In 2015, a Washington Post report revealed that U.S. prisons and jails housed over 356,000 inmates with severe mental illness—ten times the number in state psychiatric hospitals. Today, the crisis has deepened, with correctional facilities serving as de facto mental health institutions.
Scope of the Crisis
In 2012, U.S. prisons and jails held an estimated 356,268 inmates with severe mental illness, more than ten times the number in state hospitals (about 35,000 people). Currently, approximately 20% of jail inmates and 15% of state prison inmates have a serious mental illness, while an estimated 44% of those in jails and 37% in prisons report any mental health disorder, compared to 18% of the general population.
From Deinstitutionalization to Criminalization
In the mid-20th century, state mental hospitals held over 558,000 patients at their peak. Following deinstitutionalization, hospital census plummeted to around 35,000 beds, without sufficient community care, shifting the burden to the criminal justice system :contentReference[oaicite:3]{index=3}.
Contributing Factors
- Underfunded community mental health programs and workforce shortages
- Shrinking inpatient treatment capacity and restrictive admission criteria
- Lack of crisis diversion programs and mental health courts
Consequences of Incarceration
- Increased risk of solitary confinement, assault, and self-harm among inmates with mental illness
- Exacerbation of psychiatric symptoms due to stress, isolation, and prison conditions
- Higher recidivism rates without proper treatment and reentry support
Policy and Practice Reforms
- Expansion of jail diversion programs and crisis intervention teams
- Integration of mental health services within correctional settings
- Investment in community-based treatment, supportive housing, and outpatient care
- Training for law enforcement in recognizing and de-escalating mental health crises
Conclusion
Decades after deinstitutionalization, prisons and jails remain the nation’s largest mental health providers. Addressing this crisis requires a concerted effort to rebuild treatment infrastructure, implement diversion strategies, and ensure community support to prevent cycles of incarceration and mental health decline.
How Dr. Markey Is Helping: Dr. Markey partners with correctional facilities to implement evidence‐based mental health training, develop diversion programs, and advocate for humane treatment of inmates. Schedule an appointment today to discuss how he can support your organization or legal case.