[8][9] The majority of prisons in the United States attempt to employ a mental health providers,[10] however, there is a severe shortage of staff to fill these vacancies and it is difficult to retain employees.
[16] A separate research study, The Prevalence of Mental Illness among Inmates in a Rural State, noted that national statistics like those previously mentioned primarily pull data from urban jails and prisons.
The AMA Journal of Ethics discusses more specific factors contributing to the consistently high arrest rates of those with severe mental illness within certain communities, stating that the arrests of drug offenders, a lack of affordable housing, and a significant lack of funding for community treatments are the main contributors.
[27] With the introduction of Medicaid, many state-run mental health facilities closed due to a shared responsibility for funding with the federal government.
Eventually, states would close a good portion of their facilities so that mentally ill patients could be treated at hospitals where they would be partially covered by Medicaid and the government.
Bureaucratic and legal impediments to initiating mental health referrals mean arrest can be easier, and in Taplin's words, "Due to the lack of exclusionary criteria, the criminal justice system may have become the institution that cannot say no.
[44] Only 16% of participants reported offering vocational training,[45] and the researchers noted that although risk/need/responsiveness theory has been shown to reduce the risk of recidivism (or committing another crime after being released), it is unknown whether it is incorporated into mental health services in prisons and jails.
[51] A 1991 study by L. Feder noted that although mentally ill offenders were significantly less likely to receive support from family and friends upon release from prison,[52] they were actually less likely to be revoked on parole.
[53] A research paper published in 2020 by M. Georgiou remarked that having a well-defined consultation process for mental health services will allow for effective care.
Researchers J. Metzner and J. Fellner note that mentally ill offenders in solitary confinement "all too frequently" require crisis care or psychiatric hospitalization and that "many simply won't get better as long as they are isolated.
"[4] Researchers T. L. Hafemeister and J. George note that mentally ill offenders in isolation are at higher risk for psychiatric injury, self-harm, and suicide.
[60] A 2014 study that analyzed data from medical records in the New York City jail system[61] found that while self-harm was significantly correlated with having a serious mental illness regardless of whether or not an inmate was in solitary confinement, inmates with serious mental illness in solitary confinement under 18 years of age accounted for the majority of acts of self-harm studied.
[62] When brought before federal courts, judges have prohibited or curtailed this practice,[4] and many organizations that deal with human rights, including the United Nations, have condemned it.
For example, in 2006, researchers G. D. Glancy and E. L. Murray conducted a literature review in which they claimed that many frequently-cited studies have methodological concerns, including researcher bias, the use of "volunteer Non prisoners, naturalistic experiments, or case reports, case series, and anecdotes", and concluded "there is little evidence to suggest the majority...kept in SC...experience negative mental health effects.
[28] Without the presence of these facilities within communities, mentally ill individuals would carry on with no preventative treatment or care to keep the severity of their condition at a healthy level.
Statistics show that about 83% of jail inmates did not have access to needed treatment within their community before their incarceration, and so some people end up getting re-arrested as a way to return to some form of assistance.
[66] The Marshall Project has gathered data regarding those being treated in jail, and what they found was that the Federal Bureau of Prisons implicated a new policy to be initiated that was meant to improve the care for inmates with mental health issues.
[11] It is said that an institutional shift would be more effective in reducing the number of incarcerated people through the collaboration of multiple agencies, especially regarding the criminal justice system and the community.
[54] This collaboration between agencies deviates from the "self-perpetuating" system meant to incarcerate and process individuals administratively; therefore, it focuses closely on people with severe mental illness and ensures ongoing care within and out of prison to reduce recidivism.
One major area of legal concern is the emergency detention of the non-criminal mentally ill in jails while waiting for formal procedures for involuntary hospitalization.
[75] Several landmark Supreme Court cases, notably Estelle v. Gamble, have established the constitutional right of prison inmates to mental health treatment.
On the other hand, other cases, notably McGuckin v. Smith, used much stricter terms, and in 1993 researchers Henry J. Steadman and Joseph J. Cocozza commented that "serious medical need" had little definitional clarity.
[76] Langley v. Coughlin involved a prisoner "regularly isolated without proper screening or care" and clarified that a single, distinctive act is not necessary to constitute deliberate indifference but rather "if seriously ill inmates are consistently made to wait for care while their condition deteriorates, or if diagnoses are haphazard and records minimally adequate then, over time, the mental state of deliberate indifference may be attributed to those in charge.
[80] In contrast, in Breads v. Moehrle, the forcible injection of drugs in jail was not upheld because sufficient procedures were not taken to ensure "substantive determination of need".
[83] In the past, overall living and treatment conditions within US prisons were not up to par, which can be seen through the details and points made by the Coleman v. Brown case that went to trial in 1995.
Justice Alito at this time questioned whether the reduction solution was helpful when they could be looking into constructing additional prison medical and mental health facilities.
Staff injected him with haloperidol, an anti-psychotic drug, to treat him, but after some time they concluded that Rudd was not ill enough to receive proper, regular treatment and continued to categorize him as a level one inmate, meaning no significant mental health needs.
Mitchell, who had a history of substance abuse, was arrested on January 12, 2023, after a cousin asked authorities to check on his well-being for wandering through portals to heaven and hell at his home and suffering a nervous breakdown.
The lawsuit speculates that Mitchell was also taken to the prison kitchen "freezer" or similar freezing environment and left there for hours "because his body temperature was so low.
Previously in the 1990s, just about one-third of positions went unfilled for mental health staff, and it became increasingly impactful on inmates when the vacancy rates for psychiatrists reached 50% and up.