Skip to main content

Unwell in a Cell

By co-opting the language of mental health and treatment, jail expansion is taking root in several localities. But these are cages all the same.


Calling in from Rikers Island in March, prison activist Dr. Al Fatah Stewart explained one proven way for a person detained at the notorious jail complex to receive treatment for a serious bodily injury. “When an inmate is stabbed, the only way to get to medical care is to punch or slap a prison guard, because now they’ll spray you, beat you, and bring you to the clinic where it’ll be discovered the inmate has a serious stab wound,” Al Fatah said. He should know. Al-Fatah has spent several years in New York City’s jails, which have seen more than 18 deaths and countless other instances of violence between 2021 and 2022. Three years ago, Al-Fatah wrote, “Mental health staff don’t write down nothing you tell them or act on what you tell them.”

The recent spate of deaths led the new mayor, Eric Adams, to release his Blueprint to End Gun Violence plan, which includes mental wellness and psychiatric support for incarcerated people — an apparent break with his push for carceral reforms in other areas. In February, following this announcement, a plan to build new psychiatric units at Rikers stalled despite the administration’s professed commitments to inside mental healthcare. The administration continues to drag its feet, despite the fact that New York City’s jails have been wracked by endemic issues around mental illness and disability, not just now but for decades. City leaders’ only apparent solution lies in the form of four new borough-based jails, which promise “tailored housing for medical, behavioral and mental health needs,” to be built by 2027.

The lack of attention to ongoing needs raises the question about how the city will care for people incarcerated in the new jails, when it can barely meet the needs of incarcerated people now.

The reality in New York City demonstrates a phenomenon taking place across the country, as the imminent need for robust, holistic, and responsive mental healthcare inside penal facilities is deferred in favor of supposedly improved services in the future, within newer, shinier jails. Counties, sheriffs, boards of supervisors, and elected officials have pointed to the need for increased mental health support inside jails as a pretext for new jail construction, without any demonstrated commitment to the welfare of incarcerated people at the present moment. Faced with the urgent need for substantial decarceration, these power brokers perform a sudden interest in improving psychiatric services within jails.


As a co-coordinator for the No New Jails Network, an abolitionist network of decarceration and anti-jail campaigns, I’ve seen several campaigns focus their efforts on challenging trends of ableist and sanist reforms through discursive, physical, and strategic means. Advocates and organizers both inside and outside prison walls have noted how language around “therapeutic,” “mental health focused,” “trauma informed,” and “restorative” jails have pushed forward an insidious agenda of carceral expansion. These trends are both as old as incarceration itself and as new as “post-racial” liberalism in that they seek to perpetuate the Prison Industrial Complex, while obscuring, and adding to, what the PIC does. For some counties, jail expansions, psychiatric units, and so-called therapeutic renovations provide a way to market incarceration as something that will provide an influx of jobs and cash to local residents.

In other counties, the jails are simply too unpopular to be sold as jails. In New York City, for example, the borough-based jails are marketed as “civic assets,” which “embody a generative spirit.” And in other cities, they’re sold as “therapeutic” or “direct supervision jails.” Faced with a swell of interest in civic budgets and policing from local communities, cities investing in new jails deflect attention on corrections by characterizing the facilities as investments in mental health and rehabilitative alternatives.

About 37% of people inside U.S. prisons have been diagnosed with a mental illness, and of those, many could be deemed mad or disabled (psychologically, intellectually, and physically). In local jails, that number can inch past 44%, with several thousands more people remaining undiagnosed, having a mental health issue not considered “serious,” or being released without adequate support for documenting their health. The Department of Justice in 2017 reported that 1 in 4 people arrested and sent to jail meets the threshold for “serious psychological distress.” The medical units in Chicago, Los Angeles, and New York City jails see some of the largest numbers of people seeking mental health services in the country. Despite the reality and scale of need, almost none of the millions of people incarcerated in 2,850 local, county, regional, and private jails receive adequate or proper mental health treatment behind bars. As a result, deaths inside jails are on the rise, and while this jump in custodial deaths cannot be attributed in its entirety to mental health, lack of overall healthcare is nonetheless one of the leading causes of deaths inside jails.

These statistics help to broadly outline the crisis of care within jails, one exacerbated by abuse, physical disability, transphobia, intra-group violence, and disempowered healthcare providers. It comes as no surprise, then, that incarcerated people across the country are demanding higher standards of care — but not at the cost of their freedom. Proponents of expansions featuring new jails, drug courts, “gentler” prosecution, and police supervision fail to recognize that in order for a jail to become an effective provider of care, it must cease to exist.

In particular, this resurfaced trend of mental-health jails appeals to what James Kilgore has termed “carceral humanism,” a paradigm which entrenches jails, prisons, and police as social service providers in areas related to substance use, mental health, and recovery. As Kilgore writes, “the cutting edge of carceral humanism is the field of mental health.” In addition to jail expansion, a form of carceral humanism can be observed in several criminal justice reforms — including, for example, the imposition of fines or house arrest instead of jail time for people with mental health diagnoses. These can be characterized as carceral humanist projects due to their failure to address the predatory and anti-Black roots of incarceration and institutionalization.

Along with carceral humanism, another framework, “carceral sanism,” provides further context for understanding the relationship between 21st century jail expansion and mental health. The scholar Liat Ben-Moshe has made this intervention, highlighting the ways the practices, tools, histories, and technologies that make up incarceration include, resemble, and engage the practices, tools, histories, and technologies of psychiatry towards the continued surveillance and oppression of mad people. As Ben-Moshe highlights, it’s critical that campaigns to stop the construction of new jails, and close old ones, feature a mad/disabled of color analysis, as well as the presence of mad and disabled activists on the inside and outside.

Abolitionist resistance to carceral humanist and sanist narratives around jail construction must reach to the heart of the problem.

Abolitionist resistance to carceral humanist and sanist narratives around jail construction must reach to the heart of the problem. First, that the pathologization of mad and disabled people of color has its roots in anti-Indigenous and anti-Black eugenics and depicts neurodivergence and disability as something to be fixed or treated. Whether in jail or out, a policy that prefigures the arrest and institutionalization of mad and disabled people is not viable. Second, that while there are people who receive mental health treatment while imprisoned, this is more a consequence of an illegitimate and gargantuan penal system rather than its goal. Third, carceral spaces and actors are incapable of providing care within a system that is fundamentally coercive, dehumanizing, and ableist. And lastly, that the concepts of mental illness and disability are forms of social ordering and control with systematization and triage in mind. In reality, there is no singular standard or understanding of health, only a varying, subjective, faceted experience that changes based on an individual’s socioeconomic circumstances, race, gender, and location.

Mental health-focused carceral expansion has followed a period of “deinstitutionalization,” where many psychiatric and residential institutions were shuttered. Between 1955 and 2000, where the majority of deinstitutionalization occurred, so did the prison boom. As deinstitutionalization took place, cities and states were simultaneously continuing to criminalize disabled people at large through laws which impoverished them; through racism and ableism in the healthcare system; through police brutality aimed at those with disabilities; and through cultural norms that portrayed disabled people as violent and harmful. In the move from asylum to prison, incarceration simply took on a different form. In 1955, the state mental health population was 559,000, a number that is close to the number of total people incarcerated in local jails in 2022.

Deinstitutionalization featured reforms that, in response to horrible conditions inside psychiatric and residential institutions, sought to improve rather than abolish them — the logic of which resonates in several modern-day criminal justice reforms.

During the prison boom, civic budgets for healthcare, food, construction, and several other needs ballooned. Jails and prisons are now some of the largest providers of “healthcare” in the U.S., but thousands still die in these facilities every year. A 2018 report by Pew found that the Health and Hospitals System in Cook County, Illinois spent nearly $100 million on jail health care in fiscal year 2016 — “more than seven times what the county spent on traditional public health services.”

In 2019, several people cried “You can’t get well in a cell!” while resisting a nearly $2 billion contract to build a mental health-focused jail in Los Angeles. Owing to persistent and widespread organizing, the Los Angeles County Board of Supervisors voted in 2019 to cancel construction. Several other counties around the country, however, move forward with their plans. The following three counties provide a deeper look into some of the ways jail expansion is being justified.

Orange County, California

In 2016, the Orange County Board of Supervisors chairwoman said, “Based on the current population of Orange County we should have about 1,500 psych beds,” which followed a mental health jail expansion proposal by the county. This mental health jail expansion in Irvine has received intense pushback, as residents of the county argue that pandemic jail numbers have been lower than ever, negating the need for new beds. According to the Stop the Musick Coalition in Orange County, which is currently fighting to stop construction, the expansion includes adding two new housing structures and almost 900 new beds. The expansion would increase the total beds in Orange County jails to almost 7,500.

“The Orange County jail has become the de facto mental hospital of Orange County,” Sheriff Don Barnes told local media, adding, “If we are going to be the mental hospital of Orange County, we are going to be a good one.” Barnes obtained nearly $300 million dollars in state and county funds to add the beds. Two members of Stop the Musick Coalition argue that “we cannot effectively address the mental health crisis by placing the burden of mental health treatment on jail staff in carceral facilities, which are not therapeutic spaces.”

Jose Armendariz, an incarcerated organizer in Orange County, writes,

Nine hundred new jail beds will not treat the mental health condition of incarcerated people. Doctors and therapists treat mental health. Any place that disproportionately hires more deputies and officers than mental health counselors and therapists is not a mental health hospital, and it should not be receiving the funding that community mental health services outside of jails are in desperate need of. Law enforcement officers are not trained mental health professionals. They lack the patience and training necessary to deal with people suffering from mental health conditions.  Without the approval or consent of his county’s constituents, Barnes, this sheriff declared himself the “Sheriff of Mental Health” and robbed his community of $300 million to construct a jail that records show is already below capacity.

New Orleans, Louisiana

In 2016, the story of Colby Crawford, a 23-year-old Black man, made national news. Crawford died of an overdose inside Orleans Justice Center in New Orleans, 10 months after his arrest and shortly after his release from a psychiatric institution. Despite several community members affirming, at the time, that Crawford’s arrest and incarceration directly contributed to his death, the story renewed a long-standing debate between the sheriff’s office, the city, and activists about mental health inside jails.

Now, a proposed 89-bed addition to the Orleans Parish Prison is intended to provide a space for people in custody with mental health needs, currently already being held at a state prison. But activists have demanded that the city put the funds towards developing mental healthcare outside of jail. Notably, OPP has been under a federal consent decree since 2013 to improve conditions of confinement for those detained in OPP facilities. It is this consent decree that provided the basis for Sheriff Marlin Gusman, whom voters recently ousted, to argue for psychiatric beds as “improved conditions.”

Instead of the “Phase III” psychiatric unit expansion, as this project is known, organizers in New Orleans are instead advocating for a “a crisis stabilization center that would provide care outside of a carceral setting for people with serious mental illness,” as well as a cheaper retrofit to the existing jail. The 89 number is a reduction from an original proposal of 700 beds by Gusman, who seized on the lack of mental health support in the existing jail as a rationale for the expansion. Although the reduction in proposed beds is laudable, it is unclear how a crisis stabilization center or the retrofitting promote long-term decarceration in the city.

Travis County, Texas

In 2021, Travis County commissioners voted on whether to spend $4.3 million on the design contract for a new 350-bed women’s jail, which would have cost $80 million to build. Amidst a pandemic and rising homelessness, and despite reductions in the number of bookings, the Commissioners sold the facility as a “trauma informed women’s facility.” The proposal for the new jail came despite significant reductions in jail bookings between 2015 and 2020, provoking questions about why the county would push for such a thing at this stage instead of continuing to invest in reducing the numbers of people in jail. While pushing for the new jail, Travis County Sheriff Sally Hernandez said, “I don’t want it to just be a holding facility. I want to be a place that makes a difference in people’s lives,” suggesting that she was unaware of the primary purpose of incarceration.

In response to this move, Dr. Snehal Patel and Dr. Lisa Medina wrote:

As professionals trained in addressing the health effects of trauma, we are deeply concerned about the description of this jail as “trauma-informed.” Rather, we know that incarceration is an underlying cause of trauma, not only for incarcerated individuals, but also for their families and communities. In addition to long-term psychological and physical harm, incarceration involves financial ruin, family separation, loss of child custody, sexual violence, and the consequences of being humiliated by jail staff through authoritarian orders and full body searches.

Over 800 people provided testimony over email and in person ahead of the vote. Community leaders and anti-jail coalitions pointed to solutions such as Austin’s Sobering Center, which is a site for people to sober up without arrest, as an example of initiatives the county could continue to expand. Disabled and formerly incarcerated activists provided testimony, demanding better resources instead of a new jail. As a result, Travis County has postponed the vote on the contract indefinitely and passed a resolution to create a working group that will continue to reduce the number of women in jail.

Assessments and proposals around improving psychiatric care in new facilities abound in ongoing jail construction efforts across the US. Along with these three counties, there’s Tuscaloosa County, Alabama, where the county commission recently approved a $13 million expansion to supposedly meet the mental health needs of incarcerated people. Or Contra Costa, California; Dane County, Wisconsin; Toledo County, Ohio; and many more. In Montgomery County, Ohio, for example, a jails assessment has suggested that mental health is an “unmet need” among incarcerated people in the jails. “The need for dedicated beds for mental health treatment, medical housing, and segregation adds 150 – 200 additional beds to required facility capacity needs, for a total of 1,134 beds,” says the assessment, unsurprisingly compiled by several companies that stand to benefit from jail design and construction contracts.

But people who know the system know better. As Sterling, formerly incarcerated in New York’s Queensboro Correctional Facility, wrote with regards to the proposed jails in New York City: “I’m truly in support of community reparations, true rehabilitative services, housing, employment opportunities, and overall means to help, instead of the ‘joke’ mental-health services and job training in prison. This is needed in the communities . . . .”

The different strategies that communities like the ones in Orange County, New Orleans, and Travis County have used to respond to sheriffs, commissioners, and city councilmembers provide ideas for varied resistance against the advent of carceral humanism. It is critical for abolitionist organizers to question not only the logic of mental health jails and jail expansion but also the inherent ableism and sanism of all forms of psychiatric institutionalization and treatment.

In particular, incarcerated people who are mad and disabled, outside organizers with those intersecting experiences, and healthcare workers can push against the logic of carceral expansion. When almost half a million people are in jails without conviction, the alternative cannot be to divert them from a jail to a psychiatric institution or a cage by another name. As scholar and economist Ruth Wilson Gilmore writes, abolition is “about building life-affirming institutions.” In the fight for widespread moratoriums on jail, prison, and detention construction, through decarceration strategies, abolitionists will remain vigilant about what emerges in their stead.

Image: Syarafina Yusof/Unsplash