The United States prison population, including both federal and state prisons and county and city jails, was 2,162,400 inmates as of December 31, 2016.1 The percentage of jail and prison inmates assumed to be seriously mentally ill (as defined in various studies as schizophrenia, schizophrenia spectrum disorder, schizoaffective disorder, bipolar disorder, brief psychotic disorder, delusional disorder, and psychotic disorder, not otherwise specified) has generally been estimated at about 16%.2 Using these numbers (2,162,400 × 16%) yields an estimate of 345,984 incarcerated persons with serious mental illness (SMI) in jails, and state and federal prisons. The actual number may be somewhat higher or lower, depending on the accuracy of the percentage.
The figures noted above represent a substantial number of persons with SMI in correctional facilities. In a previous era, many more persons with SMI who came to the attention of law enforcement would have been hospitalized rather than arrested and incarcerated.3 The extent to which persons with SMI have been arrested has significantly impacted both the mental health and criminal justice systems. This phenomenon has been referred to as the “criminalization of the mentally ill.”
One of the major concerns in present-day psychiatry is that placement in the criminal justice system poses a number of important problems for and obstacles to the treatment and rehabilitation of persons with SMI.4,5 Even when quality psychiatric care is provided in jails and prisons, the inmate/patient still has been doubly stigmatized as both a person with mental illness and a criminal. Furthermore, correctional facilities have been established to mete out punishment and to protect society; their primary mission and goals are not to provide treatment. The correctional institution’s over-riding need to maintain order and security, as well as its mandate to implement society’s priorities of punishment and social control, greatly restricts the facility’s ability to establish a therapeutic milieu and provide all the necessary interventions to treat mental illness successfully.6
How can we explain these large numbers of people with SMI being arrested and falling under the jurisdiction of the criminal justice system? They come to the attention of law enforcement because they appear to have engaged in illegal behavior. It may well be that they have done so because their mental illness is not being treated adequately in the community. Some of the reasons for this are given in the following sections.