ANYONE interested in understanding the U.S.’s commitment to mental health care need only look to the nation’s largest single-site mental health facility: the Cook County Jail in Chicago. Cook County has an average population of around 9,000 inmates, 35 percent of whom are estimated to have mental illnesses. With a rate almost twice the national average, Chicago’s primary jail isn’t unusual, with roughly 64 percent of people in U.S. jails reporting mental health concerns. Historically, as the government has cut funding to mental health services, a process of trans-institutionalisation has occurred, with many individuals who once received treatment in mental health facilities now being shunted into correctional centers. In effect, America’s prisons and jails have become the de facto safety net for many Americans living with mental illness.
These attempts to charge disciplinary institutions with providing compassionate mental health care has been facing challenges. An estimated 33 percent of individuals with chronic mental illness have not received any form of treatment since their admission to state prisons. Instead, individuals with a mental illness have up to 170 percent increased odds of experiencing extended solitary confinement relative to peers without mental health conditions.
In 2020, Nils Melzer, the UN Special Rapporteur on Torture deemed the use of prolonged solitary in U.S. prisons to be torture. Given both the lack of care and the increased use of extreme punishment, it comes as no surprise that suicide rates – already 62 percent higher among previously incarcerated individuals than the general population – are even higher among people with a diagnosed mental illness. Taken together, there is a growing body of evidence demonstrating the incompatibility of carceral institutions as sites of mental health care.
The situation is likely to only worsen. With rising healthcare costs across the board and sharp cuts in government funding, correctional healthcare has only suffered, with most states contracting out care to for-profit companies. Jails that have privatised their healthcare have higher death rates than facilities where government agencies provide care. In Illinois, where the majority of state prisons have private, for-profit care, a recent class-action lawsuit resulted in the creation of an independent monitor to oversee the improvement of healthcare delivery in the state’s correctional facilities.
