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It’s Time to Extend Mental Health Services to Incarcerated Individuals


Every year, roughly 2 million people with serious mental illness are arrested in the United States, and nearly half a million are incarcerated at any given time. Giving these inmates access to federally-funded mental health services shortly before their release would likely help reduce those staggering numbers.

This was a focal point of the discussion when I visited Capitol Hill on May 24 to participate in a congressional briefing titled: “Innovations and Challenges in Providing Mental Health Services to People in Prison and Those Reentering the Community.” I was joined on the panel by stakeholders on every side of this issue, including mental health professionals, advocates for the incarcerated, and correctional administrators.

Prisons and jails are ill-equipped to treat people with mental illness and substance use disorders, yet in many facilities across the nation, such as the Cook County (ILL.) Jail and the L.A. County Jail, they have become the leading public mental health facilities. The number of incarcerated individuals with serious mental illness is unsustainable for the correctional facilities that lack the resources and facilities to give them the treatment they need. Inmates with serious mental illness and substance use disorders tend to stay incarcerated longer, spend more time in solitary, and have higher recidivism rates than the general population, a problem that is compounded with low access to the high quality, evidence-based treatments they need during incarceration.

H.R. 4005, a bipartisan bill introduced by Rep. Paul Tonko (D-N.Y.), aims to address this problem by opening up federal Medicaid funds for health care services for incarcerated individuals in the 30-days before their release. Currently, federal Medicaid funds are not allowed to be spent on anyone who is incarcerated.

The ability to secure Medicaid coverage for these individuals before their release could give them a leg up and reduce their risk of relapse of mental health conditions or overdose while also lowering their risk of recidivism back into the criminal justice system. Legislation like H.R. 4005 could help, but there are many issues that still need to be addressed where the incarceration of people with mental illness and substance use disorders is concerned.

Psychiatrists are the most qualified physicians to handle the treatment of mental illness and substance use disorders, and yet we are underrepresented in correctional settings, where a typical ratio is just one psychiatrist to every 150 inmates. Health care costs for incarcerated people with serious mental illness are very high as well, with some states spending $33,000 per inmate per year.

The American Psychiatric Association (APA) has taken the lead in working with leaders in government and law enforcement to address the criminalization of mental illness by finding solutions that prioritize treatment and recovery rather than punishment and incarceration. We’ll continue to talk to lawmakers in Congress about the issues our patients face and address the gaps that exist in our communities that cause them to end up in jail rather than in treatment.

What APA is Doing for You

This blog post is part of an occasional series highlighting how APA advocates on your behalf to support the profession of psychiatry and put our interests before key policymakers.


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