APRIL

15, 2020

THE INCARCERATION OF THE MENTALLY ILL

AN ISSUE BRIEF

PRERNA RANGANATHAN


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The Problem: Wrongful Incarceration of the Mentally Ill

In today’s society, mental health conditions have been and continue to deteriorate, and the effects
of mental illness can be clearly seen. According to the U.S. Centers for Disease Control and
Prevention, in 2019, the suicide rates in America were at a peak since World War II. With 1.4
million attempts at suicide in 2017, there were 47,000 deaths as a result of suicide. Between
2000 and 2006, the suicide rate increased approximately 1% annually, followed by a 2% increase
per year on average from 2006 to 2016.1

On top of the general mental health situation worsening, many people with mental illnesses end
up in prison, which does not help to improve their states. In 2012, Darren Rainey, an inmate at
Florida’s Dade Correctional Facility, “was forced into a ‘special shower’ which hit a scalding
160 degrees after he had smeared feces in the cell of the mental-health unit,” and he was left “in
the scalding water for two hours,” after which “he was dead, his skin so red it looked as if he’d
been ‘boiled’ and peeling like ‘fruit roll-ups.’”2 Although this is a drastic example, mental health
is clearly not dealt with in the right way by sending people to prisons. Rainey was in the mental-
health unit, but when he acted out, the cruel punishment led to his death. People often end up in
jail because of mental illness, and then are not given proper treatment as inmates, hindering their
potential improvement. Action needs to be taken, starting from before they reach the stage where
they go to jails to the point when they are behind bars, to fix this broken system in which people
are sent to prisons instead of being given help for their mental health conditions.

People are not able to get the help they need in relation to their mental health, which leads to the
deterioration of their mental states. Some of these people end up in jails, where they continue to
receive minimal or no treatment. These conditions then lead to a cycle in which the people
continue to get tangled up in the criminal justice system, or ultimately, lead to their death, as
conveyed with Rainey’s story. Another example can be seen with Jason Echevarria, who was an
inmate at Rikers in 2012. After attempting to commit suicide, he was put in a “solitary mental-
health unit,” where he ate toxic detergent that he was given by an officer when sewage leaked
into his cell.3 Instead of taking into consideration his mental state, and giving him a chance to
recover, he was left in the cell until he was found dead. After imprisonment, the conditions that
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people face in jails are not beneficial towards their mental health, which is one aspect of their life
that needs attention.

Lack of Treatment Before Incarceration

Those already in need of assistance with their mental health are not able to get the treatment they
need in their normal lives. The Center for Workplace Mental Health found that only about a third
of the people who need help with their mental health and substance abuse are actually able to
receive this aid.4 From young children to adults, people of all ages struggle to find proper
treatment. As of 2017, over 70% of the youth with severe major depressive episodes, for
example, are unable to obtain the assistance they need.5 Students “under the category of
emotional disturbance” are then three times more likely to receive an out-of-school suspension
compared to students in the next highest category.6 Similar to sending people to prisons, giving
students out-of-school suspensions does not help them with their “emotional disturbance.”
Students are punished, but without proper aid, they are not be able to improve themselves to
avoid such consequences. This lack of treatment options then transitions into their adult life,
during which, once again, not everyone is able to receive help. The 2012 National Survey on
Drug Use and Health reported that “almost 40% of adults diagnosed with schizophrenia or
bipolar issues remained untreated in the previous year.”7 Even with a rise in insurance coverage,
57.2% of adults with any mental illness “did not receive any mental health treatment in 2012-
2013 and in 2016-2017.”8 The figure below displays similar percentages for youth and adult
treatment in the state of California
compared to the entire United
States.9 Without the proper care
throughout their lives, people end
up in jails, where they receive no
help again, and, in some cases, their
conditions are worsened.

Incarceration of the Mentally Ill

In comparison to the approximate 35,000 people in psychiatric institutions for mental health
treatment, more than 10 times that number were behind bars in 2012.10 By 2018, there were
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about 365,000 people with mental illnesses in jails, far more than the number of people in
hospitals.11 There is a clear need to rethink the system that is currently in place to treat these
people.

To even further demonstrate the extreme amount of people with mental illnesses in prisons, the
“largest single-facility provider of mental health services in the United States today” is
Chicago’s Cook County Jail instead
of any type of proper mental health
facility.12 Additionally, the two
maps represent the amount of
people in prisons versus psychiatric
facilities in 1955 and 2010,
respectively.13 When comparing the
maps, it can be seen that there has
been a drastic transfer of individuals
from psychiatric facilities to prisons
in this time frame, resulting in every
state having more people in prisons
by 2010. Approximately half of the
people in prisons have a mental
illness, and for women, the
percentage is about 75% in state
prisons.14

Even with such a large portion of people with mental illnesses, these prisons do not properly
treat mental health patients, as they “have recreated much of the same dysfunction that pervaded
the asylums of the 19th and 20th centuries…the very abuses we sought to end by shutting them
down,” suggests journalist Alisa Roth. She reveals that the goal to eradicate “the cruelty, the
filth, the bad food, or the brutality,” has not been achieved even with the removal of asylums as a
form of treatment, as prisons resemble the same concept.15 With this type of facility to treat those
who need help, inmates are not able to recover from their situations.
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Lack of Treatment During Incarceration

For some people, their lives in jail worsen their conditions, which can result in them spending
more time than most people in prison or going back to prison more than once. Roth claims that
“treatment is rare, if not nonexistent,” and even when therapy does happen, it is not under proper
circumstances, since “it typically involves administering meds and cell-side treatment, where
understaffed clinicians have to shout through cell doors or the food slot.”16 The founder of the
Fortune Society, David Rothenberg, who worked with previously incarcerated individuals for
almost 50 years, points out that a huge flaw in the structure of the prison system is that it does
not enable inmates to consider the cause of their imprisonment, whether it be addiction, crime,
etc., but instead, they are forced to continue their behavior and thinking in order to survive the
prison culture.17

With the questionable methods used to treat people with mental illnesses during confinement,
“the depersonalized nature of incarceration, including the use of solitary confinement as a
punishment, actually heightens (and sometimes creates) symptoms of serious mental illness,”
resulting in people facing longer sentences. For example, The Treatment Advocacy Center states
that the average time that inmates spend at Rikers is 42 days in comparison to the average 215
days for those with mental illnesses.18 With inmates being incarcerated for longer periods of
time, they deal with the dehumanized
culture of confinement for a larger
duration, which would only worsen
their mental state. As shown in the
graph, serious psychological distress
is experienced at a higher rate in
prisons and jails than in the general
public, with over a quarter of jail
inmates feeling its effects.19
Therefore, when they are released
from prison, they are more likely to
end up back in jail again. According to the National Institute of Justice, nearly two-thirds of
released prisoners are back in jail within three years, and more than 75% are arrested again
 5
within five years. Although this statistic is for the general population of people in prison, people
with a mental health issue are more likely to be in this category of people who are rearrested.20

Even with the lack of care for people with mental illnesses in prisons, and the need for more
mental health care facilities, money is wrongly going to prisons and jails instead of mental
health, leading to a cost to society. Over time, as
seen in the graph to the right, prisons and jails have
become more common for the institutionalization
of adults, with prisons and jails being almost equal
to the combined total.21 The amount of people
institutionalized was decreasing while mental
hospitals were the primary mode of
institutionalization, but when the switch was made
to prisons and jails around the 1980s, the graph
shows a clear rise in the total number of people.

Although $444 million are spent on mental health concerns per year in the United States, only a
third of that money is actually spent on treatment while the rest of that sum goes towards
disability payments and lost productivity.22 The president of Mental Health America, Paul
Gionfriddo, mentions that more money is
invested into the prison system even though
“[i]t’s a really bad idea to put the money into
jails because the people don’t belong there.”23
On top of wrongful usage of money, states
choose to cut funds for mental health services
and instead use the money for funding for jails
and prisons.24 Especially during tough economic
periods, mental health funds are one of the first
to be reduced. For example, following the 2008 recession, states made a $5 million budget cut in
the mental health sector in addition to removing 4,500 public psychiatric hospital beds, which is
supported by the graph above showing some states’ budget cuts between 2009 and 2011.25
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As stated by Dr. Prakash Masand, one of Duke University’s former consulting professors of
psychiatry and behavioral sciences as well as CEO of Global Medical Education, “We need to
reorganize and strengthen the infrastructure of the mental health field. We need more inpatient
psychiatric beds so that the mentally ill
are not housed in jails or the streets.”26
This is clearly not the case, which is
portrayed in the chart to the left, as the
number of psychiatric hospitals and
patients in the hospital has been
decreasing since the 1950s.27 There is not
enough emphasis on proper mental health
services and treatment to help those in
need improve their conditions.

This lack of treatment, which is replaced by confinement through the prison system, is costly to
society as well as to the mentally ill individuals. For instance, mental health conditions that are
not checked or treated can lead to violence, such as shootings like the one that occurred on May
31, 2019, in which “a disgruntled city employee killed 12 people at a municipal building in
Virginia Beach, Va.”28 The crime rates are higher as a result, meaning safety levels are lower.
Additionally, people spend tax money on the mental health sector, but with incarceration taking a
higher priority, the money is not used to its fullest potential. In comparison to the $12 billion
dollars that were spent on resources annually for state and federal prisons about 20 years ago, the
expenditure is now $60 billion, according to the Pew Center on the States.29 Similarly, a regular
inmate cost about $80 per day to house, while a mentally ill inmate cost the same prison $130 a
day in 2007.30 Furthermore, the children of those who are in prisons are immensely impacted, as
50 to 70 percent of them will struggle with their education, as well as become more physically
aggressive and mentally unstable.31 Societal costs could be avoided, while also helping the
mentally ill recover, by increasing the focus on mental health instead of criminalization.
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The Solution: Treatment Over Punishment

The overall solution to the criminalization and incarceration of the mentally ill is to shift the
focus from sending individuals to prison to assisting them in obtaining the help they need. There
are several different approaches that could work together to tackle the current problem, and they
revolve around the proper allocation of funds. As stated earlier, only a third of the $444 million
spent on mental health concerns is actually used for treatment.32 The problem with this is that
many people looking for mental health treatment are not able to receive any. Instead, they are
sent home with “bottles of rainbow-colored pills to treat their symptoms,” but this is not an
effective solution, as the mentally ill patients need proper therapeutic care to improve their
conditions.33 Although it might seem like such a solution will help save money, this is only the
case in the short-term, since the mentally ill never have the chance to truly improve, resulting in
the need to continue treating them. In reality, if measures are taken to increase mental health care
budgets as opposed to cutting them, America would save billions of dollars. People would have
better access to treatment, which would decrease the likelihood of them ending up in prisons. In
addition, it will give them the chance to recover to a great extent, if not completely, allowing the
individuals “to contribute to the economy by returning to work or by volunteering their time or
services.”34 In this way, it will not only help the individuals, but society will also benefit instead
of facing costs.

A better overall distribution of funds can be used to implement various methods to alleviate this
issue. The strategies range from starting at a young age to treating individuals in confinement. To
begin with, an early identification of mental health problems will help to start treatment earlier, if
proper care is available, which will lower the chances of conditions worsening and people being
incarcerated. Following the early identification, mental health care would be more accessible and
affordable than the current state. For those who still end up in prison, the treatment for mental
illnesses should be of higher priority than simply locking them up. All of these topics are
addressed in the 21st Century Cares Act (H.R. 34), which was passed in December 2016.35 More
funding towards this act would assist in providing the necessary mental health care before and
during incarceration.
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Early Identification of Mental Illness

Currently, mental illness is not adequately diagnosed early enough due to a lack of resources. For
example, only about 20% of bipolar disorder patients are diagnosed correctly, with an estimated
10 year period for the correct diagnosis for a third of patients.36 Without an attempt to prevent
worsening conditions in the future, children who experience mental health issues turn into adults
who have never had the chance to recover, leading to more adults in prisons. There needs to be
an emphasis on correctly detecting mental health issues in the early stages, and this is clearly not
happening right now.

The improvement of the detection of mental illnesses can be accomplished through better
training for mental health care. Massive open online courses are an option for improved training
in mental health care. The possible drawback of students in online courses not receiving the same
level of education as those in in-person classes is counteracted by the fact that they are able to
receive education from “the best teachers in the country” through these courses.37 Through this
method, there can be a larger number of workers in the mental health care industry, and they will
have better knowledge of patients’ needs with the training they acquire. If money was invested
into this concept, diagnostic accuracy will be greatly increased, helping to provide youth with an
earlier diagnosis than they are currently receiving. As stated in a Daily Progress article, “The
sooner a patient receives the correct diagnosis, and the quicker treatment is initiated, the better
the outcome.”38 Children can recover sooner from their conditions, preventing a worse situation
that lands them in jail in the future.

Accessibility and Affordability

Even if people are properly diagnosed with mental illnesses, they need to be able to receive
proper mental health care, but two barriers to that are its accessibility and affordability. Among
the youth who are diagnosed with a mental illness, only about 50% of them are receiving
treatment.39 The map on the next page shows that in any given state, over 25% of the children are
not receiving the care they need.40
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For the adult population with any mental illness, over half of them do not receive treatment, with
44.6% reporting in 2017 that they could not afford its costs even with more Americans having
some level of health insurance.41 The solution here would be to invest more into the mental
health sector of the economy to both increase the availability of care as well as reduce the cost
for patients. The budget can be used in multiple ways, such as better implementing mental health
care in the education system, increasing insurance coverage for mental health, and eliminating
the removal of necessary resources.

Schools should be given the proper funding to “be able to either employ providers in schools or
contract with community-based resources, and to coordinate the process of necessary care
delivery for students in need.”42 One in every five students show symptoms of mental illness, but
there is a lack of accessibility and affordability to take care of these students.43 For students in
IEPs for emotional disturbance (individualized education programs), schools need to have the
resources to be able to follow through with the programs. Under the Individuals with Disabilities
Education Act (IDEA), the federal government is supposed to give 40% of expenses for each
student to special education, but in 2017, the government only provided 14.6%.44 The
government needs to actually provide the promised percentage of expenditures for special
education so that schools can offer proper mental health care. This will help children in IEPs as
well as the general student population with special needs. With proper treatment at a younger
age, mental health situations can be prevented from deteriorating in the future.
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Outside of the school environment, too, people are not able to afford mental health treatment,
which can be detrimental to their condition. With people paying out of pocket and others not
having enough insurance coverage for mental health, these individuals seek treatment from
physicians who have only trained in psychiatry for 6 to 12 weeks during medical school. These
physicians actually take care of over 90% of psychiatric treatment.45 Patients often need care
from people who are more trained than this, but they are not able to afford it. Although a greater
number of people have health insurance, the amount of coverage for mental health that the
insurance provides is not sufficient.46 To fix this, the mental health portion of insurance coverage
needs to be increased. Through a rise in coverage, people can get the treatment they need, which
will result in lower rates of the mentally ill ending up in prisons.

As mentioned earlier in this report, budget cuts to mental health lead to resources, such as
psychiatric beds in hospitals, being taken away. If the budget was increased instead, this money
could be spent on expanding the number of resources. By using a greater amount of resources,
the United States can provide better accessibility of mental health care to the public, in addition
to making it more affordable. A psychiatrist with more than 40 years of experience, John Weir
Perry, found through his own practices that supporting a patient’s conditions rather than
suppressing them is the best way to improve their condition. An estimated 85% of his patients at
Diabasis, a crisis center, “improved without any medication and continued to improve after
leaving his facility.”47 This type of support was successful, because those people were correctly
diagnosed with a mental illness, and were able to access and afford the care they needed. Clearly,
if more people were able to detect their mental health problems early enough and receive the
treatment they need, they would be able to recover in a similar way to the patients at Diabasis.
For this to be possible, however, mental health care needs to be more accessible and affordable.
This strategy will keep more people out of jails by helping them recover before they reach the
point at which they are incarcerated, proving that confinement was never the right solution for
these individuals.

Mental Health Care in Prisons

For those who do still end up being criminalized and incarcerated, they do not get meaningful
support for their mental illnesses under the current system. With prison beds replacing
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psychiatric unit beds, it is important to provide inmates with the care that they need. Otherwise,
their conditions do not improve, and sometimes even get worse, resulting in their return to
prisons more than once. To provide the necessary mental health care, prisons should employ
trained mental health professionals beyond just providing brief evaluations.48 This will give
inmates an equal opportunity to recover and integrate into society again. If they feel comfortable
and better in society after leaving prisons, they will be less likely to return and can instead use
their skills to better society. This would not only reduce recidivism, but also lower the burden on
taxpayers.49 While this might not seem like the best solution, as prisons are not the place for
people who need help in the first place, it could be a catalyst to solving the problem. Until better
methods are developed to treat the mentally ill, prisons should look into treatment rather than
punishment to help the inmates, and society as a result. In the future, this could transition to
sending more people to proper mental health care facilities instead of prisons.

Stanley Richards, the senior vice president of the Fortune Society, a non-profit to help battle the
cycle of recidivism, revealed that in 2016, the organization “helped 40 people get their GEDs,
465 get jobs, and more than 300 find stable housing” after leaving prison. According to the
organization, “the work it does avoids 88,000 prison or jail days annually, saving the city and
state of New York $8 million a year.”50 These former inmates who go to this organization are
able to improve their mental states and create a life for themselves that does not result in their
return to jail. While this organization is only in New York, if this strategy of providing treatment
were to be implemented in prisons all over the nation, many more people could recover during
their incarceration, and would not even have to wait until after their release. This would prevent
their mental states from worsening during their confinement, as well as provide them with
assistance to improve themselves, reducing their chances of returning.

The Urgency: Action Through Funding

While the current system is “a moneymaking operation” that keeps shareholders happy, it is
more important to improve the state of mental health in the United States and reduce the number
of people that land in jails because of mental illnesses thay make money off of this operation.51
To improve mental health care, the three steps suggested in this report are summarized nicely in
the statement, “Invest early to protect kids and families, focus on treatment over punishment,
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[and] make mental health treatment affordable and accessible.”52 In order for these methods to be
implemented, federal and state governments need to allocate a greater amount of funds to mental
health care in the United States. The current structure does not provide enough support for
mental health, leading to many people getting involved with the criminal justice system. Once in
the system, they are unable to break the cycle of recidivism, as they do not have the proper
resources to aid their recovery against their mental health issues.

For their well-being, federal and state governments should team up and make an effort to provide
the mental health care sector with the funds it needs to improve the state of mental health in the
nation instead of cutting the budget. While the federal government can offer states the initial
support through grants and funding, it is up to each state’s government to properly use the
support they receive to provide for their people. As stated earlier, H.R. 34 has provisions that
clearly undertake the three methods given in the solution section of this report. Increasing
funding for this act will be an enormous step towards tackling the issue of the incarceration of
the mentally ill. Not only will it improve the people’s health, but society will also be better off,
as the crime levels will decrease, less money will be wasted in the long run, and the individuals
who might have originally been criminalized and incarcerated can now help the economy. In this
way, this solution could create societal benefits in addition to reducing societal costs. With the
current state of this situation in the United States, as well as its deterioration over time, there is a
clear need for federal and state governments to effectively work together and make changes to
the system and help the mentally ill improve before they end up in jail.
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Endnotes
1
Cynthia Koons, “Latest Suicide Data Show the Depth of U.S. Mental Health Crisis,”
Bloomberg Businessweek (June 2019), available at
https://www.bloomberg.com/news/articles/2019-06-20/latest-suicide-data-show-the-depth-of-u-
s-mental-health-crisis (last accessed April 14 2020).
2
Susannah Cahalan, “The Shocking Truth About America’s Mental Health Crisis,” New York
Post (July 2018), available at https://nypost.com/2018/07/07/the-shocking-truth-about-americas-
mental-health-crisis/ (last accessed April 14 2020).
3
Ibid.
4
Koons, “Latest Suicide Data Show the Depth of U.S. Mental Health Crisis.”
5
Maddy Reinert et al., “The State of Mental Health in America 2020,” Mental Health America
(2019): 11, available at
https://www.mhanational.org/sites/default/files/State%20of%20Mental%20Health%20in%20Am
erica%20-%202020.pdf.
6
Reinert et al., “The State of Mental Health in America 2020,” p. 13.
7
GoodTherapy Staff, “4 Big Ways We Can Change Mental Health Care in America,”
GoodTherapy (January 2015), available at https://www.goodtherapy.org/blog/4-big-ways-we-
can-change-mental-health-care-in-america-0127155 (last accessed April 14 2020).
8
Reinert et al., “The State of Mental Health in America 2020,” p. 11.
9
Catherine Teare and Robbin Gaines, “Many Californians Have Coverage, But Not Care, For
Mental Health Conditions,” California Health Care Foundation Blog (March 2018), available at
https://www.chcf.org/blog/many-californians-have-coverage-but-not-care-for-mental-health-
conditions/ (last accessed April 14 2020).
10
GoodTherapy Staff, “4 Big Ways We Can Change Mental Health Care in America.”
11
Cahalan, “The Shocking Truth About America’s Mental Health Crisis.”
12
GoodTherapy Staff, “4 Big Ways We Can Change Mental Health Care in America.”
13
German Lopez, “The Tragic Collapse of America’s Public Mental Health System, in One
Map,” Vox (March 2016), available at https://www.vox.com/2016/3/7/11173756/prisons-jails-
mental-health-map (last accessed April 14 2020).
14
Cahalan, “The Shocking Truth About America’s Mental Health Crisis.”
15
Ibid.
16
Ibid.
17
David Rothenberg, “A Vicious Cycle of Imprisonment,” The New York Times (June 2014),
available at https://www.nytimes.com/2014/06/02/opinion/a-vicious-cycle-of-imprisonment.html
(last accessed April 14 2020).
18
Cahalan, “The Shocking Truth About America’s Mental Health Crisis.”
19
Wendy Sawyer, “New Government Report Points to Continuing Mental Health Crisis in
Prisons and Jails,” Prison Policy Initiative (June 2017), available at
https://www.prisonpolicy.org/blog/2017/06/22/mental_health/ (last accessed April 14 2020).
20
Andrea King Collier, “How One Nonprofit Breaks the Cycle of Incarceration,” CityLab
(February 2017), available at https://www.citylab.com/life/2017/02/how-one-nonprofit-breaks-
the-cycle-of-incarceration/517296/ (last accessed April 14 2020).
21
Lopez, “The Tragic Collapse of America’s Public Mental Health System, in One Map.”
22
GoodTherapy Staff, “4 Big Ways We Can Change Mental Health Care in America.”
23
Koons, “Latest Suicide Data Show the Depth of U.S. Mental Health Crisis.”
 14

24
GoodTherapy Staff, “4 Big Ways We Can Change Mental Health Care in America.”
25
Ibid.
26
Prakash Masand, “Solutions to Mental Health in America,” The Daily Progress (March 2014),
available at https://www.dailyprogress.com/opinion/columns/solutions-to-mental-health-in-
america/article_f15dab4e-b6b1-11e3-9026-0017a43b2370.html (last accessed April 14 2020);
Sarah Kliff, “Seven Facts About America’s Mental Health-Care System,” The Washington Post
(December 2012), available at
https://www.washingtonpost.com/news/wonk/wp/2012/12/17/seven-facts-about-americas-
mental-health-care-system/ (last accessed April 14 2020).
27
Bosman, “U.S. Jails are Bursting with the Mentally Ill,” Right Speak (September 2013),
available at http://www.rightspeak.net/2013/09/us-jails-are-bursting-with-mentally-ill.html (last
accessed April 14 2020).
28
Koons, “Latest Suicide Data Show the Depth of U.S. Mental Health Crisis.”
29
Lorna Collier, “Incarceration Nation,” Monitor on Psychology 45 (9) (October 2014): 56,
available at https://www.apa.org/monitor/2014/10/incarceration.
30
Treatment Advocacy Center Office of Research and Public Affairs, “Serious Mental Illness
(SMI) Prevalence in Jails and Prisons,” (September 2016): 3, available at
https://www.treatmentadvocacycenter.org/storage/documents/backgrounders/smi-in-jails-and-
prisons.pdf.
31
Tom Silver, “Breaking Out of the Prison Cycle,” Harvard Political Review (May 2013),
available at http://harvardpolitics.com/united-states/breaking-out-of-the-prison-cycle/ (last
accessed April 3 2020).
32
GoodTherapy Staff, “4 Big Ways We Can Change Mental Health Care in America.”
33
Ibid.
34
Ibid.
35
American Psychiatric Association, “Mental Health Reform,” available at
https://www.psychiatry.org/psychiatrists/advocacy/federal-affairs/comprehensive-mental-health-
reform (last accessed April 14 2020).
36
Masand, “Solutions to Mental Health in America.”
37
Ibid.
38
Ibid.
39
Reinert et al., “The State of Mental Health in America 2020,” p. 38.
40
Daniel G. Whitney and Mark D. Peterson, “US National and State-Level Prevalence of Mental
Health Disorders and Disparities of Mental Health Care Use in Children,” JAMA Pediatrics 173
(4) (February 2019): 389-391, available at https://doi:10.1001/jamapediatrics.2018.5399.
41
Reinert et al., “The State of Mental Health in America 2020,” p. 11.
42
Reinert et al., “The State of Mental Health in America 2020,” p. 14.
43
Democratic Governors Association, “Improving Mental Health Care in the States:
Opportunities for Governors,” (June 2017): 6, available at
http://www.fightchronicdisease.org/sites/default/files/DGA%20Behavioral%20Health%20White
%20Paper%20-%20FINAL%20%286.13.17%29.pdf.
44
Reinert et al., “The State of Mental Health in America 2020,” p. 13.
45
Masand, “Solutions to Mental Health in America.”
46
Reinert et al., “The State of Mental Health in America 2020,” p. 11.
47
GoodTherapy Staff, “4 Big Ways We Can Change Mental Health Care in America.”
48
Ibid.
 15

49
Ibid.
50
Collier, “How One Nonprofit Breaks the Cycle of Incarceration.”
51
Ibid.
52
June Gruber and Darby Saxbe, “Five Improvements We Should Make to Mental Health Care,”
Slate (February 2018), available at https://slate.com/technology/2018/02/how-to-fix-americas-
broken-mental-health-care-system.html (last accessed April 14 2020).

Photo Citation:
Cover Page - Imprisoning the Mentally Ill: MacArthur Foundation
https://www.macfound.org/press/publications/incarceration-and-mentally-ill/