The Overwhelming Crisis of Mentally Ill Inmates in Jails and the Growing Healthcare Costs: A Deep Dive

Ben H.

Hatched by Ben H.

Jul 09, 2023

4 min read


The Overwhelming Crisis of Mentally Ill Inmates in Jails and the Growing Healthcare Costs: A Deep Dive


The United States is facing a mounting crisis as the number of mentally ill inmates in jails continues to explode. A recent analysis of state data by the Wall Street Journal reveals that psychiatric hospitals across the country are struggling to accommodate this influx. This has resulted in mentally ill individuals languishing in jail without court-ordered treatment, unable to stand trial or receive the necessary care. The inadequacy of the system raises questions about the responsibility of rectifying the supply and demand for psychiatric facilities and whether incentives are aligned to allow the private market to work effectively.

The Challenges Faced by Mentally Ill Inmates in Jails

One of the key issues faced by mentally ill inmates in jails is the lack of access to court-ordered treatment. Unlike psychiatric hospitals, jails often lack the authority or resources to force inmates to take medication. The availability of prescriptions in jails is limited, making it challenging to meet the specific needs of mentally ill individuals. Additionally, the absence of healthcare practitioners on-site further complicates the monitoring and adjustment of medications. The confinement and constant presence of law enforcement can also contribute to the development or exacerbation of psychotic delusions, worsening the condition of mentally ill inmates.

The Scarcity of Behavioral-Health Services and Workers

The crisis faced by mentally ill inmates is further compounded by the scarcity of behavioral-health services and workers. State leaders and mental health advocates have highlighted the dire situation, emphasizing the need for urgent action. The shortage of psychiatric-hospital beds is particularly alarming. In Missouri alone, there are 229 inmates waiting for one of the state's 897 psychiatric-hospital beds, all of which are already occupied. It is essential to examine the state-run nature of these hospitals and the size of the network to understand the extent of the problem.

Rising Healthcare Costs and Their Impact

In addition to the challenges faced by mentally ill inmates, the healthcare industry as a whole is grappling with rising costs. According to PricewaterhouseCoopers' Health Research Institute, healthcare costs are projected to increase by 7% next year. Providers are dealing with higher expenses and seeking rate increases during contract negotiations with insurers. This follows estimates of 5.5% and 6% in 2022 and 2023, respectively. Looking ahead to 2024, PwC researchers predict that expense growth, rate increases, and pharmaceutical price hikes will contribute to healthcare inflation.

The Impact of Drug Price Hikes

Drug price hikes have been a significant factor in driving up healthcare costs. The median annual price for new drugs has risen from $180,000 in 2021 to $222,000 in 2022. Providers are forced to spend more on managing drug shortages, sourcing alternative treatments, and training staff to handle unfamiliar products. While biosimilars, which are less expensive versions of biologic drugs, are entering the market, their adoption among physicians and patients has been relatively slow. The challenge lies in encouraging their widespread use to mitigate the impact of rising drug prices.

Addressing the Crisis and Controlling Healthcare Costs

In light of these challenges, it is crucial to explore actionable solutions that can address the crisis faced by mentally ill inmates and control healthcare costs:

  • 1. Increase investment in psychiatric facilities: There is a dire need for increased investment in psychiatric facilities to accommodate the growing number of mentally ill inmates. This should be a priority for both public and private sectors, with incentives aligned to encourage the private market to contribute to the expansion of psychiatric services.
  • 2. Improve access to court-ordered treatment: Efforts should be made to enhance access to court-ordered treatment for mentally ill inmates in jails. This includes ensuring the availability of necessary medications, providing on-site healthcare practitioners, and implementing comprehensive monitoring and adjustment protocols.
  • 3. Promote cost-effective healthcare options: Employers can play a significant role in controlling healthcare costs by demanding lower-cost options from insurers. This can be achieved through the promotion of health plans with narrow networks that steer patients to low-cost, high-quality providers. Additionally, encouraging the use of telehealth for counseling and other mental health treatments can limit cost growth.


The overwhelming crisis of mentally ill inmates in jails and the rising healthcare costs present significant challenges for the United States. It is imperative to address these issues through increased investment in psychiatric facilities, improved access to court-ordered treatment, and the promotion of cost-effective healthcare options. By taking proactive measures, we can strive towards a more equitable and efficient system that ensures the well-being of mentally ill individuals and controls healthcare costs for the broader population.

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