Mental Health Behind Bars: Why Jails and Prisons Aren’t the Answer
In the United States, jails and prisons have become default providers of mental health care. But here's the reality: these systems were never designed for this role, and it shows.
The Numbers Tell the Story
Roughly 44% of people in local jails and 37% in state and federal prisons live with a diagnosed mental illness. That’s nearly double the rate in the general adult population. Yet about 60% of incarcerated individuals with a mental health history never receive treatment while locked up
How did we get here? It traces back to the decades-long shutdown of state psychiatric hospitals without building up adequate community-based mental health services. Instead of treatment, many people ended up in handcuffs.
What Mental Health Care in Jail Looks Like
Most correctional facilities attempt to provide some level of mental health care. Here’s what that typically includes:
- Screening & Assessment: Mental health and substance use screenings at intake are common, but follow-up treatment is inconsistent.
- Therapy & Counseling: Offered in many places, but only about 1 in 8 state prisoners actually receive it.
- Medication: Psychotropic medications are available, but over half of the individuals who were on medication before incarceration don’t continue their regimen behind bars.
- Crisis Intervention & Suicide Prevention: Most facilities have staff training and protocols, but their effectiveness varies widely.
- Specialized Programs: A few prisons offer skills-based recovery programs, but they’re not the norm.
The Problem Isn’t Just What’s Offered — It’s Where It Happens
Even when services are provided, the environment of incarceration works against effective care:
- Access Barriers: Understaffing, long wait times, and bureaucratic red tape delay or block care.
- Punitive Culture: Behaviors linked to mental illness are often punished rather than treated, including through solitary confinement — a practice that can intensify psychiatric symptoms.
- Inhumane Conditions: Overcrowding, noise, lack of privacy, and institutional design can worsen mental health issues.
After Release: Another Drop-Off
The lack of continuity between in-prison care and re-entry into the community is another critical failure. People are often released without a treatment plan, increasing the risk of relapse, hospitalization, or re-incarceration.
What Needs to Change
Mental health experts, advocacy groups, and even professional medical associations agree: we need less incarceration and more investment in community-based mental health systems. That includes:
- Diverting people with mental illness away from jails and into care
- Improving standards for mental health services inside correctional settings
- Prioritizing continuity of care during and after incarceration
Bottom Line
Jails and prisons were built to punish, not to treat. While they’ve taken on the role of mental health providers out of necessity, the results are inadequate. It’s time to stop using incarceration as a stand-in for treatment and start investing in mental health systems that heal.
If you found this article helpful, share it with someone in your network. Let’s keep the conversation going — our communities can’t afford to stay silent on this.