Where Have All the Clients Gone? To Jails and Prisons. When Will We Ever Learn?

More than 10 million people are imprisoned worldwide.  Although the total number with serious mental illness (SMI) is unknown, in the United States about 804,000 people with SMI are jailed each year and 72% of this population have a co-occurring substance use disorder (Steadman, Osher, Robbins, Case, & Smith, 2009; Osterweil, 2011).  Ten times more mentally ill Americans are in prisons and jails than in state hospitals.  In 2012 as estimated 356,268 inmates with SMI were in prisons and jails and only 35,000 SMI were in state psychiatric hospitals (Lewis, 2014).  A substantial portion of the prison population is not receiving treatment for mental health issues.  This lack of treatment has the potential for affecting both recidivism and health care costs after release from prison (Gonzalez & Connell, 2014).  The suicide rate in prisons is almost 15 times higher than in the general population (The National Service Framework for Mental Health, 2004).  Depression was the most prevalent mental health condition as reported by 20% of inmates, followed by mania, anxiety, and PTSD.  Studies have found that former offenders diagnosed with a mental condition have a 70% risk for return to prison compared with an approximate 50% return rate for those without a mental condition (University of Texas Health Science Center at Houston, 2015).  The ultimate solution is to (1) maintain a functioning public mental health treatment system so that mentally ill persons do not end up in prisons and jails; (2) implement and promote jail diversion programs; and (3) provide appropriate evidence-based treatment for prison and jail inmates with serious mental illness (Torrey, 2014; Human Rights Watch, 2009). 

In conclusion, it is imperative to provide adequate care and support for all individuals to reduce criminal activity that leads to incarceration and to provide that same care and support upon release from jails and prisons in order to reduce the repetitive, self-defeating cycle of recidivism.  This is the right and cost saving thing to do.  This offering presents the evidence-based practices
that help to address this ongoing problem.

Professional Mission:  Poverty, inequality, and lack of education contribute significantly to the worldwide problem of incarceration of the mentally ill.  Nurses, as the largest element of health care providers in the world, must join together with other health care professionals, mental health advocates, and legislators to advocate for reform of the system for mental health care delivery for all.