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Mentally ill people are overrepresented in United States jail and prison populations relative to the general population. A 2010 study drawing from sources such as the Bureau of Justice Statistics concluded that there were three times more seriously mentally ill persons in jails and prisons than in hospitals in the United States. The exact cause of this overrepresentation is disputed by scholars; proposed causes include the deinstitutionalization of mentally ill individuals in the mid-twentieth century  and the criminalization of mental illness itself. The majority of prisons in the United States employ a psychiatrist and a psychologist.

Prevalence
There is broad scholarly consensus that mentally ill individuals are overrepresented within the United States jail and prison populations. In the 2010 study titled “More mentally ill persons are in jails and prisons than hospitals: a survey of the states,” researchers concluded that, based on statistics from sources including the Bureau of Justice Statistics and the U.S. Department of Health and Human Services, there are currently three times more seriously mentally ill persons in jails and prisons than in hospitals in the United States, with the ratio being nearly ten to one in Arizona and Nevada. “Serious mental illness” is defined here as schizophrenia, bipolar disorder or major depression. Further, they found that sixteen percent of the jail and prison population in the U. S. has a serious mental illness (compared to 6.4 percent in 1983), although this statistic does not reflect differences among individual states. For example, in North Dakota they found that a person with a serious mental illness is equally likely to be in prison or a jail versus hospital, whereas in states such as Arizona, Nevada and Texas, the imbalance is much more severe. Finally, they noted that a 1991 survey through the National Alliance for the Mentally Ill concluded that jail and/or prison is part of the life experience of forty percent of mentally ill individuals.

A separate research study titled “The Prevalence of Mental Illness among Inmates in a Rural State” noted that national statistics like those previously mentioned actually primarily pull from data from urban jails and prisons. In order to investigate possible differences in rural areas, researchers interviewed a random sample of inmates in both jails and prisons in a rural Northeastern state. They found that in this rural setting, there was little evidence of high rates of mental illness within jails, “suggesting the criminalization of mental illness may not be as evident in rural settings as urban areas." However, high rates of serious mental illness were found among the rural prison inmates.

Finally, differences in categorizing mental illness can lead to differing statistics. The 2005 special report issued by the Bureau of Justice titled “Mental Health Problems of Prison and Jail Inmates” used personal interviews of jail and prison inmates to determine either a recent history or symptoms of a mental health problem. In doing so they found that over half of state prisoners, forty-five percent of federal prisoners, and nearly two-thirds of jail inmates had a mental health problem. Female inmates were found to have much higher rates of mental health problems than male inmates. White inmates and inmates under twenty-four years of age also had mental health problems at higher rates.

Deinstitutionalization
Researchers commonly cite deinstitutionalization, or the emptying of state mental hospitals in the mid-twentieth century, as a direct cause of the rise of mentally ill people in prisons. In the 2010 study “More mentally ill persons are in jails and prisons than hospitals: a survey of the states,” researchers noted, at least in part due to deinstitutionalization, it is increasingly difficult to find beds for mentally ill people who need hospitalization. Using data collected by the Department of Health and Human Services, they determined there was one psychiatric bed for every 3,000 Americans, compared to one for every 300 Americans in 1955. They also noted increased percentages of mentally ill people in prisons throughout the 1970s and 1980s and found a strong correlation between the amount of mentally ill persons in a state’s jails and prisons and how much money that state spends on mental health services. In the book Criminalizing the Seriously Mentally Ill: The Abuse of Jails As Mental Hospitals, researches note that while deinstitutionalization was carried out with good intentions, it was not accompanied with alternate avenues for mental health treatment for those with serious mental illnesses. According to the authors, Community Mental Health Centers focused their limited resources on individuals with less serious mental illnesses, federal training funds for mental health professionals resulted in lots more psychiatrists in wealthy areas but not in low-income areas, and a policy that made individuals eligible for federal programs and benefits only after they’d been discharged from state mental hospitals unintentionally incentivized discharging patients without follow-up.

In the article, “Assessing the Contribution of the Deinstitutionalization of the Mentally Ill to Growth in the U.S. Incarceration Rate” researches Steven Raphael and Michael A. Stoll seek to complicate the deinstitutionalization narrative by studying transinstitutionalization, or how many patients released from mental hospitals in the mid twentieth century ended up in jail or prison. Using U.S. census data collected between 1950-2000, they concluded that “those those most likely to be incarcerated as of the 2000 census experienced pronounced increases in overall institutionalization between 1950 and 2000 (with particularly large increases for black males). Thus, the impression created by aggregate trends is somewhat misleading, as the 1950 demographic composition of the mental hospital population differs considerably from the 2000 demographic composition of prison and jail inmates.” However, when estimating (using a panel data set) how many individuals incarcerated between 1980 and 2000 would have been institutionalized in years past, they found significant transinstitutionalization rates for all men and women, with largest rate for white men.

Criminalization
A related cause of the disproportionate amount of mentally ill people in prisons is criminalization of mental illness itself. In the 1984 study “Criminalizing mental disorder: The comparative arrest rate of the mentally ill,” researcher L. A. Teplin notes that in addition to a decline in federal support for mental illness resulting in more people being denied treatment, mentally ill people are often stereotyped as dangerous, making fear a factor in action taken against them. Bureaucratic and legal impediments to initiating mental health referrals means arrest can be easier, and in Teplin’s words, “Due to the lack of exclusionary criteria, the criminal justice system may have become the institution that cannot say no. Mentally ill people do indeed experience higher arrest rates than those without mental illness, but in order to investigate whether or not this was due to criminalization of mental illness, researchers observed police officers over a period of time. As a result, they concluded “within similar types of situations, persons exhibiting signs of mental disorder have a higher probability of being arrested than those who do not show such signs."

The authors of the book Criminalizing the Seriously Mentally Ill: The Abuse of Jails As Mental Hospitals claim that nationwide, 29% of jails will hold mentally ill individuals with no charges brought against them, sometimes as a means of ‘holding’ them when psychiatric hospitals are very far away. This practice occurs even in states where it is explicitly forbidden. Beyond that, the vast majority of people with mental illnesses in jails in prisons are held on minor charges like theft, disorderly conduct, alcohol/drug related chartges, and trespassing. These are sometimes “mercy bookings” intended to get the homeless mentally ill off the street, a warm meal, etc. Family members have reported being encouraged by mental health professionals or police to get their loved ones arrested as a means of getting them treatment. Finally, some mentally ill people are in jails and prisons on serious charges, such as murder. The authors of Criminalizing the Seriously Mentally Ill claim many such crimes wouldn’t have been committed if the individuals had been receiving proper care.

Mental health care in prisons and jails
A 2011 survey of 230 correctional mental health service providers from 165 state correctional facilities found that 83% of facilities employed at least one psychologist and 81% employed at least one psychiatrist. The study also found that 52 % of mentally ill offenders voluntarily received mental health services, 24% were referred by staff, and 11% were mandated by a court to receive services. Although 64% of providers of mental health services reported feeling supported by prison administration, 71% were involved in continuity of care after release from prison, 65% reported being dissatisfied with funding. Only 16% of participants reported offering vocational training, and the researchers noted that although risk/need/responsivity theory has been shown to reduce the risk for recidivism (or committing another crime after being released), it is unknown whether it is incorporated into mental health services in prisons and jails. A 2005 article by researcher Terry A. Kupers noted that male prisoners tend to underreport emotional problems and don’t request help until a crisis, and that prison fosters an environment of toxic masculinity, which increases resistance to psychotherapy. A 2000 report from the Bureau of Justice Statistics noted that “70% of facilities housing state prison inmates screen inmates at intake, 65% conduct psychiatric assessments; 51% provide 24-hour mental health care; 71% provide therapy/counseling by trained mental health professionals; 73% distribute psychotropic medications to their inmates; and 66% help released inmates obtain community mental health services. One in every 8 State prisoners was receiving some mental health therapy or counseling services at midyear 2000. Nearly 10% were receiving psychotropic medications." Finally, the book Criminalizing the Seriously Mentally Ill: The Abuse of Jails As Mental Hospitals points out that 20% of jails have no mental health resources, small jails are less likely to have access to mental health resources and are more likely to hold individuals with mental illnesses without charges brought against them, that jails in richer areas are more likely to have access to mental health resources, and that jails with more access to mental health resources also dealt less with medication refusal.