Isaac Baraki

To Treat or Not to Treat: The Issue of Mental Illness within the American Prison System

Should prisoners with mental illnesses receive more treatment than other prisoners depending on their offense(s) and mental state?

Fig 1. Prisoner sits alone in a prescription bottle: Knopf, Taylor. "Despite His Mental Illness, Devon Davis Spent 1,001 Days in Solitary at Central Prison." 30 May 2018.


Left untreated, mental ailments can become extremely harmful to the wellbeing of prisoners, as well as others around them.

Fig 2. Graph of mental illness in prisoners: Becker-Cohen, Miriam, and Kim, KeDeuk. “The Revolving Door: Mental Illness, Incarceration, Inadequate Care, and Inadequate Evidence.” 13 May 2015.

Mental health issues have become much more prevalent in prisons and rapidly worsened over time.

Fig 3. Graph of mental illness in prisoners: Sawyer, Wendy. "New government report points to continuing mental health crisis in prisons and jails." 22 June 2017.


What are some important facts?

  • In 44 states, many prisons hold more mentally ill individuals than the largest state psychiatric hospital

  • Inmates and former inmates with mental health disorders were 70% more likely to return to prison (at least once) than those with no diagnosis

  • 40% of individuals with a severe mental illness will have spent some time in jail, prison, or community corrections

Will the issue see improvement in the near future? Why is this a problem in the first place?

  • Sadly, there has been little progress in protecting or improving inmates' mental health. The treatment of mentally ill inmates has worsened over time.

  • Widespread problems in prisons (excessive time spent in solitary confinement, ignoring prisoner abuse, lack of medical assistance) are more severe for prisoners with mental illnesses.

  • Given the track record of prisons and other branches of the criminal justice system, it’s unlikely that there will be significant improvement in the care of mentally ill prisoners.

  • You may be wondering, "What qualifies as a serious mental illness?" A serious mental illness is defined as a mental, behavioral, or emotional disorder that results in serious functional impairment, which can substantially interfere with someone's day-to-day life. Some examples include schizophrenia and severe bipolar disorder, as well as other psychotic disorders.

Problems in the criminal justice system and what could be done to minimize the issue:

Fig. 4. Man alone in his cell: Earley, Pete. "Mental Illness: Ten Times More in Prison Than State Hospitals - A National Scandal." 9 April 2014.

Interactions with law enforcement

  • Individuals going through mental health crises are more likely to encounter police than seek help.

  • In 2019, police fatally shot 1,017 people; 25% of the victims suffered from mental illness

  • If police receive de-escalation training more often, the number of violent interactions between law enforcement and mentally ill individuals will surely decrease

  • Crisis Intervention Team training, known as CIT, is a collaboration between police forces and local mental health services to focus on using less lethal and non-lethal forces, focusing more on de-escalation (taught in every state but WV)

Discrimination within prisons

  • Mentally ill prisoners have a noticeably higher suicide rate than other prisoners, possibly as a result of their poor treatment

  • Sadly, mental health is typically not a priority in prisons. It's far easier to spot physical problems than mental problems, especially due to the lack of trained medical professionals in prisons.

  • Increased mental health resources and services would benefit prisoners living with identified or unidentified mental issues.

Legal discrimination

  • Many accused mentally ill individuals haven’t actually committed violent crimes; they’re either serving time for minor offences or awaiting trials.

  • People with mental illness are 9x more likely to be incarcerated than hospitalized

  • Courts issue mentally ill individuals longer sentences and they have to wait longer for trials, while also being less likely to make parole.

Yes, mentally ill prisoners should receive more treatment because...

  • It’s basic human decency. Why would you not want to give aid to someone who is clearly struggling?

  • Lack of treatment and assistance negatively affects the individual and, inevitably, those around them. Giving suffering individuals relief and treatment is the ethical thing to do.

  • Leaving mental illnesses in untreated individuals greatly harms their wellbeing and will, more likely than not, be the cause of recidivism.

  • Many studies have found that mentally ill individuals are extremely likely to return to a prison or correctional facility. This is just one of the negative effects of subpar medical care in the criminal justice system for mentally-afflicted individuals.

Potential arguments from both sides: should individuals who live with mental illness in prisons and the legal system receive greater help?

Fig 5. Graph comparing mental illness in prisons vs. mental hospitals. Gratzer, David. "Reading of the Week: Mental Illness and Prisons." 23 October 2014.

No, mentally ill prisoners should not receive more treatment because...

  • It’s too expensive to treat them since they make up a large portion of the American prison population. The cost of providing aid is far too costly.

    • Between 20-25% of the entire U.S. prison population is made up of individuals with mental illnesses

    • In 2017, incarcerating people with serious mental illness cost the US Government $80 billion and the states $71 billion

  • Not all issues with these individuals are actually diagnosed.

  • Who says that they’ll actually accept treatment? Many mentally ill individuals refuse to seek medical assistance, so providing more for them would be pointless.

  • Prison officials need to focus on containing, restricting prisoners.



Who are the stakeholders?

    • A stakeholder is an individual, group of individuals, or an organization affected by the situation at hand

    • Courts (such as judges and lawyers) and mentally afflicted individuals awaiting court verdicts

    • Authority figures in prisoners such as wardens

    • The prisoners themselves

    • Law enforcement such as the police

What are the ethical principles involved?

  • Justice: equally providing individuals or groups with fairness while taking outside factors into consideration

  • Beneficence: the moral and ethical obligation to act for the benefit of others

  • Non-maleficence: the obligation to not inflict harm on others (the word literally meaning "do no evil")

Some other relevant questions to the topic

  • How can medical experts seek to better understand the underlying effects of untreated mental illness in prisons and everyday life?

  • Should non-adherent individuals be blocked from receiving future assistance?

  • Will the issue of malpractice become more prevalent, with the present lack of medical professionals in prisons specifically?

Presenter's Statement

In the midst of a global pandemic and a failing justice system, mental illness in the American criminal justice system has steadily worsened over time. Since 2012, most individuals being incarcerated suffer from more mental illness, including psychotic disorders and major mood disorders, than in the past. Individuals living with mental illness are constantly discriminated against in prisons and courts, which compounds their suffering. Many of these individuals have developed serious mental illnesses from traumatic events or unstable upbringings. While incarcerated, mentally ill individuals face a mountain of problems. The lack of medical help and resources leaves them feeling hopeless, and the abuse they suffer at the hands of guards and wardens only makes them feel more unsafe and distrustful of others. Suicide is also far more common among these individuals. Mental illness is the leading cause of death within all American prisons, accounting for over 30% of all deaths in the American prison system. The COVID-19 pandemic has amplified this dire issue within the prison system, leading to massive outbreaks and a rise in inmate deaths across the country. This environment is beyond awful for mentally ill prisoners, who have almost no one to reach out to for help. Despite their conditions, many forget that these people, as we are, and withholding assistance to them is cruel and inhumane. Progress needs to be made in getting mentally ill individuals the help they need and deserve, because it's just.

Annotated Bibliography

Aufderheide, Dean. “Mental Illness In America's Jails And Prisons: Toward A Public Safety/Public Health Model: Health Affairs Blog.” Health Affairs, 1 Apr. 2014, www.healthaffairs.org/do/10.1377/hblog20140401.038180/full/

  • Auferderheide delves into how the U.S. has an extremely high incarceration rate of 5% of the world population, but almost 25% of the planet's prisoners. Attention is brought to the alarming growth of incarcerated individuals with mental illnesses, as well as an increase in severe mental illnesses. The disturbing reality of the matter conveys the message to the reader pretty effectively and gives thorough background information.

Carroll, Heather. “Serious Mental Illness Prevalence in Jails and Prisons.” Treatment Advocacy Center, Sept. 2016, www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/3695

  • Carroll describes how serious mental illness has become such a big deal in prisons and jails that they're now being called "the new asylums," and there were nearly 10x the amount of incarcerated people with severe psychiatric diseases than patients in state hospitals. The article shows how bad the issue started to become several years ago from an unbiased but grim point of view.

“Ethics Within the Prison System.” Neupsy Key, 3 Dec. 2016, neupsykey.com/ethics-within-the-prison-system/.

  • Key writes about the large amount of ethical issues are addressed concerning the prison system, and states that ethics are quite high on the agenda. However, this doesn't seem to be the case in reality, where the article addresses the violations of ethical standards and responsibilities by authority figures in prisons. It sheds a lot of light onto what goes on in prisons and gave a clearer understanding of how these things happen there.

Herbst, Diane. “Mental Illness and Policing: What Is Mental Health Training and Why Do Police Need It?” Psycom.net - Mental Health Treatment Resource Since 1996, 2 Oct. 2020, www.psycom.net/police-mental-health-training.

  • Herbst examines the potential necessity for further mental health training for police officers. She uses the already-existing example of CIT, a program aiming to teach increased empathy for mentally afflicted persons. Herbst's use of an effective method that already exists greatly strengthens the case for seeking reform in the American criminal justice system concerning the mentally ill.

Ponte, Katherine. “The Many Forms of Mental Illness Discrimination.” NAMI, 11 May 2020, www.nami.org/Blogs/NAMI-Blog/March- 2020/The-Many-Forms-of-Mental-Illness-Discrimination.

  • Ponte highlights the lack of awareness around the issue of mental health in general, and reasons that others need to take action in order to see change. By covering existing obstacles for the mentally ill, Ponte offers realistic options to help in addition to potential solutions to the issue. Her reasoning and detailed analysis of the issue and solution makes it easy for the reader to gain new knowledge/

Reingle Gonzalez, Jennifer M, and Nadine M Connell. “Mental Health of Prisoners: Identifying Barriers to Mental Health Treatment and Medication Continuity.” American Journal of Public Health, American Public Health Association, Dec. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4232131/.

  • Gonzalez and Connell write about how mental health disorders among prisoners consistently exceed the rates of such disorders in the general population despite American correctional facilities being considered the largest provider of mental health services. Gonzalez and Connell also offer their criticisms of the American prison system through a presentation of alarming data.

Zezima, Carolyn. “Incarcerated with Mental Illness: How to Reduce the Number of People with Mental Health Issues in Prison.” Psycom.net - Mental Health Treatment Resource Since 1996, 12 Aug. 2020, www.psycom.net/how-to-reduce-mental-illness-in-prisons.

  • Zezima gives her take on how to reduce the growing number of mentally ill prisoners. She uses statistics to convey her idea of improving general prison conditions, such as "People with mental illness stay four to eight times longer in jail than someone without a mental illness for the exact same charge." Zezima's arguments help the reader formulate other possibilities while also giving statistics on the matter.


Image Sources

Becker-Cohen, Miriam, and KiDeuk Kim. “The Revolving Door: Mental Illness, Incarceration, Inadequate Care, and Inadequate Evidence.” Urban Institute, 13 May 2015, https://www.urban.org/urban-wire/revolving-door-mental-illness-incarceration-inadequate-care-and- inadequate-evidence

Gratzer, David. “Reading of the Week: Mental Illness and Prisons.” Dr. David Gratzer, 14 Mar. 2015, davidgratzer.com/uncategorized/reading- of-the-week-mental-illness-and-prisons/.

Earley, Pete. “Mental Illness: Ten Times More In Prison Than State Hospitals - A National Scandal.” Pete Earley, 9 Apr. 2014, www.peteearley.com/2014/04/08/mental-illness-ten-times-more-in-prison-than-state-hospitals-a-national-scandal/.

Knopf, Taylor. “Despite His Mental Illness, Devon Davis Spent 1,001 Days in Solitary at Central Prison.” INDY Week, 30 May 2018, indyweek.com/news/northcarolina/despite-mental-illness-devon-davis-spent-1-001-days-solitary-central-prison./.

Initiative, Prison Policy. “New Government Report Points to Continuing Mental Health Crisis in Prisons and Jails.” Prison Policy Initiative, 22 June 2017, www.prisonpolicy.org/blog/2017/06/22/mental_health/.