Association for Public Policy Analysis & Management

Due to the deinstitutionalization of psychiatric care and institutionalization of mass incarceration, people with serious mental illness are vastly overrepresented within prisons and jails. People with serious mental illness have more difficulties navigating a correctional environment, and are more likely to accumulate infractions that lead to placement in restrictive housing, also known as segregation or solitary confinement. Mental health symptoms themselves may be treated as infractions—for example, several jurisdictions include self-harm among the behaviors punished by disciplinary restrictive housing. These realities have contributed to an established trend: mentally ill incarcerated people are placed in restrictive housing at disproportionally higher rates. This report presents extant research concerning the current treatment of people with serious mental illness in jails and prisons. Best practices for identifying and tracking serious mental illness are also reviewed. One state is used as a case study to illustrate problems with current treatment options. Mental health policy, administrative data, movement data, and focus group data from this state’s jails and prisons were analyzed to examine connections between serious mental illness and placement in restrictive housing. The state correctional agency’s mental health screening and assessment tools were also reviewed. Findings from these analyses revealed that mental health policy was not being followed in some instances, including the placement of those with severe mental health needs in institutions with inadequate resources to provide treatment. Additionally, segregation is being used as a response to suicide attempts and self-harm. Recommendations made are the following: that the state Department of Corrections update its definition of serious mental illness, eliminate the use of segregation for people with serious mental illness, that self-harm is not classified as a disciplinary infraction, and that segregation is eliminated as a response to suicide attempts, self-harm, mental health watch, or suicide watch.