Center for American Progress

Long-Term Solutions to the Overincarceration of People With Mental Health Disabilities

Long-Term Solutions to the Overincarceration of People With Mental Health Disabilities

Policymakers must focus on long-term structural changes in order to reduce the negative interactions of people with mental health disabilities with police.

Detainee cells of the Cook County Department of Corrections jail facility are seen in Chicago on September 30, 2021. (Getty/Brian Casella)

Authors’ note: The disability community is rapidly evolving to use identity-first language in place of person-first language. This is because it views disability as being a core component of identity, much like race and gender. Some members of the community, such as people with intellectual and developmental disabilities, prefer person-first language. In this issue brief, the terms are used interchangeably.

Prisons and jails are some of the United States’ largest providers of mental health services.1 Every year, more than 2 million people with serious mental illnesses are booked into jail.2 The U.S. Department of Justice’s 2011–2012 national inmate survey reported that 1 in 7 people in state and federal prisons, and 1 in 4 in jails, showed signs of “serious psychological distress.”3 The same survey reported that more than one-third of incarcerated people had a clinical diagnosis of a mental health disorder, compared with 1 in 5 nonincarcerated people.4 Individuals with mental illnesses are also 16 times more likely to be killed by police.5 The overpolicing of people with mental health disabilities has driven these disparate incarceration rates, concerning advocates, researchers, and policymakers as the nation faces an escalating mental health crisis.6

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This issue brief discusses the history and causes of overpolicing of people with mental health disabilities and provides recommendations for creating long-term solutions, including increasing funding for wraparound services, reducing administrative burdens, and increasing the availability of employment services. Reducing the likelihood of individuals with mental health disabilities experiencing crises will directly reduce these individuals’ negative interactions with police.

The lack of mental health resources results in the overinvolvement of police

Due to workforce and funding shortages, community mental health providers have struggled for decades to meet demand.7 This has resulted in delays in service provision,8 individuals ending up in emergency rooms,9 and people being unnecessarily arrested, imprisoned, or killed.10 Due to limited access to mental health services, family, friends, or bystanders may call 911 for help, which often results in police involvement. Moreover, many people’s first interaction with mental health services is mandated through judicial procedures11—an unfortunate reality, as research indicates that mandated treatment is often ineffective.12 In addition to the lack of services, low engagement in care prior to judicial intervention is often due to the stigma that exists around mental health in the United States.13 The COVID-19 pandemic made this situation even worse.14

The lack of support for mental health services is a long-standing problem. During the Reagan administration, federal spending on mental health services decreased by 25 percent.15 More recently, from 2009 to 2012, states cut $4.5 billion in mental health spending.16 In 2020, the Trump administration increased federal funding for mental health services for the first time in recent history through the CARES Act, which provided $425 million to the Substance Abuse and Mental Health Services Administration, $250 million of which went to certified community behavioral health clinics.17 And in the 2023 spending bill, the Biden administration was able to invest $15 billion in mental health services—a $707 million increase from the previous year.18 However, Americans continue to report difficulties obtaining mental health care, including 43 percent of respondents to a 2022 National Council for Mental Wellbeing survey who stated they were unable to obtain care.19 The top barriers that respondents reported included costs, lack of available providers, and lack of providers who offered treatment in culturally and linguistically appropriate formats.

An overview of the criminalization of mental health disabilities

The criminalization of mental health conditions has occurred throughout U.S. history, fueling mass incarceration and leading to a disproportionate number of individuals with mental health disabilities being confined in prisons, jails, and “insane asylums.”20 Themoral” movement that began in the 18th and early 19th centuries led reformers such as Dorothea Dix to advocate for the establishment of state-run asylums for people with mental illnesses.21 Many believed that removing individuals with mental illnesses from society to allow them to rest would help them recover.22 In practice, however, individuals languished in these institutions, often for indefinite periods of time.23 Later in the 1800s, starting in San Francisco, cities began passing laws now known as the “ugly laws,” which prohibited and restrained “certain persons from appearing in streets and public places.”24 This resulted in the mass arrest, confinement, and even sterilization of individuals whom society deemed mentally ill. Although the last ugly law was repealed in Chicago in 1974,25 echoes of these coercive policies remain in use across the country. For example, New York City Mayor Eric Adams issued a directive in 2022 granting the police the ability to identify individuals who seem to be experiencing mental health symptoms and to not be meeting their “basic living needs.”26 Individuals identified can be forcibly removed from public spaces and involuntarily committed to hospitals.

Current policy action at the federal and state levels

Federal policymakers are currently focused on four separate categories of intervention to address the United States’ mental health crisis: 1) increased funding to train law enforcement personnel; 2) community responder programs; 3) alternative mental health emergency call centers; and 4) the creation of diversion and dispositional alternative programs. While some of these interventions can be helpful in the short term, they do not address the root causes of the mental health crisis. Community mental health services can help reduce crises and stabilize individuals within their own communities, as well as provide lasting supportive care.27 These longer-term solutions are discussed in the following section.

Individuals with mental health disabilities are 16 times more likely to die from an interaction with law enforcement than the general population, according to a 2011 study.28 In recent years, law enforcement has received millions of federal dollars to fund training to improve interactions between police and individuals in mental health crises.29 Yet the deaths of Christian Glass,30 Anthony Hill,31 and Ezell Ford32—all shot by police while experiencing a mental health crisis—call into question whether this additional training is effective, as all the officers involved in the aforementioned shootings were found to have not followed existing police protocols. Moreover, popular models such as crisis intervention training show little evidence of reducing injuries or deaths,33 although recent research has shown evidence that some types of training, such as de-escalation training, can help decrease violent interactions between police and civilians.34

Community responder programs are also seeing some successes. Of the 50 U.S. cities with the largest police departments, 62 percent have established community responder programs since 2020.35 Community responder teams may include mental health professionals, nurses, or other trained professionals who respond to calls instead of police. Cities have found early success with such programs,36 including in Eugene, Oregon, where community responders answered an estimated 24,000 calls in 2019, only 311 of which required police back up.37 Officials estimated that in 2019, the community responder program saved $14 million in state emergency medical services.38 While these programs are necessary, they do not fully address the underlying issues. Communities still lack long-term care solutions, leaving few options for people to be connected with services once they are no longer in acute crisis.

In 2020, Congress passed the bipartisan National Suicide Hotline Designation Act to reroute mental health emergency calls to trained mental health providers through the direct dial number 988.39 This was intended to help reduce both police interaction and the burden on 911 call centers. Yet the new program, similar to other mental health initiatives, began with little funding. And while the Biden administration provided more than $1 billion to states to address mental health through the 2021 American Rescue Plan and the 2022 Bipartisan Safer Communities Act, few of those funds went to public campaign efforts.40 The sustainability of the funding is also unclear. One year after the 988 program’s launch, only 17 percent of Americans knew about it, and Black Americans and individuals in lower income brackets were less likely to know about the program than were other communities.41 Moreover, only eight states have passed laws to sustain funding for 988,42 and problems are starting to mount, with reports of callers hanging up due to long wait times.43 The shortage of behavioral health professionals available to answer the phone, long wait times, and poor funding for in-community mental health services all mean that many calls are routed to a national call center, making it much more difficult for callers to be referred to local services and supports.44 And while 988 touts its lack of geolocating,45 at least 2 percent of 988 calls—or about 44,000—were rerouted to 911 to geolocate so police could track a caller’s location and respond.46 The fact that some calls can be rerouted to 911, and therefore geolocated by police, means that communities may become distrustful of 988. Without sustainable solutions, 988 may become one more failed mental health program.

Dispositional alternatives are another tool cities and counties have utilized in attempts to address the overcriminalization of individuals with mental health disabilities. In 2004, Congress passed the Mentally Ill Offender Treatment and Crime Reduction Act,47 providing funding for mental health courts (MHCs), which focus on the rehabilitation of adults and juveniles with mental health disabilities, particularly first-time offenders, and grants to other programs created to help these individuals. While MHCs offer treatment as an alternative to incarceration, the period over which they monitor or mandate an individual to stay in treatment is often significantly longer than the prison or probation sentence an individual would receive for similar offenses.48 Additionally, there is very little indication that these courts help reduce recidivism: Two studies have shown no significant difference between the rate of recidivism for individuals with mental health disabilities who went through MHCs and the rate of recidivism for those who did not.49 Research has also shown mixed results on the effectiveness of compulsory treatment for mental health and substance use disorders, with some studies showing negative impacts on individuals with substance use disorders.50 It is essential that the United States provide opportunities for long-term community treatment outside the court system in order to prevent individuals with mental health disabilities from going into crisis and to provide ways to resolve symptoms without using punitive pressure tactics.

Recommendations to create longer-term solutions

Preventing mental health crises and enabling long-term treatment are key parts of reducing interactions between people with mental health disabilities and police—and thus reducing these individuals’ incarceration rate. Federal and state governments can achieve these goals by funding wraparound services such as Medicaid’s home- and community-based services (HCBS), reducing administrative burdens to decrease barriers to services and supports, and increasing employment services targeted to workers with mental health disabilities.51

Increase funding for wraparound services

Congress must increase funding for Medicaid to support wraparound services such as Assertive Community Treatment (ACT) programs, which can help prevent and reduce mental health crises.52 ACT provides case management, treatment, medication management, and other supports to enable people to continue living in their homes rather than in institutionalized care. In order to fund programs such as this, Congress must substantially increase Medicaid funding to at least $400 billion, and states must seek HCBS waivers. About 656,000 people were on waiting lists for HCBS in 2021.53 And in 2020, according to Mental Health America, 42 percent of adults with mental health disabilities were unable to afford treatment, and 10.8 percent of adults were uninsured.54

Reduce administrative burdens and eliminate barriers to safety net programs

Administrative burdens are unnecessary red tape, such as complex eligibility requirements and periodic check-ins, that affect disabled people’s ability to obtain and maintain essential services and supports, costing them time, money, and energy.55 Thousands of individuals go bankrupt or die while attempting to obtain Supplemental Security Income and Social Security Disability Insurance.56 Individuals with mental health conditions often have difficulties with executive function, meaning that many, particularly those not currently connected with services, do not apply for disability benefits or give up early in the process.57 Reducing the administrative burdens of accessing programs such as Medicaid will make it easier for individuals with mental health disabilities to obtain treatment and other services.58

Increase the availability of employment services

Increasing financial stability is positively correlated with a reduction in depression.59 It also lowers the risk that an individual will go into crisis,60 and research indicates that being employed can improve mental health symptoms.61 Individuals with chronic mental health disabilities are much more likely to be unemployed or underemployed than their peers without mental health disabilities.62 For this reason, federal policymakers must fund evidence-based employment models, such as individual placement and support, that help individuals with mental health disabilities obtain and maintain partial or full-time employment.63 With the correct support, research shows that individuals with significant mental health disabilities are better able to obtain and maintain competitive employment.64


While the Biden administration has made strides in addressing the overinvolvement of police in responding to individuals experiencing mental health crises, it must do more to alleviate the root causes of crises with longer-term, more holistic solutions. Approximately 2 million people with mental health disabilities will continue to be arrested yearly65 unless government undertakes longer-term change.


  1. Wendy Sawyer and Peter Wagner, “Mass Incarceration: The Whole Pie 2023,” Prison Policy Initiative, Press release, March 14, 2023, available at
  2. Substance Abuse and Mental Health Services Administration, “Executive Order Safe Policing for Safe Communities: Addressing Mental Health, Homelessness, and Addiction Report” (Washington: U.S. Department of Health and Human Services, 2020), available at
  3. Jennifer Bronson and Marcus Berzofsky, “Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-2012” (Washington: U.S. Department of Justice, 2017), available at
  4. Substance Abuse and Mental Health Services Administration, “Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health” (Washington: U.S. Department of Health and Human Services, 2022), available at
  5. Doris A. Fuller and others, “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters” (Arlington, VA: Treatment Advocacy Center, 2015), available at
  6. Seth J. Prins, “Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review,” Psychiatric Services 65 (7) (2014): 862–872, available at,and%20programmatic%20responses.
  7. Nirmita Panchal and others, “The Implications of COVID-19 for Mental Health and Substance Use” (Washington: Kaiser Family Foundation, 2023), available at
  8. Catherine G. McLaughlin, “Delays in Treatment for Mental Disorders and Health Insurance Coverage,” Health Services Research 39 (2) (2004): 221–224, available at,first%20contact%20with%20a%20psychiatrist.
  9. Huma Shah, “Rise in Emergency Department Visits due to Limited Access to Behavioral Health Services,” Loma Linda University Institute for Health Policy and Leadership, January 3, 2022, available at
  10. Niloofar Ramezani and others, “The relationship between community public health, behavioral health service accessibility, and mass incarceration,” BMC Health Services Research 22 (1) (2022): 966, available at
  11. Council of State Governments, “Criminal Justice/Mental Health Consensus Project” (Lexington, KY: 2002), available at
  12. Karen K. Parhar and others, “Offender Coercion in Treatment: A Meta-Analysis of Effectiveness,” Criminal Justice and Behavior 35 (9) (2008): 1109–1135, available at
  13. Annie B. Fox, Brian N. Smith, and Dawne Vogt, “How and when does mental illness stigma impact treatment seeking? Longitudinal examination of relationships between anticipated and internalized stigma, symptom severity, and mental health service use,” Psychiatry Research 268 (2018): 15–20, available at
  14. Panchal and others, “The Implications of COVID-19 for Mental Health and Substance Use.”
  15. Megan J. Wolff, “Fact Sheet: Incarceration and Mental Health,” Weill Cornell Medicine, May 30, 2017, available at
  16. Ron Honberg and others, “State Mental Health Cuts: A National Crisis” (Arlington, VA: National Alliance on Mental Illness, 2011), available at
  17. Matthew L. Goldman and others, “Mental Health Policy in the Era of COVID-19,” Psychiatric Services 71 (11) (2020), available at
  18. U.S. House Committee on Appropriations, “Consolidated Appropriations Act, 2023” (Washington: 2022), available at
  19. National Council for Mental Health Wellbeing, “2022 Access to Care Survey Results,” May 31, 2022, available at
  20. Anne Parsons, From Asylum to Prison: Deinstitutionalization and the Rise of Mass Incarceration after 1945 (Chapel Hill, NC: University of North Carolina Press, 2018).
  21. Eric Andrew Nelson, “Dorothea Dix’s Liberation Movement and Why It Matters Today,” The American Journal of Psychiatry Residents Journal 17 (2) (2021): 8­–9, available at
  22. Joel A. Dvoskin, James L. Knoll IV, and Mollie Silva, “A brief history of the criminalization of mental illness,” CNS Spectrums 25 (5) (2020), 638–650, available at
  23. Substance Abuse and Mental Health Services Administration, “Civil Commitment and the Mental Health Care Continuum: Historical Trends and Principles for Law and Practice” (Washington: U.S. Department of Health and Human Services, 2019), available at
  24. Susan M. Schweik, The Ugly Laws: Disability in Public (New York: NYU Press, 2009).
  25. Ibid.
  26. Nazish Dholakia, “New York City’s New Mental Health Plan is Dangerous,” Vera, January 24, 2023, available at,transport%20them%20to%20the%20hospital.
  27. Tanya Nicole Wanchek and others, “The Effect of Community Mental Health Services on Hospitalization Rates in Virginia,” Psychiatric Services 62 (2) (2011): 194–199, available at
  28. Fuller and others, “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters.”
  29. Farnoush Amiri, “Congress passes bipartisan bill to fund police de-escalation training,” PBS News Hour, December 15, 2022, available at
  30. Ibid.
  31. Alan Blinder, “Georgia Police Officer Indicted for Murder of Unarmed Black Man,” The New York Times, January 21, 2016, available at
  32. The Times Editorial Board, “Editorial: Three police killings in one week expose L.A.’s deadly response to mental health crisis,” The Los Angeles Times, January 13, 2023, available at
  33. Michael S. Rogers, Dale E. McNiel, and Renee L. Binder, “Effectiveness of Police Crisis Intervention Training Programs,” The Journal of the American Academy of Psychiatry and the Law 51 (4) (2023), available at
  34. Robin S. Engel and others, “Assessing the Impact of De-escalation Training on Police Behavior: Reducing Police Use of Force in the Louisville, KY Metro Police Department,” Criminology and Public Policy 21 (2) (2022): 199–233, available at
  35. Ram Subramanian and Leily Arzy, “Rethinking How Law Enforcement is Deployed” (Washington: Brennan Center for Justice, 2022), available at
  36. Amos Irwin and Betsy Pearl, “The Community Responder Model” (Washington: Center for American Progress, 2020), available at
  37. Jackson Beck, Melissa Reuland, and Leah Pope, “Case Study: CAHOOTS” (New York: Vera, 2020), available at
  38. Subramanian and Arzy, “Rethinking How Law Enforcement is Deployed.”
  39. National Suicide Hotline Designation Act of 2020, Public Law 116-172, 116th Cong, 2nd sess. (October 17, 2020), available at
  40. Christina Saint Louis, “Most States Haven’t Permanently Funded 988 Suicide Crisis Hotline,” Governing, September 13, 2023, available at
  41. Christina Caron, “Is the New 988 Suicide Hotline Working?”, The New York Times, July 13, 2023, available at
  42. Saint Louis, “Most States Haven’t Permanently Funded 988 Suicide Crisis Hotline.”
  43. Steve Eder, “As a Crisis Hotline Grows, So Do Fears it Won’t Be Ready,” The New York Times, March 13, 2022, available at
  44. Caron, “Is the New 988 Suicide Hotline Working?”
  45. 988 Suicide & Crisis Lifeline, “FAQ,” available at (last accessed January 2024).
  46. Rob Wipond, “Psychiatric Detentions Rise 120% in First Year of 988,” Mad in America, May 20, 2023, available at
  47. Mentally Ill Offender Treatment and Crime Reduction Act of 2004, Public Law 108-414, 108th Cong., 2nd sess. (October 30, 2004), available at
  48. E. Lea Johnston and Conor P. Flynn, “Mental Health Courts and Sentencing Disparities,” Villanova Law Review 62 (4) (2017): 685­–745, available at
  49. KiDeuk Kim, Miriam Becker-Cohen, and Maria Serakos, “The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System” (Washington: Urban Institute, 2015), available at; Gary Bess Associates, “Mentally Ill Offender Crime Reduction (MIOCR) Grant Program: Butte County Forensic Resource Team (FOREST) Final Program Report” (Oroville, CA: 2004), available at; Merith Cosden and others, “Efficacy of a mental health treatment court with assertive community treatment,” Behavioral Sciences & the Law 23 (2) (2005): 199–214, available at
  50. D. Werb and others, “The effectiveness of compulsory drug treatment: A systematic review,” International Journal of Drug Policy 28 (2016): 1­–9, available at
  51. U.S. Centers for Medicare and Medicaid Services, “Home- and Community-Based Services,” September 6, 2023, available at (last accessed January 2024).
  52. Gary R. Bond and others, “Assertive Community Treatment for People with Severe Mental Illness,” Disease and Management and Health Outcomes 9 (2001): 141­–159, available at
  53. Alice Burns, Maiss Mohamed, and Molly O’Malley Watts, “A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016-2023” (Washington: Kaiser Family Foundation, 2023), available at
  54. Mental Health America, “The State of Mental Health in America,” available at – :~:text=42%25 of adults with AMI,were not covered by insurance (last accessed January 2024).
  55. Justin Schweitzer and others, “How Dehumanizing Administrative Burdens Harm Disabled People” (Washington: Center for American Progress, 2022), available at
  56. U.S. Government Accountability Office, “Social Security Disability: Information on Wait Times, Bankruptcies, and Deaths among Applicants Who Appeal Benefit Denials” (Washington: 2020), available at
  57. Scott Bilder and David Mechanic, “Navigating the Disability Process: Persons with Mental Disorders Applying for and Receiving Disability Benefits,” The Milbank Quarterly 81 (1) (2003):75–106, available at
  58. Ashley M. Fox, Edmund C. Stazyk, and Wenhui Feng, “Administrative Easing: Rule Reduction and Medicaid Enrollment,” Public Administration Review 80 (1) (2020): 104–117, available at
  59. Piotr Bialowolski and others, “The role of financial conditions for physical and mental health. Evidence from a longitudinal survey and insurance claims data,” Social Science & Medicine 281 (2021), available at
  60. Olivia Guerra, Vincent I. O. Agyapong, and Nnamdi Nikire, “A Qualitative Scoping Review of the Impacts of Economic Recessions on Mental Health: Implications for Practice and Policy,” International Journal of Environmental Research and Public Health 19 (10) (2022), available at
  61. Robert E. Drake and Michael A. Wallach, “Employment is a Critical Mental Health Intervention,” Epidemiology and Psychiatric Sciences 29 (2020), available at
  62. Celia C. Lo and Tyrone C. Cheng, “Race, unemployment rate, and chronic mental illness: a 15-year trend analysis,” Social Psychiatry and Psychiatric Epidemiology 49 (2014), 1119–1128, available at
  63. Kim T. Mueser, Robert E. Drake, and Gary R. Bond, “Recent advances in supported employment for people with serious mental illness,” Current Opinion in Psychiatry 29 (3) (2016): 196–201, available at
  64. Gary R. Bond, Robert E. Drake, and Deborah R. Becker, “Generalizability of the Individual Placement and Support (IPS) Model of Supported Employment Outside of US,” World Psychiatry 11 (1) (2012): 32–39, available at
  65. National Judicial Task Force to Examine State Courts’ Response to Mental Illness, “State Courts Leading Change: Report and Recommendations” (Williamsburg, VA: Conference of Chief Justices and Conference of State Court Administrators, 2022), available at

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Mia Ives-Rublee

Director, Disability Justice Initiative

Christina Stafford

Former Intern, Disability Justice Initiative


Disability Justice Initiative

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