Joe McKendry

Across the country, correctional facilities are struggling with the reality that they have become the nation’s de facto mental-health-care providers, although they are hopelessly ill-equipped for the job. In Michigan, for example, roughly half of all the people in county jails have a mental illness, and nearly a quarter of the people in state prisons do. Nearly half of the people executed nationwide from 2000 to 2015 had been diagnosed with a mental illness or substance-use disorder in their adult life. In 2010, about 30 percent of the people at New York’s Rikers Island jail had a mental illness; by 2017, the figure had risen to 43 percent.

The mental-health crisis is especially pronounced among women prisoners. One study by the U.S. Bureau of Justice Statistics found that 75 percent of the women incarcerated in both jails and prisons had a mental illness, compared with just over 60 and 55 percent of men, respectively. In Oklahoma’s largest women’s prison—where substance use (a common form of self-medication for people with mental illness) is a major driver of incarceration—90 percent of the prisoners are receiving some form of mental-health treatment. Paradoxically, for many of these women, getting locked up carries other consequences that make the symptoms of the mental illness—often the initial trigger of the substance use—worse. For example, it can mean losing, at least temporarily, custody of one’s children, a traumatizing event.

—Adapted from Insane: America’s Criminal Treatment of Mental Illness, by Alisa Roth, published by Basic Books


This article appears in the April 2018 print edition with the headline “Prisoners or Patients?”

We want to hear what you think. Submit a letter to the editor or write to letters@theatlantic.com.