Mental illness management: The shift from community to corrections

Abstract An increasing number of individuals with mental illness are now treated in correctional environments instead of community settings. In the incarcerated population, prevalence estimates of serious mental illness range from 9% to 20%, compared to 6% in the community. Over three times more persons with serious mental illness in the United States were located in jails and prisons than in hospitals. It was not always like this. How did U.S. correctional systems become de facto mental health institutions for so many? Scholars point to a number of reasons for the increasing prevalence of mental illness among incarcerated individuals, including deinstitutionalization and limited community resources, prominent court decisions and legislative rulings, and the “revolving door” phenomenon. Many factors determine how and why individuals with mental illness are treated in correctional settings as opposed to community settings. There are numerous interlinking bridges between these two worlds, and understanding these multiple pathways is crucial for navigating the mental health care delivery systems inside and outside the walls of detention. This chapter summarizes the historical context of correctional versus community mental health, factors resulting in the increasing management of people with mental illness in correctional settings, and similarities and differences between the provision of mental health care in correctional versus community settings.