Mental health

Research on 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.


Key Statistics:

  • (New) The State of Solitary: Restrictive Housing and Treatment of Incarcerated Delawareans with Mental Illness Delaware Community Legal Aid Society, Inc. Disabilities Law Program, September, 2024“Two of the correctional facilities monitored had a separate Residential Treatment Unit (RTU) with mental health staff, services, and programming for individuals requiring that level of care for a mental health condition, while two did not.”
  • Share of Adult Suicides After Recent Jail Release Ted 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 Policies Christine 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.”
  • (New) Hidden Behind Bars The Public Health Implications of Incompetency to Stand Trial Paywall :( Nathaniel P. Morris, MD, and Jacob M. Izenberg, MD, December, 2023“People with mental illness are often arrested for low-level offenses...in many such cases, it's difficult to justify the involvement of forensic experts, months of waiting in jail for competency evaluation and restoration...”(By creating a free account, you can access this NEJM article.)
  • Barriers to access to psychiatric medications in Missouri county jails Jessica 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.”
  • Involuntary Civil Commitment as Mass Incarceration Tristan Campbell, September, 2023“Despite civil commitment often mirroring--and sometimes substituting for--incarceration, there is almost no data in comparison.”
  • 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”
  • 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 confinement Paywall :( 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].”
  • The relationship between community public health, behavioral health service accessibility, and mass incarceration Niloofar Ramezani et al, July, 2022“In this study, one county-level health factor emerged as important factor influencing per capita jail population: more physically unhealthy days within the past 30 days predicted a higher per capita jail population.”
  • report thumbnail 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.”
  • 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.”
  • 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.”
  • 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.”
  • Policing and public health calls for service in Philadelphia Jerry 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.”
  • Associations Between Parole, Probation, Arrest, and Self-reported Suicide Attempts William C. Bryson, Jennifer Piel & Stephen Thielke, August, 2020“Adults with recent arrest had higher risk of suicide attempts than those with parole, probation, or matched controls with no CJ involvement.”
  • 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.”
  • Statewide Policies Relating to Pre-Arrest Diversion and Crisis Response R Street, October, 2019“Laws that grant local officials noncriminal responses to crises can propel diversion efforts or provide alternative, supplemental crisis responses.”
  • 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.”
  • 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 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.”
  • 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.)
  • 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.”
  • A State Survey of Serious Mental Illness, Major Crimes and Community Treatment Treatment Advocacy Center, September, 2017(This report ascertain each state's structure and programming to assist individuals with serious mental illness who have committed major crimes succeed after community reentry.)
  • 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”
  • report thumbnail New government report points to continuing mental health crisis in prisons and jails Prison Policy Initiative, June, 2017“Only a third of incarcerated people experiencing serious psychological distress were receiving treatment”
  • 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.”
  • 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.”
  • 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. ”
  • 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.”
  • 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.”
  • 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[.]”
  • 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.”
  • 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.”
  • 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.)
  • 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.)
  • 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.”
  • 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.”
  • 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.”
  • The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey Treatment Advocacy Program, April, 2014“The number of individuals with serious mental illness in prisons and jails now exceeds the number in state psychiatric hospitals tenfold.”
  • Solitary Confinement and Risk of Self-Harm Among Jail Inmates American 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...”
  • A Review of Mental Health Services in Local and Regional Jails Virginia Office of the State Inspector General, January, 2014“Jails lack the capacity to satisfy the current demand for mental health services.”
  • 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.”
  • 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.”
  • 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.”
  • 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.”
  • 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.”
  • 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.”
  • 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.”
  • 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”
  • Report on Suicides Completed in the California Department of Corrections January 1, 2012 - June 30, 2912 Raymond F. Patterson, M.D., D.F.A.P.A., 2011“In 2012, a CDCR inmate died by suicide every 11.4 days on average.”
  • 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...”
  • 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.”
  • New York State Assisted Outpatient Program Evaluation New York State Department of Public Health, June, 2009
  • 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.”
  • 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 Inmates Bureau 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).”
  • Suicide and Homicide in State Prisons and Local Jails Bureau of Justice Statistics, July, 2005
  • Implementation of "Kendra's Law" Is Severely Biased New 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].”
  • The Role of Specialty Mental Health Courts in Meeting the Needs of Juvenile Offenders Judge David L. Bazelon Center for Mental Health Law, September, 2004
  • Ill-Equipped: U.S. Prisons and Offenders with Mental Illness Human Rights Watch, October, 2003
  • Status of Services for Persons with Mental Illness in Maine's Prisons: 2002 The Citizen's Committee on Mental Illness, Substance Abuse, and Criminal Justice and NAMI Maine, September, 2002
  • Consensus Project Report Criminal Justice / Mental Health Consensus Project, June, 2002(project coordinated by the Council of State Governments (CSG))
  • Mentally Ill Offenders in the Criminal Justice System: An Analysis and Prescription Sentencing Project, January, 2002
  • Mental Health Treatment in State Prisons Bureau 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.)
  • Current Status of Services for Persons with Mental Illness in Maine's Jails and Prisons NAMI Maine, September, 2000
  • report thumbnail Incarceration is not a solution to mental illness Prison Policy Initiative, April, 2000“Years ago, behavior that would have been considered annoying, such public urination, is now treated as a criminal offense.”
  • Substance Abuse Treatment in Adult and Juvenile Correctional Facilities Findings from the Uniform Facility Data Set 1997 Survey of Correctional Facilities Substance Abuse and Mental Health Services Administration, April, 2000
  • From Prisons to Hospitals and Back The Criminalization of Mental Illness Campaign for an Effective Crime Policy, January, 2000
  • Mental Health and Treatment of Inmates and Probationers Bureau of Justice Statistics, July, 1999“More than a quarter million prison and jail inmates are identified as mentally ill”
  • 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.”

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