A new national study reveals a stark contrast in mental health diagnoses between incarcerated individuals, those with recent criminal justice involvement, and the general population. Published on April 9, 2025, by Jeffrey Swanson from Duke University School of Medicine and his colleagues, the study highlights significantly higher rates of five major mental health conditions among individuals in prison and those with recent legal encounters.
In the second half of the 20th century, the closure of large public mental health institutions coincided with a sharp rise in mass incarceration across the United States. Today, individuals involved in the criminal justice system face far higher rates of mental illness compared to the general population. However, research on this issue has been limited in scope and validity. Swanson and his team aimed to provide a clearer national picture of the mental health and demographic profiles of justice-involved adults, highlighting gaps in mental health support within communities.
The study surveyed participants from various settings, including households, prisons, hospitals, and homeless shelters. The groups included incarcerated adults (321 participants), individuals with recent criminal justice involvement (269 participants), and those with no criminal legal history in the past year (5,004 participants). Semi-structured clinical interviews, conducted by mental health professionals with at least a master’s-level degree, were carried out between October 2020 and October 2022.
The findings show that about 40% of individuals with any criminal involvement in the past year met the diagnostic criteria for one of the following mental health disorders: schizophrenia-spectrum disorder, bipolar 1 disorder, obsessive-compulsive disorder, major depression, generalized anxiety disorder, and post-traumatic stress disorder. The prevalence was highest among currently incarcerated individuals, with 42% meeting the criteria. Among individuals with recent criminal legal involvement but not currently incarcerated, the rate was 37%, while 24% of those with no criminal history in the past year had similar diagnoses.
The study also analyzed the demographic breakdown of the populations surveyed. It found that men represented the majority of both the incarcerated (93%) and recently criminally involved groups (70%), while they were a minority (48%) in the general community group. Additionally, Hispanic/Latino individuals made up the largest proportion of both the incarcerated group (34%) and the recently criminally involved group (44%).
While these results offer valuable insights, the authors caution that they may not fully represent the national population and can only suggest correlation, not causation. They also point out the complex racial, class, and societal factors influencing incarceration rates in the U.S., as well as the potential limitations of self-reporting, particularly regarding recent criminal legal history.
Despite these challenges, the study underscores the urgent need for appropriate mental health care for justice-involved individuals. By providing informed treatment, the study suggests, the U.S. could reduce high incarceration rates and better support individuals in crisis.
Lead author Jeffrey Swanson, who is also affiliated with the Wilson Center for Science and Justice at Duke Law School, emphasized the importance of the findings: “Schizophrenia-spectrum disorders were at least three times more common in prison than in people who hadn’t been arrested or incarcerated in the past year. Prison is no place to recover from such a serious illness. This study provides more specific diagnostic information that can help address the U.S. mental health crisis where it exists.”
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