Skip navigation

Disabled Behind Bars - The Mass Incarceration of People With Disabilities in America’s Jails and Prisons, CAP, 2016

Download original document:
Brief thumbnail
This text is machine-read, and may contain errors. Check the original document to verify accuracy.

Disabled Behind Bars
The Mass Incarceration of People With
Disabilities in America’s Jails and Prisons
By Rebecca Vallas  July 2016


Disabled Behind Bars
The Mass Incarceration of People With Disabilities
in America’s Jails and Prisons
By Rebecca Vallas  July 2016


	 1	 Introduction and summary
	 5	Policing
	 8	Courts
	10	 Jails and prisons
	14	 Reentry
	17	 Recommendations
	24	 Conclusion
	25	 About the author
	26	 Endnotes

Introduction and summary
America’s four-decade-long experiment with mass incarceration and overcriminalization is widely recognized as a failure. We lock up a greater share of our citizens
than any other developed nation, destroying lives and separating families at an
annual cost of more than $80 billion. In addition, we do little to prepare individuals behind bars for their eventual release, yet are surprised when some two-thirds
return to our jails and prisons.
The crushing impact of the criminal justice system’s failure is felt acutely in communities across the United States. Significant and growing research shows how
certain populations—including communities of color; residents of high-poverty
neighborhoods; and lesbian, gay, bisexual, and transgender, or LGBT, individuals—have been particularly hard hit. But rarely discussed is the impact of the
criminal justice system on Americans with disabilities.1
The past six decades have seen widespread closure of state mental hospitals and
other institutional facilities that serve people with disabilities—a shift often
referred to as deinstitutionalization.2 The number of Americans residing in such
institutions dropped sharply from nearly 560,000 in 1955 to only about 70,000
in 1994.3 While widely regarded as a positive development, deinstitutionalization was not accompanied by the public investment necessary to ensure that
community-based alternatives were made available.4 As a result, while people
with disabilities—and particularly those with mental health conditions—were
no longer living in large numbers in institutions, many began to be swept up into
the criminal justice system, often due to minor infractions such as sleeping on the
sidewalk. Indeed, federal and state jails and prisons are now home to three times
as many people with mental health conditions as state mental hospitals.5
People with disabilities are thus dramatically overrepresented in the nation’s
prisons and jails today. According to the Bureau of Justice Statistics, people
behind bars in state and federal prisons are nearly three times as likely to report
having a disability as the nonincarcerated population, those in jails are more than

1  Center for American Progress  |  Disabled Behind Bars

persons are
at least three
times as likely
to report having
a disability as the

four times as likely.6 Cognitive disabilities—such as Down syndrome, autism,
dementia, intellectual disabilities, and learning disorders—are among the most
commonly reported: Prison inmates are four times as likely and jail inmates more
than six times as likely to report a cognitive disability than the general population.7 People with mental health conditions comprise a large proportion of those
behind bars, as well. The Bureau of Justice Statistics reports that fully 1 in 5 prison
inmates have a serious mental illness.8


Mass incarceration of Americans with disabilities
Prevalence of disabilities among state and federal prisoners and jail inmates, 2011–2012


Jail inmates


Jails are locally-operated
facilities that hold individuals
awaiting trial or sentencing as well as those serving
sentences of one year or less,
generally for misdemeanor




Note: Disability types include hearing, vision, cognitive, ambulatory, self-care, and independent living.
Source: Bureau of Justice Statistics, Disabilities Among Prison and Jail Inmates, 2011-2012 (U.S. Department of Justice, 2015), tables 4 and 5,
available at

Mass incarceration of people with disabilities is unjust, unethical, and cruel. But it
is also penny-wise and pound-foolish, as community-based treatment and prevention services cost far less than housing an individual behind bars. According to a
2014 study of Los Angeles County, the average cost of jailing an individual with
serious mental illness exceeds $48,500 per year. By comparison, the price tag for
providing Assertive Community Treatment, or ACT, and supportive housing—
one of the most intensive, comprehensive, and successful intervention models in
use today—amounts to less than $20,500 annually, just two-fifths the cost of jail.9
In addition to facing disproportionate rates of incarceration, people with disabilities are also especially likely to be the victims of police violence. Freddie Gray, Eric
Garner, Kristiana Coignard, and Robert Ethan Saylor were all individuals with disabilities whose tragic stories of being killed at the hands of police officers garnered
significant recent national media attention. They are but four high-profile examples of a widespread, commonplace occurrence. While data on police-involved

2  Center for American Progress  |  Disabled Behind Bars

Prisons are state- or federally-run facilities, generally for
individuals with felony convictions or serving sentences
of longer than one year.

killings are extremely limited, one study by the Ruderman Family Foundation
estimates that people with disabilities comprise a staggering one-third to one-half
of all individuals killed by law enforcement.10 According to an investigation by The
Washington Post, one-quarter of the individuals shot to death by police officers in
2015 were people with mental health conditions.11 Countless more have suffered brutality and violent treatment at the hands of police, often stemming from
misunderstandings related to mental health conditions and other disabilities.12
Furthermore, the number of individuals who have acquired disabilities while in
police custody is unknown.
While behind bars, people with disabilities are often deprived of necessary medical care, as well as needed supports, services, and accommodations. This is despite
long-standing federal disability rights laws that mandate equal access to programs,
services, and activities for all people with disabilities in custody. Poor conditions
in jails and prisons and inadequate access to health care and mental health treatment can not only exacerbate existing conditions, but also lead to further physical
and mental health problems that individuals did not have prior to incarceration.13
Many inmates with disabilities are held in solitary confinement—reportedly,
in many cases, for their own protection, due to a lack of appropriate alternative
accommodations.14 A growing array of research reveals that even short stays in solitary confinement can have severe and long-lasting consequences for people with
disabilities, and particularly those with mental health conditions. Furthermore,
many individuals who had not previously lived with mental health conditions
experience significant psychological distress following solitary confinement.15 The
tragic but all-too-common case of Kalief Browder brought this to light last year.16
Browder died by suicide after nearly two years in solitary confinement in Rikers
Island on charges, later dismissed, that he had stolen a backpack.
Moreover, while many people with disabilities already face barriers to employment, stable housing, and other necessary elements of economic security, adding
a criminal record into the mix can pose additional obstacles that make living
with a disability an even greater challenge.17 Meanwhile, reentry programs for
formerly incarcerated individuals often lack necessary accommodations and connections to community services, making them incapable of meeting the needs of
participants with disabilities.
This year marks the 17th anniversary of the landmark Supreme Court decision in
Olmstead v. L.C., which held that unjustified segregation of people with disabilities
in institutional settings constituted unlawful discrimination in violation of the
Americans with Disabilities Act, or ADA. Ending the mass incarceration of people

3  Center for American Progress  |  Disabled Behind Bars

with disabilities will require meaningful investment in the nation’s social service
and mental health treatment infrastructure to ensure availability and funding
for community-based alternatives, so that jails and prisons are no longer forced
to serve as social service providers of last resort. But bringing about this change
will also require including disability as a key part of the bipartisan conversation
on criminal justice reform taking place in Congress, as well as in states and cities
across the United States.
This report highlights steps policymakers can take to combat inappropriate and
unjust incarceration and criminalization of people with disabilities, as well as
steps to ensure appropriate and humane treatment of people with disabilities
throughout the justice system, from police practices to courts, conditions in jails
and prisons, and reentry.

4  Center for American Progress  |  Disabled Behind Bars

Law enforcement officials often serve as the entry point to the justice system for
people with disabilities. Due to the nationwide, decades-long disinvestment in
community mental health resources, police in many cases serve as de facto first
responders to mental health calls.18 Between 7 percent and 10 percent of all police
interactions involve individuals with mental health conditions—and in larger
police departments, officers report an average of six encounters per month with
people in psychiatric distress.19
In a practice referred to as mercy booking, police commonly arrest individuals
who show signs of mental health conditions for whom they believe jail offers the
best chance of securing food, shelter, and needed health care.20 Similarly, due to
a lack of appropriate training or access to alternative options, law enforcement
officials frequently take people displaying symptoms of mental health conditions
to emergency rooms when in fact outpatient care is what is needed.21
It is not only people with mental health conditions who get needlessly swept
up into the criminal justice system through interactions with law enforcement.
Police interactions involving people with communication disabilities—such
as intellectual or developmental disabilities and sensory or cognitive disabilities—frequently escalate when law enforcement personnel do not know how to
appropriately respond to or communicate with people experiencing distress. For
example, Robert Ethan Saylor, a 26-year-old man with Down syndrome, died in
2015 from a crushed larynx when police deputies sought to forcibly remove him
from a Maryland movie theater, ignoring his caretaker’s pleas to let her handle the
situation as he would “freak out” if touched by strangers.22

5  Center for American Progress  |  Disabled Behind Bars

Failure to provide accommodations can result
in jailing of innocent individuals
Abreham Zemedagegehu, a deaf Ethiopian immigrant who was raised using Ethiopian Sign Language, came to the United States in 2001.23 He eventually secured a
home and a job at FedEx in Washington, D.C.—both of which he lost in 2009 after he
suffered a serious back injury on the job.24 In December 2012, The New York Times
Neediest Cases Fund bought Zemedagegehu an iPad to communicate with him for an
article featuring his story.25
In February 2014, he was arrested at Reagan National Airport on suspicion that he
had stolen the iPad.26 He was denied a sign language interpreter and brought to an
Arlington, Virginia, jail where he waited another two days for any sort of accommodations that could help him communicate with his jailers. The jail eventually provided a
teletypewriter, or TTY, a device created in the mid-1990s to allow individuals who are
deaf or hard of hearing to communicate via telephone. However, Zemedagegehu, like
most deaf individuals who use sign language as a first or only language, was unable to
use it because it only allows for communication in English text. The jail also refused to
provide access to a videophone, which today is viewed as the functional equivalent of a
telephone for deaf and hard-of-hearing detainees behind bars.27
Zemedagegehu was held in jail for six weeks before finally being released in March
2014. According to an account he gave to The Washington Post, “he missed two or three
meals a week because he could not hear the announcement that it was time to eat.”28

The interplay of disability with race, poverty, sexual orientation, and gender
identity further complicates the link between disability and the criminal justice
system. There is a disproportionate incidence of intellectual and developmental
disabilities among low-income racial and ethnic minority populations, which have
higher rates of police involvement in their neighborhoods than higher-income
neighborhoods.29 In 2015, black men between the ages 15 and 34 were nine times
more likely than Americans of other races to be killed by police officers.30 And a
2014 report found that 73 percent of LGBT people and people living with HIV had
had in-person contact with the police in the past five years. Of those individuals, 40
percent reported verbal, physical, or sexual assault or hostility from officers.31

6  Center for American Progress  |  Disabled Behind Bars

Strategies to prevent people with disabilities from entering the criminal justice system
A growing number of police departments have begun partnering with

social services such as housing.37 Importantly, drop-off centers are

local health departments and social service providers in their commu-

only as effective as the resources with which they can connect peo-

nities to develop pre-arrest and pre-booking diversion programs.32 In

ple. San Antonio, Texas, is home to a national model for community

addition to saving taxpayer dollars in reduced incarceration, providing

drop-off centers.38 Stakeholders from the city’s jails, police offices,

law enforcement with alternatives to making an arrest or booking a

courts, and hospitals pooled their resources to build a centralized

person into jail can prevent an array of negative consequences that

mental health services complex that offers primary care, inpatient

stem from arrest, prosecution, and incarceration, including exacerba-

psychiatric services, substance abuse treatment, and supported

tion of preexisting disabilities, unaffordable fines and fees, disruption of

housing for people with serious mental illness.39 The center serves

employment or education, and damage to family relationships.

about 18,000 people per year and saved the city and surrounding
counties $50 million between 2009 and 2014 in reduced incarceration and emergency room visits.40

Law enforcement training

Crisis Intervention Team, or CIT, training involves collaboration
between police, mental health providers, and individuals and families

Assertive community treatment

affected by mental health conditions with the aim of preventing

Assertive community treatment is a multidisciplinary model of service

violence, avoiding unnecessary arrests, and improving access to

delivery and case management designed to help keep people with


mental health services. Training typically addresses mental health

serious mental illness from cycling in and out of jails and prisons. It is

conditions, how to respond to mental health crisis situations, com-

often combined with supportive housing. ACT teams typically include

munity resources that provide alternatives to emergency rooms and

service providers and professionals from a range of fields, and services

jails, and the legal framework governing involuntary hospitaliza-

can include intensive case management, substance abuse treatment,

tion. In an example of a best practice, some jurisdictions pair police

assistance with employment and housing, medication management,

officers with community mental health professionals to engage in

crisis management, family support, and outreach. ACT teams are typi-

joint responses to crisis situations. According to the National Alliance

cally available and on call at all times, equipped to provide services

on Mental Illness, CIT programs have been established in more than

in clients’ homes and in public and private settings as needed, and


2,700 communities across the United States. Research indicates that

trained to work with law enforcement, particularly to deescalate crisis

police who receive CIT training are more likely to direct individuals to

situations to prevent unnecessary arrest.

community-based services and less likely to arrest them than officers
who do not receive training.35 Importantly, law enforcement training

Evaluations of the ACT model show that it is effective at reducing

is not enough on its own and should serve as one component of a

psychiatric hospitalizations and trips to the emergency room, as well

broader set of reforms.

as arrests and incarceration.41 For example, the Pathways to Housing program—launched in New York City in the early 1990s, and

Community drop-off centers

replicated in an array of cities in the years since—has been shown to

Community drop-off centers offer another approach to divert people

cut incarceration among participants in half, hospitalizations by 71

with disabilities away from jail and give officers the opportunity to

percent, crisis response episodes by 71 percent, and shelter use by 88

connect people to needed services and community resources other

percent.42 While not all individuals for whom diversion is appropriate


than emergency rooms. Drop-off centers typically provide a range

require the intensive level of case management and services that ACT

of services, including short-term crisis beds, case management, detox

provides, it can be an effective intervention for individuals living with

and substance abuse services, and referrals to ongoing treatment and

the most serious mental illness.

7  Center for American Progress  |  Disabled Behind Bars

The Americans with Disabilities Act prohibits discrimination on the basis of disability and mandates that individuals with disabilities must be provided an equal
opportunity to participate in American life.43 Title II of the law applies to public
entities such as state and local governments, as well as the programs and services
they offer—including court services and court proceedings.44
Notably, the law creates an affirmative duty on the part of government entities to
provide accommodations where needed, as long as they are “reasonable” and do
not amount to a “fundamental alteration” of the program.45 For example, courts
must provide reasonable accommodations for individuals who are deaf or hard
of hearing or who have other communication disabilities, including “furnish[ing]
appropriate auxiliary aids and services where necessary … to ensure that communications with applicants, participants, and members of the public are as effective
as communications with others.”46
Nonetheless, a lack of accessibility and a failure to provide needed accommodations are widespread throughout the nation’s courts. Each year, the National
Center for Access to Justice creates the Justice Index, a 50-state compendium
of litigants’ access to the courts, analyzing where barriers exist, including for
individuals with disabilities.47 According to the 2016 Justice Index, less than 30
percent of court systems even list mental disability on their websites as a basis for
providing needed accommodations. Just two states—Oregon and Washington—
provide for appointment of legal counsel to litigants with disabilities as a form
of reasonable accommodation.48 Only seven states have a designated court
employee with mental health training who serves as a contact person for requests
for needed accommodations. Several states do not require that service animals
be permitted in courthouses.49 And courts in a handful of states are permitted to
charge individuals who are deaf or hard of hearing for their own sign language
interpreter, in violation of federal law.

8  Center for American Progress  |  Disabled Behind Bars

As the advocacy organization Helping Educate to Advance the Rights of the
Deaf, or HEARD, has documented, defendants who are deaf or hard of hearing
routinely are deprived of interpreters for attorney consultations and even formal
court proceedings, leaving them unable to understand or participate in their own
cases and susceptible to wrongful arrests and convictions. For example, Christine
Stein, a deaf resident of Jamestown, North Dakota, was arrested after calling 911
through a video relay system that uses sign language interpreters. She had called
911 seeking help with a suicidal man who was in her apartment. Unable to understand what she was telling them, law enforcement then arrested Stein on suspicion
of having harmed the man. According to a lawsuit against the Jamestown police
department and courts, Stein was denied a sign language interpreter not only during police questioning and booking, but also when she was brought before a judge
for court proceedings. The charges were ultimately dropped after she was able to
meet with an interpreter two days before she was scheduled to return to court.50
Lack of understanding of how to appropriately work with and ensure appropriate
accommodations for people with disabilities can also result in inadequate access
to legal representation. Severe underfunding for the nation’s public defense
system has resulted in crushing caseloads, hampering public defenders’ ability to
provide high-quality representation to each of their clients. John Oliver, host of
Last Week Tonight, brought national attention to this issue when he highlighted
how public defenders in New Orleans, Louisiana, were able to spend an average
of just seven minutes on each case.51
While a strained public defense system diminishes access to justice for all lowincome defendants who are unable to afford an attorney, it poses particular
challenges for individuals with disabilities. Some disability advocates even report
instances of public defenders refusing to accept cases involving defendants with
disabilities, apparently due to lack of comfort or experience representing clients
with disabilities.52

9  Center for American Progress  |  Disabled Behind Bars

Jails and prisons
Safe, appropriate, and accessible facilities and programming are critical to ensure
that while behind bars, the needs of prison and jail inmates with disabilities are
met—and to facilitate successful reentry upon release.
Prison and jail inmates with disabilities are entitled to reasonable accommodations as well as equal access to programs, services, and activities under the ADA
and Section 504 of the Rehabilitation Act.53 Nonetheless, as documented in a
recent report by the Amplifying Voices of Inmates with Disabilities Prison Project,
or AVID, failure to ensure accessibility and/or provide needed accommodations is
widespread in correctional facilities across the United States.54 The report highlights one example after another of inmates being denied access to needed medications, prosthetic limbs, and hearing aids; individuals with cognitive impairments
unable to access medical treatment because they were unable to fill out request
forms; inmates who are deaf or hard of hearing missing medication delivery
because of lack of accommodations; inmates who have sustained injuries due to
lack of accessible toilets and showers; and more.55
Furthermore, poor conditions ranging from lack of access to health care to inadequate nutrition create an environment in which existing physical and mental
health conditions can be exacerbated—and even developed where they did not
previously exist. According to a 2009 study published in the American Journal of
Public Health, of those behind bars with chronic medical issues, fully 68 percent
of local jail inmates, 20 percent of state prison inmates, and 14 percent of federal
prison inmates fail to receive a medical exam while behind bars.56
Inadequate nutrition is a widespread problem in prisons and jails across the
Unites States. According to an investigation launched by human rights attorneys in
2014, inmates at the Gordon County Jail in Calhoun, Georgia, were literally starving, with some reduced to licking syrup packets and even eating toothpaste and
toilet paper because the two meals served each day were severely inadequate. A
lawsuit filed on behalf of inmates at New York’s Montgomery County Jail reported

10  Center for American Progress  |  Disabled Behind Bars

that insufficient portions spurred violence among inmates, and that one inmate
could no longer fit into his prosthetic leg because he had lost so much weight.57
Inadequate nutrition not only risks worsening existing health conditions, it can
lead to poor health in previously healthy individuals. For inmates who require
special diets due to health conditions, lack of access to appropriate nutrition can
be especially harmful.
Prison and jail inmates with disabilities are also at special risk for mistreatment
by guards and other correctional employees, and abuse at the hands of their fellow inmates. A 2015 report by Human Rights Watch documents an epidemic of
“unnecessary, excessive, and even malicious force” in U.S. prisons and jails, targeting
prisoners with mental health conditions. The report describes an array of horrific
tactics including the use of chemical sprays and electric stun devices, the strapping
of inmates to chairs and beds for days at a time, and physical violence resulting in
broken jaws, noses, and ribs, as well as “lacerations, second degree burns, deep
bruises, and damaged internal organs” and even death.58 And a 2014 investigation of
New York’s Rikers Island jail by The New York Times uncovered a culture of brutality
by correctional employees against inmates with mental health conditions.59
Inmates with mental health conditions are disproportionately likely to be the
victims of violence at the hands of guards and correctional employees. For
example, Human Rights Watch found that while 3 percent of Colorado’s prison
population has a diagnosed mental illness, those individuals make up more than
one-third of the state’s use of force incidents in the state’s prisons. And in 4 out
of 12 California prisons studied, use of force against inmates with mental illness
comprised between 84 and 94 percent of all such incidents, despite the fact that
individuals with mental illness comprise 30 to 55 percent of the prison population. And inmates with disabilities are also particularly susceptible to sexual
violence while behind bars.60
Due to a lack of appropriate accommodations for inmates with disabilities,
many are held inappropriately in solitary confinement, often reportedly for their
own protection and safety.61 According to the advocacy group HEARD, which
maintains the only known national database of incarcerated individuals who are
deaf, deaf individuals are among those most likely to be held in solitary, often
as a “substitute for the provision of accommodations for and protection of deaf
and disabled prisoners.”62

11  Center for American Progress  |  Disabled Behind Bars

Kalief Browder
In May 2010, 16-year-old Kalief Browder was arrested in Bronx, New York, for allegedly stealing a backpack two weeks earlier.63 His family was unable to afford to post
his $3,000 bail, so he was sent to the notoriously violent Rikers Island to be confined
with other male adolescents.64 Browder spent the next three years in jail awaiting
trial.65 While at Rikers, he suffered violence from both officers and inmates. He also
experienced periods of time during which he was deprived of food, as well as access
to showers, educational programs, and mental health support.66 Making matters
worse, Browder spent about two of his three years behind bars in solitary confinement, where he attempted to commit suicide several times.67 Browder’s case was
ultimately dismissed, and he was released in May 2013. Six months later he attempted suicide again and spent time in a psychiatric ward at Harlem Hospital Center.68 He
died by suicide on June 5, 2015.

In recognition of the horrific consequences of solitary confinement—including exacerbating preexisting mental health conditions, psychological distress in
individuals who did not previously live with a mental health condition, and even
suicide69—Juan Mendez, the United Nations special rapporteur on torture, has
called for an absolute ban on solitary confinement in excess of 15 days. He notes:
“The practice of prolonged or indefinite solitary confinement inflicts pain and
suffering of a psychological nature, which is strictly prohibited by the Convention
Against Torture.”70 And in January 2016 the U.S. Department of Justice released
guidance in order to minimize the use of solitary confinement in federal correctional facilities, including as a form of protective custody.71
Furthermore, inmates with disabilities can face legal barriers to challenging poor
conditions and denials of accommodations behind bars. The Prison Litigation
Reform Act, enacted in 1996, requires exhaustion of administrative remedies
before an individual may file a lawsuit based on civil rights violations in jails and
prisons.72 Many people with disabilities—particularly those who are deaf or blind
or who have intellectual disabilities or other communication disabilities—are
unable to access, let alone exhaust, the grievance system, leaving the doors to the
courtroom barred to their claims.73

12  Center for American Progress  |  Disabled Behind Bars

Post-booking diversion to remove individuals
with mental health conditions from jail
At 9 percent of the county’s population, Miami-Dade County, Florida, has the highest
percentage of residents with serious mental illness of all urban communities in the United
States. Of those residents, just 1 in 10 are able to access care through the community
mental health system. Many more end up behind bars in the county jail, which serves as
the largest mental health facility in the entire state, housing 1,200 individuals with serious
mental illness on any given day, at a cost of more than $50 million each year.74
The 11th Judicial Circuit Criminal Mental Health Project, or CMHP, was launched in 2000
to get individuals with serious mental health conditions out of Miami’s jails and into
community-based treatment.75 In addition to pre-booking diversion, CMHP utilizes
post-booking diversion for individuals in jail awaiting trial.76 Individuals are each
offered transition planning tailored to their unique needs, including links to community-based treatment and support services.77 Participants would typically have spent
months in the Pre-Trial Detention Center awaiting hearings—four to eight times longer
on average than defendants without mental health conditions.78 Instead they are typically diverted within 48 hours of being booked.79 In 2014, the county was able to close
one of its five jail facilities as a result of the program’s success.80

13  Center for American Progress  |  Disabled Behind Bars

When individuals are released from prisons and jails, they frequently are sent back
into the community with a few dollars in their pocket, a bus ticket, and two to
three days’ worth of needed medications.81 Many have no housing to return to, and
because they have a criminal record they face an uphill battle finding steady employment. Combine that record with disability, and returning citizens with disabilities
can find themselves doubly at risk of discrimination when it comes to accessing the
building blocks of economic stability necessary to achieve successful reentry.
Despite tremendous progress enshrined in the Americans with Disabilities Act and
other landmark civil rights laws, many people with disabilities continue to face serious barriers to basics such as employment and housing. Workers with disabilities
face unemployment rates nearly three times the national average, with 12.1 percent
out of work in June 2016 compared with 4.8 percent of their counterparts without
disabilities.82* They also face a steep pay gap, with disabled workers earning just 63
cents on average for every dollar paid to workers without disabilities.83
Add a criminal record into the mix, and steady employment can be even further out
of reach. Today, nearly 9 in 10 employers use criminal background checks in hiring,
and a substantial body of research documents that having even a minor criminal
record—including misdemeanors and arrests that did not lead to conviction—can
serve as a powerful hiring disincentive.84 As a result, fully 60 percent of formerly
incarcerated people remain without a job one year after they are released.85
People with disabilities can also face great challenges in securing affordable, accessible housing. According to a 2008 report by the U.S. Department of Housing and
Urban Development, or HUD, 43 percent of people living in homeless shelters in
the United States report having a disability.86 In addition, roughly 40 percent of
households facing what HUD considers “worst-case housing needs”—very lowincome renters who do not receive housing aid and who either are paying more
than half their monthly incomes in rent or live in substandard housing, or both—
are non-elderly, disabled households.87

14  Center for American Progress  |  Disabled Behind Bars

*Correction, July 19, 2014:

This report incorrectly attributed
the month from which these
unemployment data were taken.
The correct month is June.

Returning citizens with disabilities face even greater challenges in securing housing. As many as one-third expect to go to a homeless shelter upon release.88 Those
with mental illness are twice as likely to have been homeless in the months before
being incarcerated.89 “One strike and you’re out” policies in public housing can
put public and subsidized housing out of reach for many people with criminal
records.90 Individuals receiving treatment in residential facilities can face barriers to permanent supportive housing, due to HUD’s definition of homelessness,
which excludes people in residential facilities for 90 days or longer.91 And with an
estimated four in five private landlords utilizing background checks, private rental
housing can be unattainable as well.92
Further complicating the reentry process, many individuals are released without
needed health insurance and other vital benefits in place. Many who received
Medicaid and/or Social Security disability benefits prior to incarceration face
interruptions in these benefits and can end up waiting months or even years after
release to get them reinstated.93 Interruptions in health coverage can be a path
straight back to jail, particularly for people with mental or behavioral health conditions unable to access needed medications and treatment.94 Spells without income
from disability benefits can leave people unable to afford housing, food, medications, and more during the critical period when recidivism is most likely. And lack
of identification can serve as a barrier to accessing needed supports and services
and stand in the way of nearly every component of reentry. Moreover, reentry
programs often lack necessary accommodations and training for staff on how to
appropriately serve returning citizens with disabilities.95

15  Center for American Progress  |  Disabled Behind Bars

Supporting reentry for people with disabilities
Some states and localities have adopted promising approaches to smooth reentry for returning citizens with disabilities.
Pre-release applications for benefits

to state Medicaid directors, states are not required to terminate

Pre-release applications for critical benefits such as Medicaid;

an individual’s Medicaid coverage upon incarceration; instead,

nutrition assistance; Social Security Disability Insurance, or SSDI;

they have the option to suspend Medicaid while an individual

and Supplemental Security Income, or SSI—through collaboration

is behind bars and reactivate coverage upon release, saving the

across corrections agencies, mental health and substance abuse

individual the need to reapply and the many months of waiting

agencies, the agencies that administer benefits, and state or local

for approval.100 This approach not only prevents harmful gaps in

government—enable returning citizens to reenter their communi-

coverage, but also enables states to save money through reduced

ties with the basics they need for successful reentry.


churn of terminations and new applications. Suspension instead of
termination of Medicaid holds great promise for preventing rein-

SSDI/SSI Outreach, Access, and Recovery, or SOAR, is an innovative

carceration by ensuring that returning citizens can access needed

program supported by the Substance Abuse and Mental Health

medical care and other supportive services critical to successful

Services Administration that helps people who are homeless or at

reentry. At least 12 states have policies in place to suspend instead

risk of homelessness to access Social Security disability benefits.97

of terminating Medicaid coverage for inmates.101

SOAR has collaborated with and provided technical assistance to
several jails and prisons through pilot projects designed to connect
individuals with disability benefits prior to release.


Continuity of care

Some courts have recently recognized the importance of ensuring access to needed medications upon release from incarcera-

One example of a SOAR pilot program that has yielded highly prom-

tion. The Ninth Circuit Court of Appeals has ruled that the Eighth

ising results is CMHP, mentioned above, in Miami-Dade County. Be-

Amendment to the U.S. Constitution requires states to ensure that

tween July 2008 and November 2012, 91 percent of 181 individuals

a person who has been receiving medication while behind bars

were approved for Social Security disability benefits, with an average

is released with “a supply sufficient to ensure that he has medica-

processing time of just 45 days. Participants are also connected with

tion available during the period of time reasonably necessary to

treatment and medications upon release, and temporary housing

consult a doctor and obtain a new supply.” This requirement is

is provided to individuals still awaiting approval of their disability

now law in Alaska, Arizona, California, Hawaii, Idaho, Montana,

benefits. The number of arrests among CMHP participants two years

Nevada, Oregon, and Washington.102 A New York state court has

after release dropped by 70 percent.99

gone further, ordering New York City to provide “adequate discharge planning” for inmates with mental health conditions so as

Suspending instead of terminating Medicaid coverage

to prevent “a return to the cycle of likely harm to themselves and/

As set forth in a 2004 letter from the U.S. Department of Health

or others” and rearrest.103

and Human Services’ Centers for Medicare and Medicaid Services

16  Center for American Progress  |  Disabled Behind Bars

As bipartisan momentum around overhauling the nation’s criminal justice system
continues to grow in Congress and in states and cities across the United States, the
following are steps that policymakers can take to reduce the mass incarceration of
people with disabilities; ensure humane and appropriate treatment of people with
disabilities behind bars; bring about just and appropriate treatment in the courts
system; and smooth reintegration for returning citizens with disabilities into their
communities to break the cycle of incarceration, release, and rearrest.

Invest in community-based services
Following a long history of disinvestment in community-based care for mental
health and disability, the United States has traded one form of mass institutionalization for another, with jails and prisons now serving as social service providers
of last resort. Reversing this shameful trend will require meaningful investment in
our social service and mental health treatment infrastructure to ensure the availability of and funding for community-based services. Outpatient treatment, peer
support, case management, supportive housing, mobile crisis teams, and—for
people with the most severe case management needs—Assertive Community
Treatment offer proven and cost-effective tools to prevent entry into the justice
system. As states and localities take steps to overhaul their criminal justice systems, cost savings from reduced incarceration should be reinvested in communitybased services, including those that prevent people with disabilities from needless
and unjust incarceration.

End criminalization of homelessness
States and cities should review and reform laws and other policies that disproportionately target or impact homeless individuals and those with mental health
conditions. Laws that prohibit loitering, begging, sleeping and/or sitting on
sidewalks, sleeping in vehicles, and other status offenses disproportionately target

17  Center for American Progress  |  Disabled Behind Bars

homeless individuals, many of whom live with mental health conditions and/
or other disabilities. Similarly, so-called quality-of-life police sweeps hit the same
populations. These policies are not only unduly harsh, they also play a large role in
funneling people with disabilities into jails and prisons.

Establish an Office of Disability within the U.S. Department
of Justice and a Federal Interagency Council on Criminal
Justice and Disability
A special funding stream and designated division within the U.S. Department of
Justice—analogous to the Office on Violence Against Women and the Office of
Community Oriented Policing Services—should be established to help states
and localities take steps to comply with the ADA and to implement policies and
practices that prevent people with disabilities from entering the justice system,
ensure accessibility of court systems, improve conditions and accessibility
behind bars, and smooth reentry.
Additionally, a cabinet-level Federal Interagency Council on Criminal Justice and
Disability, convened by the Attorney General, should be created to coordinate and
advance policies to reduce incarceration and improve treatment of people with disabilities in the criminal justice system. The Federal Interagency Reentry Council,
established in 2011 by Attorney General Eric Holder and made permanent earlier
this year, offers a model.104 Housed at the Department of Justice, the Reentry
Council brought 20 federal agencies together to coordinate and advance effective
reentry policies, demonstrating the effectiveness of an interagency approach.

Improve police practices and expand training
Interactions with police often serve as the entry point into the criminal justice
system for people with disabilities. The following are steps that states and localities
can take to improve police practices and stem the flow of people with disabilities
into the justice system:
•	 Require annual training for all law enforcement personnel—not just police
officers—delivered where possible by people with disabilities and/or disability
service providers. Training should be cross-disability—not just mental healthrelated—and informed by data on the incidence of certain types of disabilities
within a city or precinct

18  Center for American Progress  |  Disabled Behind Bars

•	 Establish Crisis Intervention Training programs, and encourage and facilitate
pre-arrest and pre-booking diversion to community-based services
•	 Examine and reform use of force policies to minimize harm and loss of life
among people with disabilities, who make up a disproportionate share of those
killed by law enforcement
•	 Implement body-worn and dashboard cameras to monitor and enforce appropriate police practices

Divert people with disabilities to community-based services
Diversion should occur as early in the process as possible—ideally before an
individual has been arrested or booked. Collaborative programs that bring police
departments together with public health agencies, treatment providers, and community advocates to equip law enforcement personnel with the training to identify
and divert individuals to behavioral health care, housing, and other social services as an alternative to arrest and detention are a best practice. Where diversion
cannot or does not occur prior to arrest or booking, pretrial diversion programs
are the next best option. Miami’s 11th Judicial Circuit Criminal Mental Health
Project offers a replicable model for pre- and post-booking diversion with proven
results. Additionally, federal grants, such as the Byrne Memorial Justice Assistance
Grant program, the leading source of federal dollars for state and local criminal
justice activities, should be reviewed for opportunities to reorient state and local
incentives away from mass incarceration of people with disabilities and toward
diversion and prevention.

Ensure accessibility, needed accommodations,
and appropriate treatment within the court system
Lack of accessibility within the court system, including failure to provide needed
accommodations, such as a sign language interpreter, can serve as a recipe for
unjust treatment and outcomes for individuals with disabilities. The Department
of Justice should issue guidance clarifying states’ obligations under the ADA.
Additionally, states should enact laws, regulations, or other forms of written guidance mandating full accessibility of their court systems. Policies and practices to
ensure access to justice for people with disabilities include:

19  Center for American Progress  |  Disabled Behind Bars

•	 Provision of sign language interpreters free of charge
•	 Provision of counsel at no cost to the litigant where needed as a form of reasonable accommodation
•	 Admittance of service animals on court premises
•	 Clear information on court websites on how and from whom to request
accommodations—as well as how and to whom disability access complaints
should be made
•	 Annual training on the ADA and other relevant disability law for all stakeholders of the court, including prosecutors, judges, clerks and other court personnel,
and public defenders, to ensure that they understand their obligations, such as
providing reasonable accommodations
•	 Establishment of specialized units within public defender offices to handle
representation of defendants with serious mental health conditions, analogous
in structure to the specialized units that handle death penalty cases105
•	 Creation of statewide boards to set, monitor, and enforce minimum training
requirements, performance standards, and performance evaluation of attorneys

Ensure safe, accessible, and appropriate conditions behind bars
Safe, accessible, and appropriate conditions in jails and prisons are critical to
ensure that individuals with disabilities have their needs met while behind
bars, and to facilitate successful reentry upon release from incarceration. The
Department of Justice should issue guidance clarifying prisons’ and jails’ obligations under the ADA regarding accommodations and accessibility for inmates
with disabilities, and setting forth best practices, including:
•	 Annual training for all jail and prison personnel on the ADA and Section 504 of
the Rehabilitation Act, as well as disability sensitivity training to prevent needless and unjust punishment due to misunderstandings about instructions or
other perceived noncompliance

20  Center for American Progress  |  Disabled Behind Bars

•	 Designated ADA coordinators at each facility to handle requests for accommodations and to ensure accessibility of all physical spaces and programming
•	 Independent ombudspeople to hear grievances and address complaints
•	 Comprehensive health care—including mental health care—for all inmates,
both for existing conditions and to prevent inmates from developing new health
problems or disabilities while behind bars
•	 Improved access to communications accommodations for inmates who are
deaf or hard of hearing or have communication disabilities—both for everyday
activities within prisons and jails, and for communications with loved ones and
visitors (including the installation of videophones, captioned telephones, and
other auxiliary aids)
•	 Sound use of force policies enforced through training, supervision, reviews,
investigations, and accountability
•	 Adoption of policies to prevent prison rape
In the meantime, states and localities should take steps to comply with the
ADA and Section 504 and to implement the above best practices. Additionally,
Congress should review and reform the Prison Litigation Reform Act as needed to
ensure that inmates with disabilities are able to enforce their rights and challenge
civil rights violations behind bars.106

Support successful reentry
Overcoming barriers to employment, housing, and more associated with having a
criminal record can be challenging for any returning citizen. When combined with
the barriers to economic security that many people with disabilities face, successful reentry can be an even steeper uphill battle. Policies and practices to smooth
reentry for returning citizens with disabilities include:
•	 Provision of accessible education and training behind bars, with coordination
between state departments of corrections and vocational rehabilitation agencies

21  Center for American Progress  |  Disabled Behind Bars

•	 Provision of discharge planning well in advance of release, that takes disability
and health needs into account
•	 Suspension, instead of termination, of inmates’ Medicaid benefits in order to
reduce interruptions in health coverage
•	 Leverage of the pre-release application model for health care and nutrition
assistance, and the SOAR model for Social Security disability benefits, to ensure
access to needed supports prior to release
•	 Implementation of continuity of care policies to ensure that individuals are
released with enough medication to get by until they are able to see a doctor
•	 Physical and programmatic accessibility at halfway houses, job training programs, and other community-based reentry services
•	 Revision of HUD’s definition of homelessness to expand access to supportive
housing for individuals leaving residential treatment facilities
•	 Reauthorization of and increased funding for the Second Chance Act, awarding
additional points to providers that include a disability lens across their services
and requiring that Second Chance grantees receive annual training on their
obligations and best practices for working with people with disabilities
•	 Increased resources for civil legal services, which plays a vital role in removing
barriers to employment, housing, and public assistance, supporting reentry
•	 Enactment of policies that give returning citizens a fair shot at employment, housing, education and training, and other basic building blocks of economic stability107

Improve data collection
Data collection is critical for prevention, monitoring, enforcement, and policy
development. Increased data collection should target:
•	 Police encounters with people with disabilities, as well as the circumstances
leading up to these encounters

22  Center for American Progress  |  Disabled Behind Bars

•	 Police-involved shootings and deaths, including the presence of a disability
•	 Disabilities acquired by individuals while in custody
•	 Requests as well as provision, denial, or removal of reasonable accommodations
at the time of individuals’ arrest or at any point while in custody
•	 The Obama administration’s recently established Data-Driven Justice
Initiative—a bipartisan effort bringing together 67 state and local governments
to divert individuals with mental health conditions away from the criminal justice system—offers an example of how data can be leveraged to drive reform.108

23  Center for American Progress  |  Disabled Behind Bars

In the wake of the deinstitutionalization movement, prisons and jails have taken
the place of institutional facilities as the modern-day warehouses for Americans
with disabilities. Seventeen years after the Supreme Court declared unjustified segregation of people with disabilities in institutional settings to be unlawful discrimination in violation of the Americans with Disabilities Act, it is long
past time that the mass incarceration of people with disabilities came to an end.
What’s more, diverting people with disabilities away from the criminal justice
system and into community-based services is not just the right thing to do, it is
the smart thing to do, as community-based treatment and prevention services cost
far less than putting and keeping a person behind bars. Bipartisan momentum
around criminal justice reform continues to grow in Congress and in states and
cities across the United States. Now is the time for policymakers at all levels to
put in place policies and practices that break the link between mass incarceration
and disability and ensure the appropriate treatment of people with disabilities
throughout the criminal justice system.

24  Center for American Progress  |  Disabled Behind Bars

About the author
Rebecca Vallas is the Managing Director of the Poverty to Prosperity Program

at the Center for American Progress. She began her anti-poverty career working
directly with low-income individuals and communities, with a focus on people
with disabilities and those with criminal records, as an attorney and policy advocate at Community Legal Services in Philadelphia. She was twice named one of
Forbes’ “30 Under 30” for law and policy.

The author wishes to thank Rebecca Cokley, Jennifer Mathis, T. L. Lewis, Dara
Baldwin, Nicole Jorwic, Rachel West, Shawn Fremstad, and Todd Cox for helpful comments and suggestions; Ashley Blackwell, Eliza Schultz, Jackie Odum,
and Rachel Berger for invaluable research assistance; and Lauren Vicary for her
exceedingly helpful editing.

25  Center for American Progress  |  Disabled Behind Bars

	 1	 Throughout this report, the terms disability and
disabilities refer to people with all types of physical,
sensory, cognitive, emotional, or psychiatric disabilities,
including people with mental health conditions. The
Americans with Disabilities Act defines disability broadly to include individuals who either 1) have a physical
or mental impairment that substantially limits one or
more major life activities, 2) have a history or record of
such an impairment, or 3) who are perceived by others
as having such an impairment. “42 U.S.C. § 12101 : US
Code - Section 12102: Definition of disability,” available
	 2	 William H. Fisher, Jeffrey L. Geller, and John A. Pandiani,
“The Changing Role of The State Psychiatric Hospital,”
Health Affairs 28 (3) (2009): 676–684, available at http://
	 3	 Wyman E. Fischer and Donald L. Barnes, Tackling the
Issues: Critical Thinking About Social Issues (Portland, ME:
J. Weston Walch, 1994).
	 4	 Dean Aufderheide, “Mental Illness in America’s Jails and
Prisons: Toward a Public Safety/Public Health Model,”
Health Affairs Blog, April 1, 2014, available at http://
	 5	 Jamie Fellner, “Callous and Cruel: Use of Force Against
Inmates With Mental Disabilities in US Jails and Prisons”
(New York: Human Rights Watch, 2015), available at
	 6	 The Bureau of Justice Statistics used data from the
2011–2012 National Inmate Survey and the 2012
American Communities Survey to compare the
incarcerated population with the nonincarcerated,
noninstitutionalized general population. In order to
ensure an apples-to-apples comparison, because the
demographic characteristics of the general population
are much different from those of the prison and jail
population, the study’s authors standardized the general population to the inmate population based on sex,
age, race, and Hispanic origin. As the authors explain:
“The standardized general population estimates for
disabilities can be interpreted as the estimate of disabilities among the general population, if the general
population had the same sex, age, race, and Hispanic
origin distribution as the prison and jail populations.”
Jennifer Bronson, Laura M. Maruschak, and Marcus
Berzofsky, “Disabilities Among Prison and Jail Inmates,
2011–2012” (Washington: Bureau of Justice Statistics,
2015), available at
pdf/dpji1112.pdf. Note: The statistics in this report are
based on self-report survey data, which carry obvious
limitations especially with respect to individuals with
mental health conditions, cognitive disabilities, etc.
	 7	 Ibid. Note: In this report, the Bureau of Justice Statistics
uses the term “cognitive disabilities” to describe conditions “affecting different types of mental tasks, such as
problem solving, reading comprehension, attention,
and remembering.” The authors note that cognitive disabilities are distinct from mental disorders, highlighting
schizophrenia, depression, and anxiety disorders as
examples of the latter.
	 8	 Lauren E. Glaze and Doris J. James, “Mental Health Problems of Prison and Jail Inmates” (Washington: Bureau
of Justice Statistics, 2006), available at http://www.bjs.

	 9	 Sarah Liebowitz and others, “A Way Forward: Diverting
People With Mental Illness Away From Inhumane and
Expensive Jails Into Community-Based Treatment That
Works” (Los Angeles: American Civil Liberties Union of
Southern California, 2014), available at https://www.
	 10	 David M. Perry and Lawrence Carter-Long, “The
Ruderman White Paper on Media Coverage of Law
Enforcement Use of Force and Disability: A Media Study
(2013–2015) and Overview” (Newton, MA: Ruderman
Family Foundation, 2016), available at http://www.
	11	 The Washington Post, “990 People Shot Dead By Police
in 2015,” available at https://www.washingtonpost.
com/graphics/national/police-shootings (last accessed
July 2016).
	 12	 See, for example, David M. Perry and Lawrence CarterLong, “How Misunderstanding of Disability Leads to
Police Violence,” The Atlantic, May 2, 2014, available at
	 13	 Lawrence O. Gostin, Cori Vanchieri, and Andrew Pope
(Eds.), Ethical Considerations for Research Involving
Prisoners (Washington: National Academies Press,
2007), available at
	 14	 Dean Aufderheide, “Mental Illness in America’s Jails
and Prisons”; see also Robert A. Barton and Roy W.
Wesley, “2015 Special Review: High Desert State Prison”
(Sacramento, CA: Office of the Inspector General, 2015),
available at
Reports/Reviews/2015_Special_Review_-_High_Desert_State_Prison.pdf; U.S. Department of Justice,
Findings Letter Re: Investigation of the State Correctional
Institution at Cresson and Notice of Expanded Investigation, May 31, 2013, available at
	 15	 Stuart Grassian, “Psychiatric Effects of Solitary
Confinement,” Washington University Journal of
Law & Policy 22 (325) (2006): 325–383, available at
cgi?article=1362&context=law_journal_law_policy; see
also Andrew Cohen, “An American Gulag: Descending
Into America’s Supermax,” The Atlantic, June 18, 2012,
available at
archive/2012/06/an-american-gulag-descending-intomadness-at-supermax/258323, describing a major class
action lawsuit challenging solitary confinement of inmates with mental health conditions at ADX-Florence, a
large Supermax prison near Florence, Colorado.
	 16	 Mark Berman, “Kalief Browder and What We Do and
Don’t Know About Solitary Confinement in the U.S.,”
The Washington Post, January 26, 2016, available at

26  Center for American Progress  |  Disabled Behind Bars

	 17	 For a discussion of the barriers to economic security
confronting many individuals with criminal records,
see Rebecca Vallas and Sharon Dietrich, “One Strike and
You’re Out: How We Can Eliminate Barriers to Economic
Security and Mobility for People With Criminal Records”
(Washington: Center for American Progress, 2014),
available at
criminal-justice/report/2014/12/02/102308/one-strikeand-youre-out. For a discussion of the barriers that
people with disabilities can face to economic security
and mobility, see Rebecca Vallas, Shawn Fremstad, and
Lisa Ekman, “A Fair Shot for Workers With Disabilities”
(Washington: Center for American Progress, 2015),
available at
	 18	 See Liebowitz and others, “A Way Forward.”
	 19	 David Cloud and Chelsea Davis, “First Do No Harm:
Advancing Public Health in Policing Practices” (New
York: VERA Institute of Justice, 2015), available at http://
	20	 Ibid.
	21	 Ibid.
	 22	 Theresa Vargas, “Grand Jury Rejects Criminal Charges
in Death of Robert Saylor, Man With Down Syndrome,”
The Washington Post, March 22, 2013, available at
	 23	 Sarah Wheaton, “For a Homeless Deaf Man, an iPad
Makes Life Easier,” The New York Times, January 10, 2013,
available at
	24	 Ibid.
	25	 Ibid.
	 26	 Matt Zapotosky, “A Deaf Man’s Jail Ordeal in Arlington: ‘I
felt stuck. I was stuck.’” The Washington Post, September
30, 2015, available at https://www.washingtonpost.
	 27	 Videophones are the preferred and primary method of
telecommunications used by deaf people who use sign
language as a first or only language. TTY devices are
inappropriate and ineffective for many deaf individuals—particularly prison and jail inmates, who read at a
first- to third-grade level on average. For the past five
years, HEARD has been spearheading the Deaf Prisoner
Phone Justice Campaign, urging the Federal Communications Commission to ensure access to appropriate
telecommunications for deaf inmates, including videophones, captioned telephones, and other auxiliary aids.
For more information on the campaign, see HEARD’s
Deaf Prisoner #PhoneJustice Campaign, available at (last accessed July 2016).
	28	 Ibid.
	 29	 Tammy Smith and others, “Individuals With Intellectual
and Developmental Disabilities in the Criminal Justice
System and Implications for Transition Planning,”
Education and Training in Developmental Disabilities 43 (4) (2008): 421–430, available at http://

	 30	 Jon Swaine and others, “Young Black Men Killed by
US Police at Highest Rate in Year of 1,134 Deaths,” The
Guardian, December 31, 2015, available at http://www.
	 31	 Christy Mallory, Amira Hasenbush, and Brad Sears,
“Discrimination and Harassment by Law Enforcement
Officers in the LGBT Community” (Los Angeles: The
Law Williams Institute, 2015), available at
	 32	 The “sequential intercept model” recommends that
people with disabilities be diverted as early in the
process as possible. See, for example, Mark R. Munetz
and Patricia A. Griffin, “Use of the Sequential Intercept
Model as an Approach to Decriminalization of People
With Serious Mental Illness,” Psychiatric Services 57(4)
(2006): 544–549, available at http://ps.psychiatryonline.
	 33	 See Liebowitz and others, “A Way Forward.”
	 34	 National Alliance on Mental Illness, “Law Enforcement
and Mental Health,” available at
(last accessed July 2016).
	35	 Ibid.
	 36	 See Liebowitz and others, “A Way Forward.”
	37	 Ibid.
	 38	 Kelly McEvers, “Its Mental Health Treatment System
Saves San Antonio Millions,” National Public Radio,
August 20, 2014, available at http://www.npr.
	39	 Ibid.
	40	 Ibid.
	 41	 See Liebowitz and others, “A Way Forward.”
	 42	 Fairmont Ventures, Inc., “Evaluation of Pathways to
Housing Philadelphia” (2011), available at http://c.
resource/resmgr/research_reports/pathways_to_housing_report_.pdf; see also Sam Tsemberis and Ronda F.
Eisenberg, “Pathways to Housing: Supported Housing
for Street-Dwelling Homeless Individuals With Psychiatric Disabilities,” Psychiatric Services 51 (4) (2000):
487–493, available at
doi/pdf/10.1176/ Other ACT programs
have shown similarly striking results, including
Chicago’s Threshold Justice Program, New York City’s
Nathaniel Project, and King County’s Forensic ACT
Program. See Liebowitz and others, “A Way Forward.”
	 43, “Information and Technical Assistance on the
Americans with Disabilities Act,” available at https:// (last accessed July 2016).
	44	 Ibid.
	45	 Ibid.
	 46	 Ibid.; see also 28 C.F.R. 35.160; National Center for
Access to Justice, The Justice Index 2016, “Disability Access: Support for People With Disabilities,” available at
(last accessed July 2016).
	 47	 The Justice Index 2016, “Disability Access: Support for
People with Disabilities,” available at http://justiceindex.
org/2016-findings/disability-access (last accessed July

27  Center for American Progress  |  Disabled Behind Bars

	 48	 National Center for Access to Justice, The Justice Index
2016, “Disability Access: Support for People With
Disabilities.” Distinct from the Sixth Amendment right
to counsel in criminal cases, Oregon and Washington
provide for appointment of counsel as a reasonable accommodation for litigants with disabilities in all types
of cases, including civil matters. See, for example, Oregon Department of Justice, General Counsel Division,
“Opinion Request OP-1998-7” (1998), available at http://
	 49	 National Center for Access to Justice, The Justice Index
2016, “Disability Access: Support for People With Disabilities.”
	 50	 Christopher Johnson, “Deaf Woman Sues City of Jamestown Over ‘Wrongful Arrest,’” The Grand Forks Herald,
June 16, 2016, available at
	 51	 LastWeekTonight, “Last Week Tonight With John
Oliver: Public Defenders,” YouTube, September
13, 2015, available at
watch?v=USkEzLuzmZ4. See also The Editorial Board,
“Federal Oversight on Public Defense,” The New York
Times, September 7, 2013, available at http://www.
	 52	 See, for example, DC Bar, Legal Beat 2013, “Groups
Seek More Access to Justice for Deaf, Hard-of-Hearing
Clients,” available at www.dcbar./org/bar-resources/
publications/washington-lawyer/articles/october2013-legal-beat-cfm (last accessed July 2016).
	 53	 The Americans with Disabilities Act applies to state prisons and local jails, and Section 504 of the Rehabilitation
Act applies to federal prisons and jails. Disability Rights
Legal Center, “Know Your Rights: Prisoner Accommodations,” available at https://disabilityrightslegalcenter.
(last accessed July 2016).
	 54	 Rachel Seevers, “Making Hard Time Harder: Programmatic Accommodations for Inmates with Disabilities
Under the Americans with Disabilities Act” (Seattle: The
Amplifying Voices of Inmates with Disabilities Prison
Project, 2016), available at
	55	 Ibid.
	 56	 Michelle Andrews, “Even in Prison, Health Care Often
Comes With a Copay,” National Public Radio, September
30, 2015, available at
	 57	 For a detailed discussion of these investigations and
lawsuits, and on nutrition behind bars more generally,
see Alysia Santo and Lisa Iaboni, “What’s in a Prison
Meal?” The Marshall Project, July 7, 2015, available at
	 58	 Human Rights Watch, “Callous and Cruel.”
	 59	 See, for example, Michael Winerip and Michael
Schwirtz, “Rikers: Where Mental Illness Meets Brutality
in Jail,” The New York Times, July 14, 2014, available at
	 60	 National Prison Rape Elimination Commission, “National
Prison Rape Elimination Commission Report” (2009),
available at

	 61	 U.S. Department of Justice, “Report and Recommendations Concerning the Use of Restrictive Housing” (2016),
available at
download; see also Seevers, “Making Hard Time Harder.”
	 62	 See Helping Educate to Advance the Rights of the
Deaf, “#DeafInPrison Campaign Fact Sheet,” available at
deafinprison%20fact%20sheet%20.pdf; Helping
Educate to Advance the Rights of the Deaf, “HEARD
Publishes Second Report on Abuse of Deaf Prisoners
in Florida,” 2014, available at http://www.behearddc.
James Ridgeway and Jean Casella, “Deaf Prisoners in
Florida Face Abuse and Solitary Confinement,” Solitary
Watch, May 21, 2013, available at http://solitarywatch.
com/2013/05/21/deaf-prisoners-in-florida-facebrutality-and-solitary-confinement. For HEARD’s
database of deaf individuals who are behind bars, see
Helping Educate to Advance the Rights of the Deaf,
“Prison Advocacy,” available at http://www.behearddc.
org/advocacy/prison-advocacy.html (last accessed July
	 63	 Jennifer Gonnerman, “Before the Law,” The New Yorker,
October 6, 2014, available at http://www.newyorker.
com/magazine/2014/10/06/before-the-law. See also
“Kalief Browder—Teen Imprisoned at Rikers Island for
Three Years Without Trial—Dies by Suicide,” VICE News,
June 8, 2015, available at
	64	 Ibid.
	65	 Ibid.
	66	 Ibid.
	 67	 Jennifer Gonnerman, “Kalief Browder, 1993–2015,” The
New Yorker, June 7, 2015, available at
	 68	 Brigit Katz, “Mother of Kalief Browder: The Judicial System is ‘the Reason My Son is Dead’,” The New York Times,
January 29, 2016, available at http://nytlive.nytimes.
	 69	 U.S. Department of Justice, “Report and Recommendations Concerning the Use of Restrictive Housing”; see
also Dean Aufderheide, “Mental Illness in America’s Jails
And Prisons.”
	 70	 Aylin Menduric, “UN Human Rights Experts (Again)
Push for Access to U.S. Prisons, Call for Solitary Reform,”
Solitary Watch, July 24, 2015, available at; see also UN News Centre, “Solitary
Confinement Should Be Banned in Most Cases, UN
Expert Says,” October 18, 2011, available at http://www.
	 71	 U.S. Department of Justice, “Report and Recommendations Concerning the Use of Restrictive Housing.”
	 72	 For a discussion of the requirement that an inmate exhaust administrative remedies in order to file a lawsuit
under the Prison Litigation Reform Act, see American
Civil Liberties Union, “Know Your Rights: The Prison
Litigation Reform Act” (2011), available at www.aclu.

28  Center for American Progress  |  Disabled Behind Bars

	 73	 8th 4.3e jobs report, disability unemployment rose
to 3x nat’ to him or her.he als with criminal records,
see ropriate treatment. A recent U.S. Supreme Court
ruling interpreting the Prison Litigation Reform Act
may begin to address some of these barriers. In June
2016, the Court held in Ross v. Blake that a prisoner
need only exhaust the administrative remedies that are
actually available to him or her. Full opinion available
at Ross v. Blake, No. 15-339,
	 74	 11th Judicial Circuit of Florida, “Criminal Mental Health
Project,” available at
scsingle.aspx?pid=285 (last accessed July 2016).
	75	 Ibid.
	76	 Ibid.
	77	 Ibid.
	 78	 John Buntin, “Miami’s Model for Decriminalizing Mental
Illness in America,” Governing, August 2015, available
	79	 Ibid.
	80	 Ibid.
	 81	 Some states provide inmates with a small sum of
money—sometimes referred to as “release funds”—
upon their release from prison. A review of state
policies found that, on average, release funds amount
to just $53, which is not enough to cover a full day of
living expenses if the individual needs temporary lodging. See Douglas Evans, The Debt Penalty: Exposing the
Financial Barriers to Offender Reintegration (New York:
John Jay College of Criminal Justice, 2014).
	 82	 Bureau of Labor Statistics, “The Employment Situation—June 2016,” Press release, July 8, 2016, available
	 83	 Michelle Yin, Dahlia Shaewitz, and Mahlet Megra, “An
Uneven Playing Field: The Lack of Equal Pay for People
With Disabilities,” (Washington: American Institutes
for Research, 2014), available at
	 84	 Vallas and Dietrich, “One Strike and You’re Out.”
	85	 Ibid.
	 86	 Office of Community Planning and Development, “The
2008 Annual Homeless Assessment Report to Congress”
(Washington: U.S. Department of Housing and Urban
Development, 2009).

	 90	 Importantly, guidance released in November 2015 by
HUD made clear that arrests without conviction may
not be considered evidence of “criminal activity” and
thus may not serve as the basis for denial of housing
or eviction in public housing. For a detailed discussion
of barriers to public housing for people with criminal
records, see Vallas and Dietrich, “One Strike and You’re
Out”; Rebecca Vallas and others, “Removing Barriers
to Opportunity for Parents With Criminal Records and
Their Children” (Washington: Center for American Progress, 2015), available at https://www.americanprogress.
	 91	 National Coalition to End Homelessness, “Changes
in the HUD Definition of ‘Homeless’” (n.d.), available
	 92	 For a detailed discussion of barriers to private housing
for people with criminal records, see Vallas and Dietrich,
“One Strike and You’re Out.” It should be noted that
additional HUD guidance released in April 2016 further
clarified how criminal records may be considered by
private landlords and home sellers in renting and selling housing.
	 93	 See Vallas and Dietrich, “One Strike and You’re Out”; see
also Dazara Ware and Deborah Dennis, “Best Practices
for Increasing Access to SSI/SSDI Upon Exiting Criminal
Justice Settings” (Washington: Substance Abuse and
Mental Health Services Administration, 2013), available
	 94	 Alexandra Gates, Samantha Artiga, and Robin Rudowitz, “Health Coverage and Care for the Adult CriminalJustice Involved Population” (Washington: The Henry J.
Kaiser Family Foundation, 2014), available at http://kff.
	 95	 For example, for individuals with intellectual or developmental disabilities, successful reentry can require
access to community providers who can provide
Medicaid-funded long-term services and supports,
including somewhere to live, employment services, and
any other services that the individual requires.
	 96	 For a more detailed discussion of pre-release applications for benefits, see Vallas and Dietrich, “One Strike
and You’re Out”; see also Judge David L. Bazelon Center
for Mental Health Law, “Making the Connection: Meeting Requirements to Enroll People With Mental Illnesses
in Healthcare Coverage” (2014), available at http://

	 87	 Technical Assistance Collaborative, “The Hidden Housing Crisis: Worst Case Housing Needs Among Adults
With Disabilities” (2008), available at http://www.

	 97	 Ware and Dennis, “Best Practices for Increasing Access
to SSI/SSDI Upon Exiting Criminal Justice Settings.”

	 88	 Vallas and Dietrich, “One Strike and You’re Out.”

	 99	 Ware and Dennis, “Best Practices for Increasing Access
to SSI/SSDI Upon Exiting Criminal Justice Settings.”

	 89	 Twenty percent of inmates with mental illness
were homeless in the months prior to incarceration
compared with just 10 percent of the general prison
population. Stephen Metraux and Dennis P. Culhane,
“Homeless Shelter Use and Reincarceration Following
Prison Release: Assessing the Risk,” Criminology & Public
Policy 3 (2) (2004): 201–22.

	 98	 Ibid.; see also Judge David L. Bazelon Center for Mental
Health Law, “Making the Connection.”

29  Center for American Progress  |  Disabled Behind Bars

	100	For the letter to state Medicaid directors, see Letter from
Glenn Stanton to State Medicaid Directors, “Ending
Chronic Homelessness,” May 25, 2004, available at https:// For more information on how states
can leverage suspension of Medicaid for inmates, see
Council of State Governments Justice Center, “Medicaid
and Financing Health Care for Individuals Involved With
the Criminal Justice System” (2013), available at http://
	101	Council of State Governments Justice Center, “Medicaid
and Financing Health Care for Individuals Involved With
the Criminal Justice System.”
	102	 Wakefield v. Thompson, 177 F.3d 1160, 1164 (9th Cir.
1999); see also Judge David L. Bazelon Center for
Mental Health Law, “For People With Serious Mental
Illnesses: Finding the Key to Successful Transition From
Jail or Prison to the Community.”
	103	 Brad H. v. City of New York, 185 Misc.2d 420, 431 (N.Y.
Sup. Ct. 2000), a’d, 276 A.D.2d 440 (N.Y. App. Div. 2000);
see also Judge David L. Bazelon Center for Mental
Health Law, “For People With Serious Mental Illnesses.”
	104	For more information on the Federal Interagency
Reentry Council, see Council of State Governments
Justice Center, “Federal Interagency Reentry Council,”
available at
firc (last accessed July 2016). The Reentry Council was
made permanent via executive order in April 2016. See
The White House, “Presidential Memorandum—Promoting Rehabilitation and Reintegration of Formerly
Incarcerated Individuals,” Press release, April 29, 2016,
available at

	105	See, e.g., Michael L. Perlin, A Prescription for Dignity:
Rethinking Criminal Justice and Mental Disability (New
York: Ashgate, 2013). This would enable designated attorneys to build up the expertise required to represent
people with disabilities effectively and could increase
the amount of time they have available to spend on
each case.
	106	The U.S. Supreme Court’s ruling in Ross v. Blake also
offers an opportunity to reexamine inmates’ access to
legal recourse under the Prison Litigation Reform Act.
	107	See Vallas and Dietrich, “One Strike and You’re Out”
for a comprehensive roadmap of these policies. See
also Vallas and others, “Removing Barriers to Opportunity for Parents with Criminal Records and Their
Children: A Two-Generation Approach” (Washington:
Center for American Progress, 2015), available at
	108	The White House, “Fact Sheet: Launching the Data-Driven Justice Initiative: Disrupting the Cycle of Incarceration,” Press release, June 30, 2016, available at https://

30  Center for American Progress  |  Disabled Behind Bars

Our Mission

Our Values

Our Approach

The Center for American
Progress is an independent,
nonpartisan policy institute
that is dedicated to improving
the lives of all Americans,
through bold, progressive
ideas, as well as strong
leadership and concerted
action. Our aim is not just to
change the conversation, but
to change the country.

As progressives, we believe
America should be a land of
boundless opportunity, where
people can climb the ladder
of economic mobility. We
believe we owe it to future
generations to protect the
planet and promote peace
and shared global prosperity.

We develop new policy ideas,
challenge the media to cover
the issues that truly matter,
and shape the national debate.
With policy teams in major
issue areas, American Progress
can think creatively at the
cross-section of traditional
boundaries to develop ideas
for policymakers that lead to
real change. By employing an
extensive communications
and outreach effort that we
adapt to a rapidly changing
media landscape, we move
our ideas aggressively in the
national policy debate.

And we believe an effective
government can earn the
trust of the American people,
champion the common
good over narrow self-interest,
and harness the strength of
our diversity.

1333 H STREET, NW, 10TH FLOOR, WASHINGTON, DC 20005  •  TEL: 202-682-1611  •  FAX: 202-682-1867  •  WWW.AMERICANPROGRESS.ORG