April 10, 2017

Jail or Treatment for Mental Illness: How the states stack up

For thousands of people with severe mental illness in the United States, jails have become their primary care provider. Many of these individuals would have once been served by state psychiatric hospitals, but drastic decreases to the patient capacity of these facilities has severely reduced access to inpatient care without corresponding increases in the availability of outpatient care options. For those who cannot obtain adequate care in time, jail has become the de facto hospital – a function it is ill equipped to serve.

The following graphics illustrate data collected by the Treatment Advocacy Center on the availability of inpatient psychiatric care, the number of individuals with severe mental illness in jail, and the effectiveness of criminal deterrence programs by state.

The source data is available through the Treatment Advocacy Center here.

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Diminishing treatment resources

As it stands, there are too few beds available to accommodate the number of individuals with severe mental illness in jails on any given day, let alone the larger population. Bed capacity in the United States has decreased since its peak in 1955 from 337 per 100,000 people to 11.7 in 2016, well below the recommended capacity of 40 to 60 beds per 100,000. Just to accommodate the current jail population, about 20 beds per 100,000 would be required, almost twice the current number. It would require almost four times as many to adequately serve the entire population.

Source: Treatment Advocacy Center, “Going, Going, Gone: Trends and Consequences of Eliminating State Psychiatric Beds,” 2016

Choropleth Map of USA: Psychiatric inpatient beds per capita change 2010 to 2016 -25 25 12.5 -12.5 0 Beds per capitagained / lost Changes in Psychiatric Inpatient BedAvailability per Capita from 2010 to 2016

Odds of receiving treatment vs. going to jail

As state hospitals have closed and contracted, jails have seen the share of inmates with severe mental illness balloon. A 2010 study by the Treatment Advocacy Center conservatively estimated that 16 percent of jail inmates suffered from severe mental illness and that 40 percent of individuals with severe mental illness had been in jail or prison at some point. These individuals are most often in jail as a result of minor offenses, often precipitated by their illness. However, the shortage of affordable care options for individuals with severe mental illness often means the first treatment many low-income individuals receive follows their arrest.

Source: Treatment Advocacy Center, “More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States,” 2010

Criminal diversion programs

Criminal diversion programs are critical to preventing individuals with mental illness from entering jail for minor crimes and guiding them towards treatment. In a 2013 survey of the states, the Treatment Advocacy Center evaluated criminal diversion programs in every state by looking at the availability of mental health courts and crisis intervention training for police.

Mental health courts focus on obtaining community-based treatment for defendants who have committed minor crimes rather than sending them to jail while crisis intervention teams of police are specially trained to interact with individuals experiencing psychiatric crises and divert persons with mental illness to appropriate resources rather than booking them into jail where possible.

Grades were assigned to states based on what percentage of the population lived in jurisdictions where these diversion programs were available.

Source: Treatment Advocacy Center: “Mental Health Diversion Practices A Survey of the States,” 2013

hexmap Criminal Diversion Gradesby State (hover for state information) 100% 100% of population servedby a mental health court of population served bycrisis intervention training Grades A+ A A- B+ B B- C+ C C- D F