary Confinement on Prisoners with Serious Mental Illness and/or Intellectual Disabilities U.S. Department of Justice, February, 2014“The manner in which PDOC subjects prisoners with SMI to prolonged periods of solitary confinement involves conditions that are often unjustifiably harsh and in which these prisoners routinely have difficulty obtaining adequate mental health care...”
Selected Issues in Mental Health and Corrections: A Collection and Summary of Research Disability Rights Nebraska, 2014“Although only 7% of inmates were in solitary confinement, they accounted for 53% of acts of self-harm.”
Inside the Box: The Real Costs of Solitary Confinement in New Mexico's Prisons and Jails The New Mexico Center on Law and Poverty; The ACLU of New Mexico, October, 2013“New Mexico urgently needs to reform the practice of solitary confinement in its prisons and jails.”
Three Quarter Houses: The View from Inside John Jay College of Criminal Justice, Prisoner Reentry Institute, October, 2013“Illegal evictions derail recovery and reintegration and can lead to relapse, street homelessness, unemployment, and violations of parole mandates that can result in re-incarceration.”
Report on Suicide Prevention Practices within the District of Colombia, Department of Corrections' Central Detention Facility DC Department of Corrections, September, 2013“...correctional officers that are assigned to the mental health unit ...in the Central Detention Facility do not receive any specialized mental health and/or suicide prevention training.”
Justifiable Homicides by Law Enforcement Officers: What is the Role of Mental Illness? Treatment Advocacy Center, National Sheriff's Association, September, 2013“The transfer of responsibility for persons with mental illness from mental health professionals to law enforcement officers has brought with it major problems for the latter.”
A Death Before Dying: Solitary Confinement on Death Row ACLU, July, 2013“93 percent of states lock up their death row prisoners for 22 or more hours per day. Most of these prisoners live under conditions of extreme social isolation and enforced idleness.”
Jail Mental Health Design and Programming "Options and Opportunities" National Institute of Corrections, United States Department of Justice, July, 2013“More people are being booked into the McLean County Detention Facility with more serious criminal charges and they are staying longer.”
Out of Sight, Out of Mind: Colorado's continued warehousing of mentally ill prisoners in solitary confinement ACLU of Colorado, July, 2013“As of March 2013, CDOC housed at least 87 seriously mentally ill prisoners in solitary confinement, 54 of whom have been living in isolation for over a year and 14 of whom have been in solitary confinement for more than 4 years.”
PTSD, Trauma, and Comorbid Psychiatric Disorders in Detained YouthOffice of Juvenile Justice and Delinquency Prevention, June, 2013“Of the study sample, 92.5 percent of youth had experienced at least one trauma, 84 percent had experienced more than one trauma, and 56.8 percent were exposed to trauma six or more times.”
Improvements Needed in Bureau of Prisons' Monitoring and Evaluation of Impact of Segregated Housing Government Accountability Office, May, 2013“Without an assessment of the impact of segregation on institutional safety or study of the long-term impact of segregated housing on inmates, BOP cannot determine the extent to which segregated housing achieves its stated purpose.”
Buried Alive: Solitary Confinement in the US Detention System Physicians for Human Rights, April, 2013“...solitary confinement can cause severe and lasting physiological/psychological harm. Moreover, in many cases, the resulting harm rises to the level of torture or cruel, inhuman, and degrading treatment, in violation of domestic and international law.”
Reforming Juvenile Justice A Developmental Approach National Research Council, November, 2012“A harsh system of punishing troubled youth can make things worse, while a scientifically based juvenile justice system can make an enduring difference in the lives of many youth who most need the structure and services it can provide.”
Growing Up Locked Down Youth in Solitary Confinement in Jails and Prisoner Across the United State Human Rights Watch and American Civil Liberties Union, October, 2012“HRW and ACLU estimate that in 2011, more than 95,000 youth were held in prisons and jails. A significant number of these facilities use solitary confinement to punish, protect, house, or treat some of the young people who are held there.”
The Affordable Care Act Implications for Public Safety and Corrections Populations Sentencing Project, September, 2012“The expansion of Medicaid means that states can essentially use federal Medicaid funds to increase treatment services that could reduce incarceration and recidivism and, in doing so, potentially lower associated local and state corrections expenditures.”
Unasked Questions, Unintended Consequences Fifteen Findings and Recommendations on Illinois' Prison Healthcare System John Howard Association of Illinois, September, 2012“[I]ncarceration is overused as a primary means to manage drug and non- violent offenders [...]. This comes at great cost to taxpayers and has little positive impact on recidivism or public safety.”
Closing the Gap Using Criminal Justice and Public Health Data to Improve the Identification of Mental Illness Vera Institute of Justice, July, 2012“Most of the cohort members who had mental health needs (83%) were known to at least 1 criminal justice agency as having such a need between 2006-11. Yet the Department of Mental Health knew about only 59% who had mental health needs during that period.”
Youth in Minnesota Correctional Facilities and the Effects of Trauma Responses to the 2010 Minnesota Students Survey Minnesota Department of Public Safety, March, 2012“[O]ver half of youth in correctional facilities report at least one form of trauma on the MSS (53%) compared to just over one-quarter of a matched sample of mainstream students (28%).”
Half of Women on Probation or Parole Experience Mental IllnessSAMHSA, March, 2012“[A]mong women aged 18 to 49, about half of those who had been on probation (49.4%) or on parole (54.2%) in the past year experienced any mental illness in the past year, compared with 27.5 percent of women who had not been on probation or parole.”
Adults with Behavioral Health Needs Under Correctional Supervision A Shared Framework for Reducing Recidivism and Promoting Recovery Council of State Governments Justice Center, the National Institute of Corrections, and the Bureau of Justice Assistance, 2012“This paper is written in recognition of the current need for a strategic approach to address the overrepresentation of people with mental health and substance use disorders in the justice system, & the impact their treatment has on public safety & health.”
Colorado Department of Corrections Administrative Segregation and Classification Review National Institute of Corrections, October, 2011“Currently about 7% (1,427) of the prison population is in administrative segregation, which is significantly above the national average of 1-2 %.”
When Treatment is Punishment The Effects of Maryland's Incompetency to Stand Trial Policies and Practices Justice Policy Institute, October, 2011“Too many people found not competent to stand trial are unnecessarily locked in a secure setting for treatment and, on average, confined for longer periods than research demonstrates is clinically reasonable.”
Medicine and the Epidemic of Incarceration in the United StatesNew England Journal of Medicine, June, 2011“[The Affordable Care Act] could redirect many people with serious illness away from the revolving door of the criminal justice system, thereby improving overall public health in the communities to which prisoners return and decreasing [recidivism] costs.”
Thinking Outside the Cell Alternatives to Incarceration for Youth with Mental Illness Texas Appleseed, April, 2011“...youth should be supported close to their families and home environments and that detention should always be a last resort.”
Out and Down: The Effects of Incarceration on Psychiatric Disorders and Disability Jason Schnittker, Michael Massoglia, and Christopher Uggen, February, 2011“Incarceration has a robust relationship with subsequent mood disorders, related to feeling”
Criminal Justice Interventions for Offenders With Mental Illness Evaluation of Mental Health Courts in Bronx and Brooklyn, New York Urban Institute, 2011“Findings from the impact analysis indicate that mental health court participants are significantly less likely to recidivate, as compared to similar offenders with mental illness who experience business-as-usual court processing...”
Healing Invisible Wounds Why Investing in Trauma-Informed Care for Children Makes Sense Justice Policy Institute, July, 2010“Joseph Tulman between 75 and 93 percent of youth entering the juvenile justice system annually in this country have experienced some degree of trauma.”
Sexual Victimization Reported by Former State Prisoners, 2008Bureau of Justice Statistics, May, 2010“An estimated 9.6% of former state prisoners reported one or more incidents of sexual victimization during the most recent period of incarceration in jail, prison, and post-release community-treatment facility.”
More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States Treatment Advocacy Center, May, 2010“Among the ten states mostly likely to have mentally ill individuals in jails and prisons, five were also among the states spending the least money per capita.”
National Study of Jail Suicide: 20 Years Later U.S. Department of Justice, April, 2010“In 2006, the suicide rate in detention facilities was 36 deaths per 100,000 inmates, which is approximately 3 times greater than that in the general population. This rate represents a dramatic decrease in the rate of suicide in detention facilities.”
Justice for Immigration's Hidden Population Protecting the Rights of Persons with Mental Disabilities in the Immigration Court and Detention System Texas Appleseed, March, 2010“Detention often exacerbates mental illness,3 separates immigrants with mental disabilities from therapeutic services and family, frequently leads to misdiagnosis, and interrupts continuity of care.”
Juvenile Suicide in Confinement A National Survey Office of Juvenile Justice and Delinquency Prevention, February, 2009“Almost half (48.1 percent) the suicides occurred in facilities administered by state agencies, 39.2 percent took place in county facilities, and 12.7 percent occurred in private programs.”
Health and Prisoner Reentry: How Physical, Mental, and Substance Abuse Conditions Shape the Process of Reintegration Urban Institute, February, 2008“Nearly all returning prisoners—8 in 10 men and 9 in 10 women—had chronic health conditions requiring treatment or management.”
Mental Illness and the Death Penalty in North Carolina A Diagnostic Approach Charlotte School of Law, May, 2007“[E]ntrenched obstacles within the criminal justice system impede efforts to recognize those with severe mental illness and to treat them fairly.”
Women in the Criminal Justice System Briefing Sheets Sentencing Project, May, 2007“In state prisons in 1998, 23.6% of women were identified as mentally ill, compared to 15.8% of men, while in federal prisons the proportions were 12.5% of women and 7% of men.”
Prisoner-assisted homicide: more 'volunteer' executions loom Amnesty International, May, 2007“Race and mental health appear to be the strongest predictors of who will waive their appeals - most”
Rates of Sexual Victimization in Prison for Inmates With and Without Mental Disorders Psychiatric services, 2007“Approximately one in 12 male inmates with a mental disorder reported at least one incident of sexual victimization by another inmate over a six-month period, compared with one in 33 male inmates without a mental disorder.”
Mental Health Problems of Prison and Jail InmatesBureau of Justice Statistics, September, 2006“Female inmates had higher rates of mental health problems than male inmates (State prisons: 73% of females and 55% of males; Federal prisons: 61% of females and 44% of males; local jails: 75% of females and 63% of males).”
Evidence-based Treatment of Alcohol, Drug, and Mental Health Disorders: Potential Benefits, Costs, and Fiscal Impacts for Washington State Washington State Institute for Public Policy, June, 2006“Per dollar of treatment cost, we estimate that evidence-based treatment generates about $3.77 in benefits for people in Washington. Expressed as a return on investment, this is equivalent to roughly a 56 percent rate of return.”
Community Based Management Pilot Programs for Youth with Mental Illness... Program Evaluation Report: Year Four Colorado Department of Public Safety, October, 2005(The number of new offenses after the program is strongly influenced by the program. Of program completers, 46% fewer individuals received a new court case in the 12 months after the program as the 12 months before.)
Implementation of "Kendra's Law" Is Severely BiasedNew York Lawyers For The Public Interest, Inc., April, 2005“There are major racial, ethnic, and geographic disparities throughout New York State in the implementation of "Kendra's Law" [,which allows courts to mandate outpatient treatment for some people with mental illness].”
Mental Health Treatment in State PrisonsBureau of Justice Statistics, July, 2001(None of the prison systems have any idea how many mentally ill prisoners they have. Using the BJS reports for anything other than whether or not prisoners identified as mentally ill are actually receiving services would be a mistake.)
Incarceration is not a solution to mental illnessPrison Policy Initiative, April, 2000“Years ago, behavior that would have been considered annoying, such public urination, is now treated as a criminal offense.”
Prisons and Jails: Hospitals of Last Resort: The Need for Diversion and Discharge Planning for Incarcerated People with Mental Illness in New York Correctional Association of New York and the Urban Justice Center, 1999
Report on the Psychiatric Management of John Salvi in Massachusetts Department of Correction Facilities 1995-1996 University of Massachusetts Medical Center Department of Psychiatry, January, 1997“...in our opinion, the number of full-time equivalent psychiatrists within the DOC is far too low to meet the psychiatric needs of the inmate population.”
Mental Illness in US Jails: Diverting the nonviolent, low-level offender Center on Crime Communities and Culture, November, 1996
Prison Suicide: An Overview and Guide to Prevention U.S. Department of Justice, June, 1995“During the past 10 years, the rate of suicide in prisons throughout the country was 20.6 deaths per 100,000 inmates. States with small prison populations appear to have exceedingly high rates of suicide -- often more than 2.5 times the national average.”
