The Mental Health Effects of Being in Prison

According to the Prison Policy Initiative, 10.6 million people go to jail and 600,000 people enter prison in the United States each year. Many justice-involved individuals have pre-existing mental health issues. And some individuals who were considered mentally healthy prior to their arrest develop mental health symptoms once they are in prison. 

Being in prison can take a serious toll on an individual’s psychological well-being. New conditions often develop, and pre-existing conditions may worsen. Sadly, many justice-involved individuals are released back into the community without ever receiving any type of treatment.

Mental Health Concerns Among Incarcerated Individuals

According to the American Psychological Association, 64% of incarcerated individuals in jail, 54% of incarcerated individuals in state prison, and 45% of incarcerated individuals in federal prison report mental health concerns. Substance abuse is rampant among incarcerated individuals as well. Quite often, mental health issues and substance abuse issues occur alongside one another.

The American Psychological Association estimates that between 10% and 25% of incarcerated individuals have a "serious mental illness," such as schizophrenia. In the general population, it’s estimated that about 5% of individuals have a serious mental illness.

Many other incarcerated individuals may experience depressive disorders, anxiety disorders, or PTSD. For some, these issues may be pre-existing conditions. For others, the issues may have started after their incarcerations.

Quite often, disorders go unrecognized by people in prison and prison staff. The response of individuals with mental health issues to the prison system may simply seem like a “normal” reaction to an institutionalized setting; this assumption prevents any type of acknowledgement of the problem, letting people with mental health issues suffer in silence.

Black individuals are more likely to be incarcerated before trial, to fare worse in plea agreements that might have otherwise kept them out of prison, to receive the death penalty, and to be arrested and charged with drug crimes.

While some people feel that increasing the number of people behind bars keeps communities safer, the statistics don’t necessarily show a decrease in crime. For example, in 2014 there were 10 times as many people in prison for drugs than there were 30 or 40 years ago, but the number of drug-related crimes hadn't decreased.

The Toll Prison Takes on Psychological Well-Being

 Incarceration takes a serious toll on mental health for several reasons:

They Are No Longer Considered Productive Members of Society

People can experience a loss of purpose when they’re locked up. Prisons are not obligated to pay their occupants a minimum wage for labor, and they can charge high fees for phone calls with families. Thus, it can be difficult for a justice-involved person to contribute to their family's financial or emotional needs. A perceived lack of purpose in life can take a serious toll on anyone's psychological well-being.

Their Identities Get Stripped

When someone is incarcerated, they are no longer known for their profession, such as being a musician or a delivery driver, and they aren’t known for their skills, talents, or knowledge. The loss of sense of self can be quite disorienting, confusing, and troublesome.

They’re Separated From Loved Ones

They can no longer be with their friends and families. Missing their loved ones and not being part of their daily lives increases feelings of isolation and loneliness. Additionally, they can't be there for their loved ones, so they may worry about those they can't support, such as an elderly family member. They may also experience a lot of grief over missing out on a child's activities or not being able to be there for a partner.

Physical Environment Adds to Stress

Concrete walls, little natural night, and a lack of overall stimulation can take a serious toll on mental health. People in prison have few ways to relieve stress. And their sterile environment is likely to fuel boredom, which can be quite stressful in itself.

Research shows the environment even takes a toll on the prison staff. Frequent staff shortages can mean individuals don't get out of their cells as often, which can add even more stress to their daily lives. This can create a cycle of stress that is tough to break.

Exposure to Violence

Incarcerated individuals are often exposed to violence while behind bars. They may witness fights breaking out at meal times or during recreation times. They may also witness acts of violence between guards and incarcerated peers, or they may become victims of aggression.

Research shows that exposure to violence while in prison creates emotional distress. In addition, exposure to violence has a direct impact on how well individuals adjust to life outside of prison after they're released. Those who are exposed to greater acts of violence are more likely to have trouble settling back into the community.

Solitary Confinement

Whether individuals are placed in solitary confinement due to disciplinary issues or they're segregated because of a safety issue, being locked up alone for 23 hours a day can take a serious toll on a person's well-being. For years the American Civil Liberties Union (ACLU) and other organizations have sought to have solitary confinement banned as a human rights violation, but the practice is still fairly common in the U.S.

Researchers have found that the vast majority of individuals who are placed in solitary confinement have "serious mental illness." These conditions may be why they exhibited behavioral issues in the first place. Solitary confinement can exacerbate symptoms.

But others are likely to develop mental health issues as a result of the extreme isolation. Studies show solitary confinement increases the risk of anxiety, insomnia, paranoia, aggression, and depression.

Lack of Treatment

Even when mental health concerns are known, disorders often go untreated. Most prisons lack the funds to offer adequate mental health treatment. Those who do offer services of some kind may be limited in the types of treatments they provide.

Additionally, services in prison may not be all that effective. It’s tough for individuals to open up to someone when they lack physical and psychological safety.

A 2014 study published in the American Journal of Public Health found that 26% of inmates were diagnosed with a mental health condition at some point during their lives. Only about 18% of them were taking medication for their condition when they became incarcerated. Of those who were taking medication, less than 50% were prescribed medication during their admission.

Inmates with schizophrenia were more likely to receive medication as compared to those with other mental health conditions, like depression.

Although courts mandate adequate treatment for mental health care, treatment is usually reserved for diagnoses that are considered the most serious. Medications are often expensive, and quite often, in an effort to save costs, prescriptions are not made readily available.

Specialized treatment is rarely available in prisons. And generic groups or services may not be able to assist with specific conditions. Additionally, most prisons do not provide adequate access to treatment providers.

So incarcerated individuals' conditions often go unrecognized. Quite often, inmates are given simple screening questionnaires to complete at intake. They aren’t assessed by a mental health professional at all and likely never come into contact with one throughout their time in prison.

Consequences of Inadequate Treatment

The consequences of inadequate mental health care contribute greatly to the suffering of the affected individuals and their families. Untreated psychiatric conditions among the prison population even takes a toll on society financially, in the form of taxpayers' money.

A 2020 study looked at the rates of recidivism among individuals who were released from prison. Those who reported poor mental health in prison were more likely to recidivate than those who had average mental health during their sentence. The rates of recidivism were between 33% and 68% higher for people with poor in-prison mental health than for their peers.

State Hospital Closures

Since the 1970s, there has been a big push toward the deinstitutionalization of individuals with mental health issues. On the surface, closing “asylums” and institutions that housed people with severe psychiatric conditions seemed like a good idea. Many of the institutions were understaffed and unable to give patients the individual treatments they needed.

So rather than reside in a state-run hospital, many individuals with mental health issues now spend much of their time in jail.

According to research conducted by The Treatment Advocacy Center, the number of individuals with "serious mental illness" is now 10 times higher in jails than in state psychiatric hospitals.

A Word From Verywell

Anyone who is facing incarceration should consider revealing any pre-existing mental health conditions. Disclosing those issues may increase the likelihood of accessing treatment.

But bigger changes are needed at the systemic and legal levels. Better access to mental health services overall may prevent crime. Treating people during incarceration and providing access to ongoing treatment after they’re released may reduce recidivism rates.