Research Brief: Mental Illness in US Jails

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Research Brief
Occasional Paper Series * No. 1 * November 1996

Mental Illness in US Jails:
Diverting the nonviolent, low-level offender
Jails are becoming America's
new mental hospitals.
Increasing numbers of
seriously and chronically
mentally ill people are
detained in US jails each
year. As a result, jail facilities
are faced with a role that
they were neither designed
nor staffed to assume.
Alarmingly high numbers of
severely mentally ill
detainees are steadily
causing our nation's jails to
replace public mental
hospitals as primary mental
health service providers.
In the Los Angeles County jail
system,
16% of inmates require
mental health services on a
daily basis, making it
de facto the largest mental
institution in the country. 24
Several county jails across
the country experience
similar levels of saturation:
Miami's Dade County jails, for
example, house more
mentally ill persons than any
single institution or hospital
in the county. 25
In Travis County jail in
Austin, Texas, 300 inmates,
or roughly 14% of the
general inmate population,
have serious psychiatric
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Approximately 670,000 mentally ill people are admitted to
US jails each year.1 This is nearly eight times the number
of patients admitted to state mental hospitals.2 Some
mentally ill offenders must be held in jail because of the
seriousness of their offenses and should receive mental
health treatment while incarcerated. Many others who are
mentally ill, however, have committed less serious,
nonviolent offenses such as disturbing the peace, vagrancy
and trespassing.3 There are at least three reasons why the
diversion of these individuals into community-based mental
health programs would be preferable to incarceration: 1)
community treatment programs provide a public safety
benefit by reducing the likelihood that the mentally ill
offender will be rearrested,4 2) community treatment
programs provide a management benefit by enabling jails
to operate more efficiently, to focus on keeping dangerous
offenders off the streets, and to more effectively ensure
the safety of jail staff and other detainees, 3) community
treatment programs provide more effective mental health
treatment through an array of integrated services that
most jails do not offer.
Jails are critical places to address mental health issues
because of the sheer number of mentally ill persons behind
bars on any given day. Jails serve as the first point of
entry into the criminal justice system for nearly 10 million
individuals arrested each year, as many as 13% of whom
suffer from severe mental disabilities,5 compared to less
than 2% in the general population.6
This research brief focuses on the diversion of low-level,
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Research Brief: Mental Illness in US Jails

illnesses. This rivals the
psychiatric population of
Austin State Hospital, which
houses 340 patients. 26
In Seattle's King County jail,
approximately 8% of the
inmate population is severely
mentally ill, making the
correctional facility King
County's largest institution
for the mentally ill. 27
The Center on Crime,
Communities &Culture is a
project of the Open Society
Institute-New York. OSI-New
York is a private operating and
grantmaking foundation that
promotes the development of
open societies around the world
both by running its own
programs and by awarding
grants to others. OSI-New York
develops and implements a
variety of domestic and
international programs in the
areas of educational, social, and
legal reform, and encourages
public debate and policy
alternatives in complex and
often controversial fields. OSINew York is part of a network of
more than 24 autonomous
nonprofit foundations and other
organizations created and
funded by philanthropist George
Soros in Central and Eastern
Europe, the former Soviet
Union, Haiti, and South Africa,
as well as in the United States.
OSI-New York assists these
foundations by creating
programs on common issues and
by providing technical,
administrative and financial
support.
The Center wishes to thank
Henry J. Steadman, Ph.D.,
president of Policy Research
Associates, for his comments on
a draft of this research brief.
Open Society Institute
The Center on Crime,
Communities & Culture
400 West 59th Street
New York, NY 10019
Tel: 212 548-0135
Email: cccc@sorosny.org
Website: www.soros.org/
crime/

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nonviolent mentally ill offenders to treatment programs in
the community as an alternative to detention in
dangerously overcrowded and understaffed jails. This type
of cooperative program between the criminal justice
system and the larger mental health care community is a
proven way of effectively treating persons with mental
illness. It also reduces the administrative burden on jails
that are ill-equipped to provide the sophisticated level of
mental health services currently expected of them.7
WHY ARE SO MANY SERIOUSLY MENTALLY ILL
INDIVIDUALS IN JAILS?
Mentally ill offenders are often arrested because jails lack
adequate procedures to divert them into community-based
treatment programs, when appropriate. Less than 5% of
jails polled nationwide in 1992 had instituted procedures to
divert mentally ill inmates from the criminal justice system
into the mental health treatment system.8 Where
treatment programs do exist in jails, effectiveness is often
undermined by inadequate staffing and weak links to the
professional mental health community.
Mentally ill offenders are often jailed because communitybased treatment programs are either nonexistent, filled to
capacity, or inconveniently located. Police report that they
often arrest the mentally ill when treatment alternatives
would be preferable but are unavailable.9 Consequently,
jails often detain mentally ill misdemeanants for months at
a time pending the availability of psychiatric examinations,
psychiatric beds, or transportation to public psychiatric
hospitals, which, in rural communities, can be far from jail
facilities.10 In 1992, due to the lack of psychiatric
services, beds, or transportation to a hospital, a shocking
29% of jails surveyed reported to have incarcerated
mentally ill persons against whom no criminal charges
were filed.11
Mentally ill offenders are often jailed for relatively minor
offenses. Jail officials affirm that seriously mentally ill
individuals are commonly jailed for relatively minor
breaches of the law, such as vagrancy, trespassing,
disorderly conduct, alcohol-related charges, or failing to
pay for a meal.
When it is mental illness and not criminal intent that
underlies a petty criminal act, treatment in mental health
programs is demonstrably more effective at reducing
recidivism than a sentence to jail.
WHAT DOES CORRECTIONS THINK OF MENTAL HEALTH
SERVICES?

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Research Brief: Mental Illness in US Jails

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Most criminal justice administrators report that jail
programs are ill-equipped to respond effectively to the
needs of mentally ill offenders. Jail administrators and
other corrections officials cite mental health services as
one of the most serious institutional service needs.12
Responding to a survey of the National Institute of Justice,
administrators described their mental health programs as
"grossly understaffed" and "in urgent need" of program
development and of intervention by mental health
organizations.13
Sixty-four percent of jail administrators indicated the need
for improved medical services for the
mentally ill offender.14
Eighty-two percent of probation and parole agency
directors indicated the need for better access to mental
health professionals.15
WHY DIVERT MENTALLY ILL OFFENDERS FROM JAIL?
Diversion of mentally ill misdemeanants into welladministered community-based programs ensures greater
public safety and protection through a combination of
specialized mental health treatment and supervision
directed toward preventing recidivism.16
Appropriate diversion of mentally ill misdemeanants from
the criminal justice system helps promote smooth jail
operations 17 by reducing overcrowding and disruption in
jail.
Diversion of mentally ill misdemeanants into appropriate
mental health treatment programs in the community
results in a better long-term prognosis for individual
offenders and reduces the likelihood of their return to jail
for a similar offense.18
Diversion of mentally ill misdemeanants into communitybased mental health programs ensures specialized care by
trained and professional health care staff.
DOES THE LACK OF MENTAL HEALTH SERVICES
CONTRIBUTE TO THE HIGH RATE OF SUICIDE IN JAILS?
Suicide is one of the 10 leading causes of death
in the US.19 However, it is the leading cause of death in
jails. 20The vast majority of jail suicides occur in the
mentally ill population. That the rate of suicide among
mentally ill offenders in jail remains much higher than any
other inmate category or in the general population
underscores the necessity for effective and comprehensive
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Research Brief: Mental Illness in US Jails

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intervention and prevention policies in corrections.
Suicide in jails is predictable and preventable.
Over 50% of suicides in jails are committed within the first
24 hours of incarceration; 29% are committed within the
first three hours.21
Over 95% of those who commit suicide in correctional
facilities have a treatable psychiatric illness, 75%
communicate their intent in advance, and 30% have made
previous attempts.22
The rate of suicide among those inmates who have made
previous attempts is more than 100 times the rate in the
general population.23
Jail inmates who are mentally ill are at a disturbingly high
risk for suicide. The successful prevention of suicides in
jails depends largely on the ability and willingness of
corrections staff and mental health professionals to work
together in identifying those at risk and providing the
treatment and monitoring necessary to ensure their safety
and rehabilitation.
MENTAL ILLNESS IN JAIL...
US jails are troubled by serious overcrowding. Many
corrections officials agree that jail facilities are
inadequately equipped to handle the growing inmate
population, particularly the number of inmates with serious
mental illnesses.
Although all competent violators of the law, mentally ill or
not, are legally responsible for the crimes they commit, it
is clear that incarceration cannot be the only solution. For
those mentally ill offenders who commit serious crimes,
especially crimes that threaten the safety of the
community, jail or other forms of incarceration may be the
most appropriate choice. For the low-level offender who is
seriously mentally ill, however, incarceration may be
inappropriate and unnecessary.
...IS THERE ANOTHER SOLUTION?
A more effective alternative is to divert misdemeanants
who are mentally ill from jail to appropriate communitybased mental health programs where they can receive
treatment and other vital support services. Diversion to
treatment centers outside of jail has proven to be highly
effective in reducing the likelihood of recidivism.

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Research Brief: Mental Illness in US Jails

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US jails are not mental health facilities. Let us re-establish
our jails as centers of true justice and place mentally ill
persons in treatment programs - not behind bars.
REFERENCES
1. Steadman, H.J., Morris, S.M., Dennis, D.L. (1995). The
Diversion of Mentally Ill Persons from Jails to CommunityBased Services: A Profile of Programs. American Journal of
Public Health, 85(12), 1634.
2. Torrey, E.F. (1995). Editorial: Jails and Prisons America's New Mental Hospitals. American Journal of
Public Health, 85(12), 1612.
3. Landsberg, G. (1992). Developing Comprehensive Mental
Health Services in Local Jails and Police Lockups. In S.
Cooper &T.H. Lentner (Eds.), Innovations in Community
Mental Health, (p. 100). Sarasota, Florida: Professional
Resource Press. See also National Coalition for Jail
Reform. (1984). Removing the Chronically Mentally Ill from
Jail. Washington, DC: Author.
4. Policy Research Associates. (no date). Jail Diversion:
Creating Alternatives for Persons with Mental Illnesses
[pamphlet]. Steadman, H.J.: Author.
5. National Institute of Justice. (1995). The Americans with
Disabilities Act and Criminal Justice: Mental Disabilities and
Co (NCJ Publication No.115061). Washington, DC: U.S.
Government Printing Office.
6. National Institute of Mental Health. Mental Illness in
America: The National Institute of Mental Health Agenda
[on-line] Available: gopher:// zippy.nimh.nih.gov:70/00/
documents/nimh/other/America
7. National Coalition for Jail Reform. (1984). Removing the
Chronically Mentally Ill from Jail. Washington, DC: Author.
8. Jails surveyed were restricted to those with a capacity
of more than 50 inmates. See Steadman H.J., Barbera,
S.S., Dennis, D.L. (1994). A National Survey of Jail
Diversion Programs for Mentally Ill Detainees. Hospital and
Community Psychiatry,45(11), 1111.
9. Abram, K.M., Teplin, L.A. (1991). Co-Occurring
Disorders Among Mentally Ill Jail Detainees: Implications
for Public Policy. American Psychologist, 46(10), 1036.
10. Torrey, E.F. (1995). Editorial: Jails and Prisons America's New Mental Hospitals. American Journal of
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Research Brief: Mental Illness in US Jails

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Public Health, 85(12), 1612.
11. Torrey, E.F. (1995). Editorial: Jails and Prisons America's New Mental Hospitals. American Journal of
Public Health, 85(12), 1612.
12. McEwen, T. (1995). National Assessment Program:
1994 Survey Results (NIJ Publication No. NCJ 150856: p.
66). Washington, DC: National Institute of Justice.
13. McEwen, T. (1995). National Assessment Program:
1994 Survey Results (NIJ Publication No. NCJ 150856: pp.
67-68). Washington, DC: National Institute of Justice.
14. McEwen, T. (1995). National Assessment Program:
1994 Survey Results (NIJ Publication No. NCJ 150856: p.
65). Washington, DC: National Institute of Justice.
15. National Institute of Justice. (1995). NIJ Survey of
Probation and Parole Agency Directors (NIJ Update).
Washington, DC: U.S. Government Printing Office.
16. Steadman, H.J., Morris, S.M., Dennis, D.L. (1995). The
Diversion of Mentally Ill Persons from Jails to CommunityBased Services: A Profile of Programs.American Journal of
Public Health, 85(12), 1634.
17. Policy Research Associates. (no date). Jail Diversion:
Creating Alternatives for Persons with Mental Illnesses
[pamphlet]. Steadman, H.J.: Author.
18. Policy Research Associates. (no date). Jail Diversion:
Creating Alternatives for Persons with Mental Illnesses
[pamphlet]. Steadman, H.J.: Author.
19. DuRand, C.J., Burtka, G.J., Federman, E.J., Haycox,
J.A., &Smith, J.W. (1995). A Quarter Century of Suicide in
a Major Urban Jail:
Implications for Community Psychiatry. American Journal
of Psychiatry 152(7), 1077.
20. Hayes, L.M. (1995). Prison Suicide: An Overview and a
Guide to Prevention. The Prison Journal, 75(4), 431-456.
21. Rowan, J.R. &Hayes, L.M. (1995). Training Curriculum
on Suicide Detection and Prevention in Jails and Lockups
(2nd ed., p. 3.11). National Center on Institutions and
Alternatives. U.S. Department of Justice.
22. DuRand, C.J., Burtka, G.J., Federman, E.J., Haycox,
J.A., &Smith, J.W. (1995). A Quarter Century of Suicide in
a Major Urban Jail:
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Implications for Community Psychiatry. American Journal
of Psychiatry 152(7), 1077.
23. DuRand, C.J., Burtka, G.J., Federman, E.J., Haycox,
J.A., &Smith, J.W. (1995). A Quarter Century of Suicide in
a Major Urban Jail:
Implications for Community Psychiatry. American Journal
of Psychiatry 152(7), 1077.
24. Torrey, E.F. (1995). Editorial: Jails and Prisons America's New Mental Hospitals. American Journal of
Public Health, 85(12), 1611-1612.
25. Torrey, E.F. (1995). Editorial: Jails and Prisons America's New Mental Hospitals. American Journal of
Public Health, 85(12), 1611. See also Rogers, P. (1993,
August 1). Plan aims to help mentally ill inmates. Miami
Herald, p. B1.
26. Torrey, E.F. (1995). Editorial: Jails and Prisons America's New Mental Hospitals. American Journal of
Public Health, 85(12), 1611. See also Gamino, D. (1993,
April 17). Jail rivals state hospital
in mentally ill population. Austin American-Statesman, p.
A1.
27. Torrey, E.F. (1995). Editorial: Jails and Prisons America's New Mental Hospitals. American Journal of
Public Health, 85(12), 1611. See also Keene, L. (1993, July
6). A helping hand keeps mentally ill out of jail - program
assists `helpless, hopeless.' Seattle Times, p. A1
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