Individuals with Serious Mental Illness (SMI) are disproportionately represented among the populations of the nation’s correctional facilities. Some have dubbed jails and prisons the “New Asylums” as the criminal justice system has become the de facto service provider for individuals with severe psychiatric disorders. It is commonly believed this trend is a tragic byproduct of a deinstitutionalization movement that began in the 1950s with the advent of new psychotropic medications and emerging calls for reform. As the census of state-operated psychiatric facilities dwindled to a fraction of its peak in the mid-20th century, incarceration rates among individuals with SMI have exploded. Many cite this inverse correlation as evidence of a “transinstitutionalization” wherein former (or would-be) hospital patients are now relegated to carceral settings ill equipped to serve them. To attribute the prevalence of SMI in America’s jails and prisons solely to the deinstitutionalization movement is an oversimplification, however, and it obscures other factors that underpin an exceedingly complex problem for which solutions of sufficient nuance and sophistication are warranted.
The widespread incarceration of individuals with SMI corresponds to rising rates of incarceration in general, as the U.S. now imprisons significantly more of its citizens than other industrialized nations. During the first half of the 20th century, incarceration rates remained relatively stable at approximately 110 prison inmates per 100,000 people (Schlosser, 1998). The 1970s marked an inflection point at which incarceration rates climbed sharply. Exponential increases followed in the ensuing decades, and the U.S. now incarcerates approximately 1.9 million people (541 per 100,000) within its state and federal prisons, county jails, and other detention centers (The Global Statistics, 2026). America’s reliance on incarceration as a default corrective for crime and social disorder is a consequence of factors through which the modern “Prison Industrial Complex” has emerged to perpetuate the status quo. Politically driven imperatives to enact “tough-on-crime” legislation, perhaps most notoriously in the form of the Rockefeller Drug Laws enacted in the early 1970s, which imposed mandatory minimum prison sentences for convictions of even relatively minor drug-related offenses, produced a predictable spike in incarceration rates among the urban poor and other marginalized communities (Schlosser, 1998). A consequent crisis of overcrowding in the nation’s correctional facilities became a boon to private prison operators eager to relieve state and federal governments of their administrative responsibilities. Moreover, the political climate for these operators could not have been more auspicious. A prevailing antipathy toward “Big Government” and corresponding devolution of authority to the private sector provided fertile ground on which a new prison industry blossomed. What emerged is an inordinately complex web of actors whose economic interests are inextricably tied to the mass incarceration of the American people, including a disproportionate share of the most vulnerable among us.
Individuals with SMI are uniquely susceptible to involvement in the criminal justice system for reasons that underscore the failings of this system and of others on which they rely for essential healthcare and social support services. A subset of this population is prone to repeated episodes of arrest and incarceration for minor criminal offenses related to symptoms of untreated disorder or associated life challenges. Such “offenses” include loitering, panhandling, camping in public spaces, visibly erratic behavior, and other manifestations of mental illness or homelessness. Thus, the prevalence of homelessness among individuals with SMI is, in and of itself, a leading risk factor for encounters with law enforcement officials (Urban Institute, 2020). Once incarcerated, individuals with SMI often remain incarcerated longer than other inmates charged with comparable offenses (Ditton, 1999). The trauma of imprisonment is felt most acutely by individuals with preexisting disorders of thought, mood, and behavior, so it is unsurprising that many should experience profound difficulty in navigating its stressors in a manner that would expedite their release. For instance, individuals with SMI are more likely to be involved in (and victims of) assault while incarcerated (Blitz, Wolff, & Shi, 2008), and many are also unable to consistently abide by the strictures of carceral life (Halvorsen, 2018). These factors do not merely prolong the terms of imprisonment for those with SMI. They render them uniquely vulnerable to solitary confinement — a punishment deemed exceptionally traumatic for members of this population. A broad coalition of stakeholders now supports a prohibition on the use of solitary confinement, particularly among individuals with SMI, as it has been found to induce or to exacerbate mental illness and to undermine opportunities for rehabilitation that might otherwise interrupt cycles of arrest and incarceration (Karplus, 2023).
Life upon release from incarceration poses additional challenges for individuals with SMI that contribute to recidivism and deeper entrenchment in the criminal justice system. As it is not uncommon for inmates to lose community housing arrangements they might have maintained prior to incarceration, homelessness is an all but inevitable consequence of confinement. An acute shortage of affordable and supportive housing leads to prolonged periods of homelessness and reexposure to the adverse conditions that preceded incarceration, ensnaring many in a seemingly endless “Homelessness-Jail” cycle (Urban Institute, 2020). Some research suggests individuals with SMI who receive community supervision through the Division of Parole are particularly susceptible to this cycle, as they are more likely than other parolees to be reincarcerated for violating the conditions of parole (Wood, 2011). An intervention designed to facilitate offenders’ successful reentry and enduring community tenure may undermine these aims when applied to those too compromised to accommodate its terms.
In consideration of the multiplicity of factors implicated in the criminalization of serious mental illness, some researchers suggest strategies must be carefully calibrated to individuals’ conditions and circumstances to successfully mitigate their risk of incarceration. Adherents of a Sequential Intercept model describe interventions that may be applied to effectively “capture” individuals at various stages of involvement in the criminal justice system and to redirect them to treatment and other support resources (Mulvey & Schubert, 2017). For such interventions to be successful, however, they must be readily available and accessible to those in greatest need. They must also target root causes of recidivism, foremost of which are the health-related social needs that often go unmet among individuals with SMI. To this end, some promising initiatives have emerged. Mental health courts offer alternative venues for the adjudication of non-violent offenses in which defendants may be remanded to behavioral healthcare in lieu of incarceration provided they adhere to certain court-imposed conditions. Forensic Assertive Community Treatment (FACT) Teams deliver mobile, multidisciplinary behavioral health and rehabilitation services to individuals with SMI and histories of criminal justice involvement who have failed to benefit from more conventional interventions. Most recently, New York State embarked on an ambitious demonstration project in partnership with the federal Centers for Medicare & Medicaid Services (CMS) that provides housing and nutritional assistance, transportation, and other vital services for vulnerable Medicaid recipients, many of whom experience mental illness and have been exposed to the criminal justice system. An authentic transformation of our carceral system requires these and other approaches, including some yet to be conceived, to achieve consistent outcomes on a substantially larger scale. It also requires a radical reevaluation of the pecuniary pillars on which it stands. Proponents of the Prison Industrial Complex will not consent to its dissolution unless it proves economically expedient to do so.
The author may be reached at (914) 428-5600 (x9228) or [email protected].
References
Blitz, C. L., Wolff, N., & Shi, J. (2008). Physical victimization in prison: The role of mental illness. International Journal of Law and Psychiatry, 31(5), 385–393. https://doi.org/10.1016/j.ijlp.2008.08.005
Ditton, P. (1999, July). Mental health treatment of inmates and probationers. U.S. Department of Justice, Bureau of Justice Statistics. https://bjs.ojp.gov/content/pub/pdf/mhtip.pdf
The Global Statistics. (n.d.). Imprisonment statistics in the U.S. https://www.theglobalstatistics.com/united-states-imprisonment-statistics/
Halvorsen, A. (2018). Solitary confinement of mentally ill prisoners: A national overview & how the ADA can be leveraged to encourage best practices. Southern California Interdisciplinary Law Journal, 27(205), 205–229. https://gould.usc.edu/wp-content/uploads/legacy/why/students/orgs/ilj/assets/docs/27-6-Solitary%20Confinement%20of%20Mentally%20Ill%20Prisoners%20-%20Ashley%20Halvorsen_original.pdf
Karplus, M. (2023). Forgotten in solitary: Mentally ill inmates in solitary confinement and how the law can protect them. Stanford Journal of Civil Rights & Civil Liberties, 19(2), 97–156. https://law.stanford.edu/publications/forgotten-in-solitary-mentally-ill-inmates-in-solitary-confinement-and-how-the-law-can-protect-them/
Mulvey, E. P., & Schubert, C. A. (2017). Mentally ill individuals in jails and prisons. Crime and Justice, 46, 231–277. https://www.journals.uchicago.edu/doi/abs/10.1086/688461
Schlosser, E. (1998, December). The prison-industrial complex. The Atlantic. https://www.theatlantic.com/magazine/archive/1998/12/the-prison-industrial-complex/304669/
Urban Institute. (2020, September 16). Five charts that explain the homelessness-jail cycle—and how to break it. https://www.urban.org/features/five-charts-explain-homelessness-jail-cycle-and-how-break-it
Wood, S. R. (2011). Co-occurring psychiatric and substance dependence disorders as predictors of parolee time to rearrest. Journal of Offender Rehabilitation, 50(4), 175–190. https://pmc.ncbi.nlm.nih.gov/articles/PMC3349337/pdf/nihms331032.pdf
