Jails and Prisons

Juxtaposed with approximately 36,000 individuals with severe mental illnesses in our nation's network of state hospitals, on any given day best estimates suggest there are over 100,000 people with mental illnesses in jails, over 250,000 in prisons, and over 1 million on probation and/or parole arrangements [1-3]. With over 31% of women in jail and 15% of men in jail identified as having mental illnesses [3] and 24% and 16% of those women and men, respectively, identified as having mental illnesses [2], it is clear the criminal justice system has become a de facto provider of care for this vulnerable population. Much has been written about the high rates of chronic health conditions and reduced life expectancies among those with mental illnesses [4-6], such as cancer, diabetes, and heart disease [7, 8], which are exacerbated by high rates of tobacco use and co-occurring substance use [9, 10] as well as the fact that physical health needs of persons with mental illnesses in the community routinely go unmet [11]. To exacerbate matters for the criminal justice system, justice-involved people with mental illnesses are more likely to have more health problems compared to those who are not justice-involved [12] and there is evidence that individuals with mental illness, in general, are more likely to be homeless and have greater psychological disability and trauma [13]. Thus, jails and prisons are called upon to be custodians of health for individuals with mental illnesses who have complex and costly co-occurring physical health and behavioral health…