In the courtroom, the judge has just sentenced a person to a term of imprisonment. The judge may determine a date to self-surrender or a ruling may be made that a person is to be reprimanded  into custody immediately following sentencing, meaning someone is taken immediately from the courtroom to custody. No formal goodbyes to family, no formal resignation to their employer. Imagine being a mom who drops her children off at childcare the morning before her sentencing. She may be dropping her children off and not seeing them for several years outside of visitation times in prison. On the other hand, she may be granted the luxury to self-surrender at a later date, delaying the day she will have to say goodbye to her children for an extended period of time.

U.S. jails and prisons hold in custody a disproportionate number of people with mental disorders. According to the National Alliance on Mental Illness (NAMI), “About two in five people currently incarcerated have a history of mental illness — a rate twice as high as the average in this country.”  This statistic is alarming because it speaks to the fact that rates of mental disorders are significantly higher in custody than in the community (National Alliance on Mental Illness, n.d.). Although the United States has moved away from psychiatric institutions, we struggle as a country to develop sustainable community support to keep people with mental disorders out of the prison system. Without on-going improvements to support these individuals in the community, we as a society continue to perpetuate a system that incarcerates people who are diagnosed with mental disorders and developmental disabilities. If we provide wrap-around integrated health services, supportive employment, and sustainable housing, we give people the opportunity to thrive in the community.

Beginning in 1959, many people with mental disorders who were previously housed in psychiatric hospitals began to be released into the community (National Institute of Corrections, n.d.). Reasons for this shift, commonly referred to as deinstitutionalization and discussed in Chapter 1 of this text, included advancements in psychiatric medications and access to social security funds. Deinstitutionalization provided people with mental disorders more freedom, but in some cases the community was not set up to support them. This led to an increase in houselessness for some people with mental disorders, which ultimately contributed to increased incarceration of this group for petty crimes such as theft, disorderly conduct, and trespassing. Many efforts have been made to provide more access to treatment and divert crimes that are more indicative of mental health versus criminality. However, the criminalization of mental disorders continues to be a major issue in our criminal justice system. Criminalization is a focus of Chapter 4 of this text and is discussed in depth there.

Given that a large number of people with mental disorders are, for complex reasons, being treated in jails and prisons, it is important to understand and improve the programs and opportunities available for support and treatment within these facilities. This chapter will discuss current programming established in jails and prisons to support incarcerated people diagnosed with mental disorders.

Figure 7.1 Describes the U.S. incarceration system from time of arrest and incarceration to placement at Bureau of Prisons and state correctional facilities.

7.1.3 Chapter Overview Licenses and Attributions

“Chapter Overview” by Kendra Harding is licensed under CC BY 4.0. Some information summarized and one paragraph copied verbatim from People with Mental Health Conditions in Corrections | National Institute of Corrections (nicic.gov)