Published in Correctional Mental Health Report

According to a new Federal Bureau of Justice Statistics (BJS) report, about half of the jail and prison population in the United States—1,254,800 men and women—has a mental health problem. The figure is staggering, but not surprising. It testifies to the persistent failure of the state and federal governments to stem the tide of the mentally ill swept into the criminal justice system. It also testifies to public ignorance—or is it deliberate indifference?—to the tragedy of putting the mentally ill behind bars.

People with mental illness often end up in prison because the community mental health system in the United States is in shambles—fragmented, underfunded, unable to serve the population that most need its services, including the poor and homeless. The new BJS report reveals that approximately one in five state inmates with mental health problems had received treatment in the year before arrest; only half had ever received any mental health treatment. It found that state inmates with mental health problems were twice as likely to have been homeless before arrest as other inmates, and provides some other statistics that point to their personal histories at the economic and social margins of society. Untreated and unstable, some people with mental illness will break the law and then they confront punitive law enforcement and sentencing policies.

BJS reports that 51% of state inmates with mental health problems were convicted of nonviolent offenses, primarily drug and property offenses. One in five had no prior criminal sentence. Another one in three were non-violent recidivists.

Alternatives to incarceration may well have served community safety interests just as well as prison for many of these offenders. But politicians remain loathe to reform their “tough on crime” legislation or to support and fund programs, like mental health courts, that divert offenders with mental illness from the criminal justice system. As a result, prisons receive men and women suffering from mental health disorders, including such serious illnesses as schizophrenia, bipolar disorder, and major depression.

The BJS reports that 34% of state inmates and 24% of federal inmates with mental health problems have received treatment after admission to prison. As a quantitative matter, on their face these figures suggest many inmates are not receiving services they need.

But even with regard to those inmates who do get some sort of treatment, the figures say nothing about its quality, nature or effectiveness. As we documented in Ill Equipped: U.S. Prisons and Offenders with Mental Illness, prison mental health services are all too often wholly inadequate. They are crippled by understaffing, insufficient facilities, and limited programs.

The significant steps that many state correctional systems have made to improve their mental health services have been swamped by the tsunami of inmates who need them. With little or no effective mental health treatment and support, offenders with mental illness are forced to navigate on their own prison environments that pose unique challenges for them. These inmates often prove to be ill equipped to cope with the stresses and rules of prison life. They are likely to be victimized by other inmates; they have difficulty following the rules. Again, the new BJS statistics are revealing: 58% of state prison inmates with mental health problems have been charged with rule violations, compared to 43% of inmates without such problems. The former are more than twice as likely to be charged with verbal assault as the latter.

In addition, BJS reveals that inmates with mental health problems are twice as likely as those without to be injured in a fight. Mentally ill prisoners face prison rules that were never designed to accommodate their unique needs. They face correctional officers ill trained to work with them and ignorant of the nature and significance of their symptoms. Prisoners who are mentally ill are far more likely to end up in segregation than other inmates. Data that is available from individual states reveals a significantly disproportionate presence of these most vulnerable of inmates in this harshest form of confinement.

What state and federal governments must do is easy to prescribe. They must dramatically increase the scope and effectiveness of community mental health systems. They must reform needlessly harsh sentencing laws and law enforcement practices to reduce the number of persons with mental illness needlessly ending up in prison. They must also improve the quantity and quality of prison mental health services, rehabilitative programming and reentry services provided to people behind bars.

Financial considerations have played a role in frustrating the needed reforms. But more is at work here than money. The lack of funds reflects inadequate commitment, compassion and common sense on the part of elected officials. These officials need to address the crisis of mental health care in the United States, even if doing so is not a “vote-getter.” They need to abandon the politically popular but counter-productive and unnecessarily punitive “tough on crime” policies that have given the U.S. the highest incarceration rate in the world. They must accept responsibility for those who are incarcerated and ensure prisons have the funds needed to help turn inmates lives around and to, at the very least, provide the necessary mental health services.

During the deinstitutionalization era, the United States succeeded in shutting down the large, barren public mental health hospitals in which hundreds of thousands of people with mental illness were involuntarily confined and received little treatment. It now involuntarily confines hundreds of thousands of people with serious mental illness in large, barren prisons in which they receive little treatment. Prisons are today’s mental health facilities. Could there be a sadder commentary on how this wealthiest of countries treats its most vulnerable residents?