Incarcerated individuals and those with recent criminal-legal involvement report significantly higher rates of mental health diagnoses than other community members, calling for reforms in community mental health support

A new national epidemiological survey provides a demographic and diagnostic picture of people living with mental ill health in prison, those with criminal legal involvement in the last year, and those with no criminal legal history in the last year—finding significantly higher rates of five mental health conditions in incarcerated individuals and individuals with recent criminal legal history. The results are described in a study published on April 9, 2025 from Jeffrey Swanson of Duke University School of Medicine, United States, and colleagues.

In the second half of the 20^th century, large public mental health institutions in the United States began to close and rates of mass incarceration increased. Today, individuals involved with the criminal legal system in the US have much higher rates of diagnosed mental ill health than the general US population, though studies around this topic are limited in scope and/or validity. Here, Swanson and co-authors attempt to refine the national picture of the psychiatric diagnostic and demographic profile of justice-involved adults as compared to other adults in the community to better understand the current gaps in community mental health support.

The authors surveyed persons sampled from households, prisons, hospitals, and homeless shelters across the US: currently-incarcerated adults (N=321); adults not incarcerated but involved with the criminal justice system in the past year (N=269); and adults with no criminal legal history in the past year (N=5,004). These semi-structured clinical interviews took place between October 2020 and October 2022, conducted by clinicians with at least a masters-level degree in mental health, social work, or a related field.

The analysis revealed that approximately 40 percent of individuals surveyed with any criminal involvement in the past year met diagnostic criteria for at least one of the following: schizophrenia-spectrum disorder, bipolar 1, obsessive-compulsive disorder, major depression, generalized anxiety disorder, and/or post-traumatic stress disorder. The prevalence of these disorders was highest for people currently incarcerated (42 percent; 95% CI: 33-51 percent), lower in the community resident population with past-year criminal-legal history (37 percent; 95% CI: 25-51 percent), and lowest for individuals with no recent criminal-legal history (24 percent; 95% CI: 22-27).

The authors analyzed demographic representation within the three populations in order to better understand the needs of specific communities and thus inform interventions. They report that within the surveyed participants, men were the significant majority in both the currently incarcerated (93 percent) and recent criminal-legal history groups (70 percent), though the minority (48 percent) in the general community group. They also report that among incarcerated individuals and those with recent criminal legal history, the largest proportion identified as Hispanic/Latino (34 and 44 percent, respectively).

It's critical to remember that these results may not represent the population on a national level and can only show correlation but not necessarily causation. As the authors note, there are many complex racial, class, and societal factors at play in terms of who is incarcerated in the United States. The authors also note they relied on self-reporting, which has implications for transparency - especially when exploring recent criminal-legal history among individuals not currently incarcerated.

Nonetheless, the results underscore the critical need for informed and appropriate care and treatment for individuals who need support for psychiatric conditions as a way to reduce the high rates of incarceration in the United States and better support community members in crisis.

Lead author Jeffrey Swanson, also affiliated with the Wilson Center for Science and Justice at Duke Law School, adds: “We found that 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. What’s new about this study is more specific diagnostic information to help address the U.S. mental health crisis where we find it.”

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In your coverage please use this URL to provide access to the freely available article in PLOS Mental Health: https://plos.io/42uec9Y

Citation: Swanson JW, Stenger M, Easter MM, Bareis N, Chwastiak L, Dixon LB, et al. (2025) Mental disorders and criminal legal involvement: Evidence from a national diagnostic epidemiological survey. PLOS Ment Health 2(4): e0000257. https://doi.org/10.1371/journal.pmen.0000257

Author Countries: United States

Funding: This work was supported by the Substance Abuse and Mental Health Services Administration (SAMHSA, Grant/Award Number: H79FG000030 (authors: HG, MJE); the National Institute of Mental Health (NIMH) grant ID: K23 MH129628 (author: NB), the Elizabeth K. Dollard Charitable Trust (authors: JS, MS, MSS, MME), and the Wilson Center for Science and Justice (authors: JS, MS, MSS, MME). The funders had no role in the conceptualization, design, data collection, analysis, decision to publish or preparation of the manuscript.