A new national study published on April 9, 2025, by Jeffrey Swanson of Duke University School of Medicine, reveals that individuals involved with the criminal legal system in the United States exhibit significantly higher rates of mental health disorders compared to the general population. This study aims to provide a more refined understanding of the mental health challenges faced by those incarcerated or with recent criminal legal histories, as well as the associated demographic profiles.
The Rise of Incarceration and Mental Health
The study comes at a time when the U.S. continues to grapple with the impacts of mass incarceration, especially following the closure of large public mental health institutions in the latter half of the 20th century. As the number of people incarcerated has risen, so too have the rates of diagnosed mental illnesses among justice-involved individuals. However, despite the growing recognition of this issue, research in this area has been limited in scope and quality, which is why this study aims to fill those gaps.
Swanson and his team used data from semi-structured clinical interviews with individuals sampled from diverse settings across the U.S., including households, prisons, hospitals, and homeless shelters. The participants included currently incarcerated adults (N=321), adults with criminal legal involvement in the past year but not incarcerated (N=269), and adults with no criminal legal history in the past year (N=5,004). These interviews were conducted by trained clinicians with advanced degrees in mental health, social work, or related fields between October 2020 and October 2022.
Findings: Higher Prevalence of Mental Health Disorders
The study found that approximately 40% of individuals with any criminal involvement in the past year met diagnostic criteria for one or more mental health disorders. These disorders included schizophrenia-spectrum disorder, bipolar disorder, obsessive-compulsive disorder, major depression, generalized anxiety disorder, and post-traumatic stress disorder (PTSD). The prevalence was highest among incarcerated individuals, with 42% meeting diagnostic criteria, followed by 37% in those with recent criminal-legal involvement and 24% among individuals with no recent criminal-legal history.
Specifically, schizophrenia-spectrum disorders were found to be at least three times more common in the incarcerated population than in those who had not been arrested or incarcerated in the past year. This significant disparity highlights the challenges of managing serious mental illnesses in the prison system, where conditions for recovery are far from ideal.
Demographic Representation and Implications
The study also looked at the demographic representation within the three groups. Men made up the vast majority of both the incarcerated (93%) and recent criminal-legal history (70%) groups, while being a minority (48%) in the general community group. Among incarcerated individuals and those with a recent criminal legal history, the largest proportion identified as Hispanic/Latino (34% and 44%, respectively).
These findings underscore the critical need for tailored mental health care for individuals in the criminal justice system. The disproportionate representation of men and Hispanic/Latino individuals in the incarcerated and justice-involved groups suggests that interventions must account for both mental health and demographic factors to effectively reduce the impact of criminalization and mental illness.
Study Limitations
While the study provides valuable insights, the authors acknowledge that the results are based on correlation rather than causation and may not fully represent the national population. They also note that self-reporting was used, which can influence transparency, particularly when it comes to accurately reporting recent criminal-legal history among individuals not currently incarcerated.
Conclusion: Addressing Mental Health in the Criminal Justice System
The findings from this study highlight a significant gap in mental health care for individuals involved in the criminal justice system. Lead author Jeffrey Swanson emphasizes that individuals with schizophrenia-spectrum disorders, in particular, face extreme challenges in prison, where recovery is hindered. The study offers more detailed diagnostic information that can help address the U.S. mental health crisis by targeting interventions where they are needed most.
Overall, the study underscores the urgent need for informed and appropriate psychiatric care to support individuals with mental health conditions, both to reduce the rates of incarceration and to better support individuals in crisis within communities.
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