In 2023, more than 44% of people held in local U.S. jails reported having a history of a mental health condition, according to the Bureau of Justice Statistics. Among women in jail, that figure rose to nearly 69%.[1] In many communities, the criminal justice system has become one of the largest points of contact for people struggling with serious mental health needs.
That reality reveals a difficult challenge. Consider a person experiencing untreated schizophrenia who becomes involved with law enforcement during a psychiatric crisis:
- Is the situation primarily a public safety issue, a healthcare issue, or both?
- What happens when symptoms influence behavior that carries legal consequences?
- Who is best equipped to evaluate those questions fairly?
Every day, judges, attorneys, clinicians, law enforcement officers, and correctional professionals make decisions that sit at the intersection of mental health and criminal justice. To understand why this challenge persists (and what can be done about it), we consider the science, policies, and professionals of both fields.
Key Takeaways
- Large numbers of incarcerated individuals have a history of mental health conditions, making access to treatment, evaluation, and support a critical part of both public health and public safety.
- Diversion programs, mental health courts, Crisis Intervention Team (CIT) training, co-responder models, and the 988 crisis system are designed to connect people with treatment earlier and reduce unnecessary involvement with the justice system.
- Growing reform efforts are creating new opportunities for forensic evaluators, correctional behavioral health specialists, and policy advocates.
How People With Mental Illness End Up Underrepresented Behind Bars
For many people, involvement with the criminal justice system often starts with a lack of access to consistent mental healthcare.
Consider someone experiencing untreated bipolar disorder, schizophrenia, or severe depression: all very common disorders in the general population.
- Without access to medication, therapy, crisis services, supportive housing, or community-based health treatment, symptoms can worsen over time.
- What begins as a health issue may eventually lead to behaviors that attract police attention, particularly during moments of crisis.
This is why many researchers describe incarceration as a downstream outcome of unmet mental health needs rather than an isolated criminal justice problem.
Correctional facilities have increasingly become de facto mental health providers. Researchers and advocacy organizations have noted that large jail systems such as the Los Angeles County Jail, Chicago’s Cook County Jail, and New York City’s Rikers Island collectively provide mental health services to thousands of individuals with mental conditions on any given day.[2] In many communities, the criminal justice system has become one of the largest points of contact for people living with serious mental illness.
Competency Evaluations and the Legal Threshold the System Struggles to Meet
Not every defendant who enters a courtroom is legally capable of participating in their own defense. This is “competency to stand trial,” one of the most important concepts in criminal law.
- Legally, competency refers to whether a defendant can understand the nature of the proceedings against them and meaningfully assist their attorney.
- Clinically, the question is often more complicated, since a person may have schizophrenia, bipolar disorder, major depression, or another serious mental health condition and still be competent to stand trial. Conversely, severe symptoms such as delusions, disorganized thinking, or cognitive impairment may prevent someone from meeting the legal standard.
The demand for evaluations has grown dramatically while system capacity has struggled to keep pace. Across the United States, defendants deemed incompetent to stand trial routinely spend months waiting in jail for evaluation or restoration services, despite having been identified as needing treatment rather than punishment. In some jurisdictions, wait times have stretched well beyond six months.[3]
Competency cases typically follow a predictable sequence.
- A concern is raised regarding a defendant’s ability to participate in court proceedings.
- A judge orders a competency evaluation.
- A forensic evaluator assesses the defendant and submits a report. If the defendant is found incompetent to stand trial, they are referred for competency restoration services.
Ironically, a process designed to identify mental illness can sometimes worsen it. Defendants may spend months in jail awaiting evaluations or treatment, often with limited access to mental health services.
This is where forensic evaluators become critical. Their role is not to determine guilt or innocence, but to assess whether a defendant can meaningfully participate in the legal process. Through interviews, record reviews, psychological testing, and court-admissible reports, they help judges make informed decisions about how a case should proceed.
Diversion Programs and Mental Health Courts: What the Data Actually Shows
One of the most widely studied alternatives to traditional criminal justice, diversion programs try to redirect people toward treatment and support rather than relying exclusively on arrest, prosecution, or incarceration.
Here, the point of intervention is important.
- Pre-arrest diversion occurs before formal charges are filed. Crisis Intervention Team (CIT) programs are a common example, where officers trained in mental health response may connect individuals directly to mental health treatment providers instead of making an arrest.
- Pre-trial diversion occurs after arrest but before a case proceeds through the traditional court process. Participants may enter treatment programs and, upon successful completion, avoid prosecution or receive reduced legal consequences.
- Post-booking diversion occurs after formal entry into the criminal justice system, with mental health courts being the most prominent example.
Although these approaches differ structurally, they share a common objective: reducing unnecessary incarceration while increasing access to treatment.
Mental Health Courts
The strongest evidence currently exists for well-designed mental health courts, where participants receive court supervision while undergoing treatment and recovery. Successful mental health courts typically include:
- Strong treatment partnerships
- Regular judicial interaction
- Intensive case management
- Clear eligibility criteria
- Long-term follow-up support
California’s Collaborative Courts model provides one example.[4] Participants typically undergo screening to determine eligibility, enter structured treatment plans, appear regularly before the court, and work toward individualized goals related to mental health stability, housing, employment, or substance use recovery. Program length often ranges from several months to more than a year, depending on participant needs and local requirements.
Crisis Intervention Models: When the First Responder Is the Last Line
For many people with serious mental illness, the criminal justice system begins not in a courtroom, but during a crisis. What happens during those first few minutes can determine whether the outcome is treatment, hospitalization, arrest, injury, or, in some cases, death.
Now, crisis intervention models attempt to bring psychological expertise into emergency response earlier. One of the most widely adopted approaches is Crisis Intervention Team (CIT) training.
Originally developed in Memphis, Tennessee, CIT programs train law enforcement officers to recognize mental health crises, de-escalate situations safely, and connect individuals to treatment when appropriate.[5] Today, thousands of agencies across the United States use some form of CIT training.
Co-Responder Models
Training alone cannot solve every challenge. This has led many jurisdictions to adopt co-responder models, where law enforcement officers respond alongside licensed behavioral health professionals.
Suppose a 911 control room gets a call involving a person experiencing severe paranoia who refuses medical assistance. Earlier, a traditional police response may have focused only on safety and compliance. Now, however, while officers maintain scene safety, clinicians can resolve situations that might otherwise end in arrest.
The 988 Hotline
The launch of the 988 Suicide and Crisis Lifeline represented another major shift for mental illness and the criminal justice system.[6] Designed to function as a behavioral health equivalent of 911, 988 provides immediate access to trained crisis counselors who can assess risk, provide support, and connect callers to local resources.
Since its launch, the system has handled millions of calls, texts, and chats nationwide. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 16 million contacts were answered through the 988 network between July 2022 and early 2025.[7] In many cases, that support prevents crises from escalating to law enforcement involvement at all.
Careers Driving Reform at the Intersection of Mental Health and Criminal Justice
Mental health challenges affect nearly every stage of the criminal justice process, from the initial 911 call to competency evaluations, diversion decisions, incarceration, and community reentry.
However, while policies can create opportunities for change, only people can make those changes happen.
Forensic Mental Health Evaluator
Few professionals work closer to the intersection of psychology and law than forensic mental health evaluators. Their work often begins when courts need answers to highly specific legal questions, like:
- Is a defendant competent to stand trial?
- Did a mental illness affect a person’s ability to understand their actions at the time of an alleged offense?
- Does an individual present a significant risk to themselves or others?
Answering those questions requires specialized training in both behavioral science and legal standards. Graduate education in forensic behavioral science provides the foundation for that work, helping professionals develop expertise in:
- Assessment
- Ethics
- Research methods
- Criminal justice systems
- Courtroom communication
Correctional Behavioral Health Specialist
For many people with serious mental illness, the first consistent mental healthcare they receive occurs after incarceration. That reality places correctional behavioral health professionals at the center of one of the most challenging environments in modern healthcare.
Inside jails and prisons, clinicians provide a wide range of services, including:
- Mental health assessments
- Crisis intervention
- Suicide prevention
- Individual and group counseling
- Medication support
- Reentry planning
- Coordination with community treatment providers
A typical day may involve stabilizing an individual experiencing acute psychosis in the morning, conducting suicide risk assessments in the afternoon, and helping another person prepare for release later that day.
While this work is demanding, it is also highly impactful.
Policy Analyst and Advocate
Not every professional working to improve outcomes operates inside a courtroom, jail, or treatment facility. Some professionals, like policy analysts and advocates, work at a systems level. They translate behavioral science research into practical recommendations that shape legislation and criminal justice reform efforts, an area increasingly informed by AI and crime research tools.
Every example of recent reform discussed in this article, be it mental health courts, 988 crisis services, or the nationwide expansion of Crisis Intervention Team programs, was developed by policy specialists.
For professionals interested in creating change at a broader level, policy work offers an opportunity to influence not just individual cases but entire systems.
Build the Career That Closes the Gap
The relationship between mental health and criminal justice is often framed as a crisis. In many ways, it is. Yet, it is also one of the most solvable challenges facing the justice system today.
- Some professionals work directly with courts, conducting competency evaluations and helping judges understand how mental illness may affect legal proceedings.
- Others design and manage diversion programs that connect people with treatment before deeper justice-system involvement occurs.
- At a broader level, behavioral scientists help shape legislation, funding priorities, and reform efforts through research that informs policy decisions.
For students drawn to both behavioral science and criminal justice, this creates a unique opportunity. The field increasingly needs professionals who can understand mental health through a clinical lens while also navigating the legal, ethical, and systemic realities of the justice system.
The MS in Forensic Behavioral Science at ĢƵ is designed to prepare students for exactly that work. Through a curriculum grounded in behavioral science, evidence-based practice, and real-world forensic applications, students develop the skills needed to address some of the most complex challenges facing the justice system today.
If you are ready to help shape the future of forensics, explore the forensic behavioral science programs at ĢƵ and connect with an Admissions Counselor to learn more.
Sources:
[1] McLeod, Katherine E, Kevin A Wong, Sumner Rajaratnam, Paige Guyatt, Stephanie Di Pelino, Naveera Zaki, Hanaya Akbari, et al. “Health conditions among women in prisons: a systematic review.” The Lancet Public Health. June 30, 2025. https://doi.org/10.1016/s2468-2667(25)00092-1. Accessed June 30, 2026.
[2] Cherson, Jeremy. “America’s Three Largest Mental Health Facilities Are Jails.” The Bail Project. May 14, 2025. https://bailproject.org/learn/americas-three-largest-mental-health-facilities-are-jails/. Accessed June 30, 2026.
[3] Aspinwall, Cary. “Why thousands in jail suffer without mental health treatment.” The Marshall Project, September 6, 2025. https://www.themarshallproject.org/2025/09/06/health-texas-florida-jail-prison. Accessed June 30, 2026.
[4] Post, Stephanie. “What are Collaborative Courts? | San Joaquin County Probation Department.” San Joaquin County Probation Department. October 31, 2024. https://sjcprobation.org/2024/10/31/what-are-collaborative-courts. Accessed June 30, 2026.
[5] Rodriguez, Christian. “Improving public safety through better accountability and prevention.” Center for American Progress. May 15, 2025. https://www.americanprogress.org/article/improving-public-safety-through-better-accountability-and-prevention/. Accessed June 30, 2026.
[6] Purtle, Jonathan, and Michael Lindsey. “The 988 Suicide and Crisis Lifeline in the US: status of evidence on implementation.” World Psychiatry. Jan 15, 2025. https://doi.org/10.1002/wps.21285. Accessed June 30, 2026.
[7] Saunders, Heather. “Demand for 988 continues to grow at third anniversary.” KFF. August 9, 2025. https://www.kff.org/mental-health/demand-for-988-continues-to-grow-at-third-anniversary/. Accessed June 30, 2026.