BACKGROUND
In 44 states, a jail or prison holds more mentally ill individuals than the largest remaining state psychiatric hospital; in every county in the United States with both a county jail and a county psychiatric facility, more seriously mentally ill individuals are incarcerated than hospitalized. A 2004–2005 survey found there were “more than three times more seriously mentally ill persons in jails and prisons than in hospitals.”
SMI IN JAILS
A 2009 study based on inmate interviews conducted in Maryland and New York jails found that, within the month previous to the survey, 16.7% of the inmates (14.5% of males and 31% of females) had symptoms of a serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder, major depression or brief psychotic disorder). However, 31% of the inmates who were asked to participate in the study refused, a subset that almost certainly included many individuals with paranoid schizophrenia. The interviews were conducted between 2002 and 2006. Given the continued growth of mental illness in the criminal justice system since that time and the high rate of refusers in the survey, it is reasonable to estimate that approximately 20% of jail inmates today have a serious mental illness.
SMI IN STATE PRISONS
The US Department of Justice (DOJ) in 2006 found that “an estimated 10% of state prisoners . . . reported symptoms that met criteria for a psychotic disorder.” Given the continued growth of mental illness in the criminal justice system since the DOJ data was collected in 2004, a prevalence rate of 15% would appear to be conservative at this time.
SMI POPULATION ESTIMATES
In 2014, there were 744,600 inmates in county and city jails in the United States. If 20% of these individuals had a serious mental illness, jail inmates with severe psychiatric disease in US jails numbered approximately 149,000 that year. The number has grown since then.
In 2014, there were 1,561,500 inmates in state prisons. If 15% of them had a serious mental illness, state prison inmates with severe psychiatric disease numbered approximately 234,200 that year. The number has grown since then.
Combining the estimated populations of jail and state prison inmates with serious mental illness produces an estimated population of 383,200 affected inmates. Since there are only approximately 38,000 individuals with serious mental illness remaining in state mental hospitals, this means 10 times more individuals with serious mental illness are in jails and state prisons than in the remaining state mental hospitals.
MENTAL ILLNESS BEHIND BARS
Mentally ill inmates remain in jail longer than other inmates.
In Florida’s Orange County Jail, the average stay for all inmates is 26 days; for mentally ill inmates, it is 51 days. In New York’s Riker’s Island, the average stay for all inmates is 42 days; for mentally ill inmates, it is 215 days.
The main reason mentally ill inmates are incarcerated longer than other prisoners is that many find it difficult to understand and follow jail and prison rules. In one study, jail inmates were twice as likely (19% versus 9%) to be charged with facility rule violations. In another study, in Washington state prisons, mentally ill inmates accounted for 41% of infractions even though they constituted only 19% of the prison population.
Additionally, pretrial inmates with serious mental illness experience longer incarcerations than other inmates in many states if they require an evaluation or restoration of competency to stand trial. A survey of state hospital officials in 2015 found that 78% of the 40 responding states were wait-listing pretrial inmates for hospital services. The waits were “in the 30-day range” in most states, but three states reported forensic bed waits of six months to one year. Mentally ill inmates in some states are reported to spend more time waiting for competency restoration so they can be tried than they would spend behind bars convicted of the offense for which they have been charged.
Incarcerating mentally ill inmates is costly.
Mentally ill inmates cost more than other prisoners for a variety of reasons, including increased staffing needs. In Broward County, Florida in 2007, it cost $80 a day to house a regular inmate but $130 a day for an inmate with mental illness. In Texas prisons in 2003, a study reports, “the average prisoner costs the state about $22,000 a year,” but “prisoners with mental illness range from $30,000 to $50,000 a year.” Psychiatric medications are a significant part of the increased costs. The cost of settling or losing lawsuits stemming from the treatment of mentally ill inmates also can add to the costs.
