top of page

Mental Health Struggles Behind Bars

Kennedy Kibler

Edited by Ruth Yao and Vedanth Ramabhadran

Historically, the American penal system is built on foundational principles of rehabilitative goals; in contemporary times, the emphasis on rehabilitation appears to have taken a backseat to the system's punitive measures. Incarceration rates have increased over time at a disproportionate rate in comparison to the stability in crime rates: in essence, the amount of crime being committed remained relatively similar while incarcerations skyrocketed. As the number of incarcerations increased, so has the number of inmates with mental illnesses. Although imprisonment has decreased due to the current era of criminal justice reform, the negative effect of mass incarceration can be seen clearly when discussing mental health. The overload of inmates with mental illnesses and lack of care that those inmates receive hinders their ability to reenter society and questions the overarching legitimacy of the American prison system in being rehabilitative rather than punitive. 

An incarceration rate is “the number of people incarcerated as a proportion of its total population.”[1] Various factors contribute to this rate such as crime rates, law enforcement decisions, and the amount of time served in prison. Although the U.S. has higher crime rates than many other developed countries, the country’s incarceration rate has historically been abnormally large. Based on the Criminal Justice Conundrum discussed by Alfred Blumstein in 1998, “Even though incarceration rates increased steadily and are now almost quadruple what they were 20 years ago, most crime rates have remained confined within a fairly narrow range, with no strong trend” [2]. More recently in 2016, Holger Spaaman, a Harvard Law School Professor, stated “tThe coincidence of the non-negative U.S. crime residuals with the very large positive U.S. incarceration residual constitutes a puzzle” [3]. However, it is also important to note that the U.S. has higher rates for harsher crimes such as homicide, which is likely due to factors such as high teen birth rate, greater income inequality, labor laws, and ethnic fractionalization. Therefore, it could be argued that the greater rates of serious crimes like these may contribute to the elevated U.S. incarceration rate in comparison to other countries, as these crimes theoretically would be more likely to lead to incarceration. Following this argument, this “puzzle” could be solved. Yet, other studies find that there is no empirical evidence for U.S. punishment being particularly harsh for some crimes while less harsh on others, indicating more violent crimes would not lead to higher incarceration. For example, Johnson and Raphael (2012) find that the crime-prison flexibility is higher for property crimes than for violent crimes, but Levitt (1996) and Buonanno et al. (2011) find the opposite [3]. Regardless of crime-specific incarceration rates and how this compares to other countries, it is undeniable that the U.S. has incarcerated people at a rate disproportionate to its overall crime rates in the past, with much of its peak in the 90s. Specifically, the “growth has expanded the incarceration from 110 per 100,000 to 427 per 100,000 in 1996. This represents a compounded growth rate of about 6.5% since the early 1970s” [9] . The “tough-on-crime” era of the 1970s and 1980s had long-lasting consequences on mass incarceration with the incarceration rate only dropping in the past few year [15].

Along with these increased incarceration rates over time comes an increase in the amount of inmates with mental illnesses. Of the over 10 million people in prison throughout the world, the prevalence of mental illness is higher in prisons than in the regular population [4]. According to a 2010 U.S. Department of Justice publication, previously unpublished data for 2004-2005 reveals that the number of seriously mentally ill people in prisons is more than triple the number in hospitals or mental institutions [5]. Not only that, but the lack of care in prisons throughout time is alarmingly evident. 66% percent of individuals in federal prisons and 74% in state prisons did not receive any mental health care while incarcerated. Based on a 2016 Bureau of Justice Statistics’ report, “over half of the people in state prisons report mental health problems, but only 1 in 4 has received professional help in prison” [6]. As a result of limited treatment, they face a greater risk of self-harm, violence, and suicide [8].  Although recent data on this topic is more limited, as of 2022, there is still an estimated “44% of those in jail and 37% of those in prison have a mental illness, yet 18% of the general population has a mental illness” [16]. This data ultimately questions the American prison system’s ability to handle the number of mentally ill prisoners and highlights the need for criminal justice reform.

In reference to the amount of inmates with mental illness versus those in mental hospitals, it is important to define the term deinstitutionalization as “the set of policies and treatment innovations driving the half-million-person decrease in the mental hospital population between 1955 and the present” [8]. Some of these treatments include psychotropic drugs or policy changes like the 1963 Community Mental Health Act, which established community mental health centers. Rather than the institutionalized care of mental hospitals, the community mental health centers were for patients that planned to be treated while living at home. Another factor that led to the decreasing mental hospital population was the Supreme Court decision in O’Connor v. Donaldson, which found that mental illness by itself was not sufficient grounds for involuntary commitment, or involuntary hospitalization, of a patient. Moreover at the end of the 20th century, funding for mental health significantly decreased. To make matters worse, the Great Recession led states themselves to cut $4.5 billion in services for the mentally ill. The damage of deinstitutionalization was profound, resulting in a state of homelessness, suffering, and lack of resources as community mental health centers were not equipped to handle the newly discharged patients. Eventually, this led to people who are seriously mentally ill to get caught up in the criminal legal system. Those with mental illnesses often have poor judgment and impulse control and are at an even further risk of committing crimes if they have substance abuse [17]. They are oftentimes arrested for more minor offenses like shoplifting or not paying for meals at a restaurant, but are also convicted of felonies involving violence at higher rates compared to the general adult population [8]. For example, “aA mentally ill person might assault a bystander because they think they are about to be attacked, or refuse to pay for a meal because they think they are a divine power, or destroy property because they think monsters are inside” [17]. Ultimately, the mentally ill are overrepresented within the U.S. prison system and various forms of deinstitutionalization have strongly contributed to this phenomenon over time.

In addition to the influx of mentally ill inmates, there is an undeniable lack of care that often prevents successful reentry into society for them; this lack of care is due to factors like increasing health care costs, lack of budget in correctional facilities, and privatization of mental health and medical services [9]. This phenomenon undermines the argument that the U.S. prison system is a rehabilitative entity, as the idea of rehabilitation emphasizes the goal of helping inmates address the underlying issues that contributed to their criminal behavior and prepares them for successful reintegration into society upon release. According to a 2004 Survey of Inmates in State and Federal Correctional Facilities, “after release from prison, former inmates who received a professional diagnosis of any Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, mental health disorder were 70% more likely to return to prison at least once than were those who were not diagnosed.” According to a study ten years later, the rates of recidivism (the tendency of a relapse in criminal behavior) are still greater than 50% higher for those with mental health conditions than for those without, among those who have been previously incarcerated [10]. Thus, more recent data demonstrate similar trends of criminal justice entities lacking the resources necessary to ensure that all mentally ill or at risk inmates receive care to successfully re-enter society. Reports identify that many prisons also have a lack of sanitation, limited medical services, poor sanitation, and mistreatment of inmates [13]. According to the Substance Abuse and Mental Health Services Administration, “eEvidence-based treatment, curtailed to the individual’s needs, should ideally be coordinated between corrections and community-based facilities prior to release from jail to ensure there are no gaps in care” [11]. Ultimately, it is clear that the care mentally ill inmates are receiving is unacceptable.

Furthermore, there is a negative relationship between mental hospitalization and incarceration rates. Based on the 2006 results from a national survey of strategies used to help the mentally ill reenter society after incarceration, both the criminal justice system and mental health system overlap on efforts to provide services. A striking finding from this study was that a significant amount of programs were actually led by the criminal justice system; they dominate responsibility for the treatment of inmates with mental illnesses, yet this is not their primary function [7]. It has also been found that the withdrawal of service in mental hospitals results in more crime; thus, redirecting resources towards mental health services and preventive measures could significantly reduce incarceration rates among the mentally ill [8]. The issue of mentally ill individuals within the prison system must be tackled in a way that advocates for both the reallocation of resources for mental health services to decrease the number of mentally ill inmates as well as the establishment of sustainable resources within prisons to support rehabilitation post-release.

The response of the criminal justice system to mental health concerns raises the overarching question of whether the American prison system can really be considered rehabilitative. Scholars see the point of mass incarceration in the 1970s as the turning point of the shift towards more punitive measures [12]. In modern penology, prisons have been transformed into a place where those who are convicted face oppression and brutal conditions that oftentimes diminish their hope of ever returning to a normal life [13]. According to the rights model of rehabilitation, while many European nations include rehabilitation as a constitutional mandate, it is unrecognized within the American system [14]. Rehabilitation can be viewed as a debated topic in the United States, in which the Supreme Court has made conflicting opinions surrounding the meaning of rehabilitation and the government’s role in its process. In Wolff v. McDonnell, the court held that due process safeguards for inmates facing the possibility of their “good time” credits revoked would hinder rehabilitative goals. “Good time” refers to a system where inmates can earn a reduction in their sentence for good behavior, participation in educational or vocational programs, or other positive actions while incarcerated. Due process safeguards, such as cross examination or confrontation in prison disciplinary proceedings, were decided here to be harmful to criminals because these institutional proceedings had greater levels of scrutiny. Yet, the dissenting side saw the greater regulation as increasingly fair, enhancing rehabilitative measures. In another example, Procunier v. Martinez, the court held that prisoner mail censorship (another form of greater regulation) worked to uphold rehabilitation. The opposing side saw the censorship as restricting communication with the outside world and therefore increasing alienation. Thus, it is clear that rehabilitation can be used to justify government intervention or disciplinary action; but, it can be used to justify the opposite when it serves to expand prisoners’ rights like due process [14]. This confusion in meaning makes it difficult for the U.S. to successfully have a rehabilitative prison system. Without truly establishing what this system would entail and working towards it, the prisons and court system seem to perpetuate a more punitive structure. Thus, in an era without a clear direction for rehabilitative goals, the overrepresentation of mentally ill prisoners puts the criminal justice system between a rock and hard place when attempting to handle such a sensitive group of individuals and the care they need.


[1] Marc Mauer, Incarceration Rates in an International Perspective, in Oxford Research Encyclopedia of Criminology and Criminal Justice (2017), (last visited Apr 3, 2024).

[2] Alfred Blumstein, U.S. Criminal Justice Conundrum: Rising Prison Populations and Stable Crime Rates, 44 Crime Delinquency 127 (1998).

[3] Holger Spamann, The U.S. Crime Puzzle: A Comparative Perspective on U.S. Crime and Punishment, 18 Am. Law Econ. Rev. 33 (2016).

[4] Seena Fazel et al., Mental Health of Prisoners: Prevalence, Adverse Outcomes, and Interventions, 3 Lancet Psychiatry 871 (2016).

[5] More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States | Office of Justice Programs, (last visited Apr 3, 2024).

[6] Prison Policy Initiative, Mental Health, (last visited Apr 3, 2024).

[7] Amy Blank Wilson & Jeffrey Draine, Collaborations Between Criminal Justice and Mental Health Systems for Prisoner Reentry, 57 Psychiatr. Serv. 875 (2006).

[8] Assessing the Contribution of the Deinstitutionalization of the Mentally Ill to Growth in the U.S. Incarceration Rate, (last visited Apr 3, 2024).

[9] Anasseril E Daniel, Care of the Mentally Ill in Prisons: Challenges and Solutions, 35 J. Am. Acad. Psychiatry Law (2007).

[10] Mental Health of Prisoners: Identifying Barriers to Mental Health Treatment and Medication Continuity, (last visited Apr 3, 2024).

[11] Jason R Trautwein et al., The Need for Continuity of Care in the Criminal Justice System.

[12] Rehabilitation in the Punitive Era: The Gap Between Rhetoric and Reality in U.S. Prison Programs - Phelps - 2011 - Law & Society Review - Wiley Online Library, (last visited Apr 3, 2024).

[13] Rais Gul, Our Prisons Punitive or Rehabilitative? An Analysis of Theory and Practice, 15 Policy Perspect. 67 (2018).

[14] Edgardo Rotman, Do Criminal Offenders Have a Constitutional Right to Rehabilitation?, 77 J. Crim. Law Criminol. 1973- 1023 (1986).

[16] About Criminal and Juvenile Justice, (2020), (last visited Apr 3, 2024).

[17] Corinna Lain, The Road to Hell Is Paved With Good Intentions: Deinstitutionalization and Mass Incarceration Nation, (2024), (last visited Apr 3, 2024).

3 views0 comments

Recent Posts

See All


bottom of page