A new national epidemiological survey, published on April 9, 2025, provides a detailed picture of the mental health conditions of people involved in the criminal justice system. Conducted by Jeffrey Swanson from Duke University School of Medicine and colleagues, the study found significantly higher rates of mental health conditions among incarcerated individuals and those with recent criminal legal involvement, compared to the general population.
The survey explores the intersection of mental health and criminal justice in the U.S., a topic that has been under-researched despite growing concerns. Since the closure of large public mental health institutions in the late 20th century, the U.S. has seen an increase in mass incarceration. Today, individuals with criminal justice involvement are more likely to experience mental health disorders than the general public. This study aims to fill gaps in understanding the psychiatric profiles of justice-involved adults and highlight the need for better community mental health support.
The study involved semi-structured clinical interviews conducted between October 2020 and October 2022 with a diverse group of participants: 321 currently incarcerated adults, 269 adults with recent criminal justice involvement, and 5,004 adults with no criminal legal history. The interviews were carried out by clinicians with at least a master’s degree in mental health or related fields.
Key Findings on Mental Health Disorders
The survey found that 40% of individuals with any criminal legal involvement in the past year met the diagnostic criteria for at least one of the following mental health conditions: schizophrenia-spectrum disorder, bipolar I disorder, obsessive-compulsive disorder, major depression, generalized anxiety disorder, or post-traumatic stress disorder (PTSD). The highest prevalence of these disorders was observed among those who were currently incarcerated (42%), followed by individuals with recent criminal legal history (37%), and the lowest prevalence was found among those with no recent criminal legal history (24%).
Demographic Insights and Implications for Intervention
The study also explored the demographic makeup of the three groups to better understand the needs of specific communities. In both the incarcerated and recent criminal legal history groups, men made up the majority: 93% of the incarcerated group and 70% of the recent criminal legal history group. In contrast, men made up only 48% of the general population group. The largest proportion of individuals in both the incarcerated and recent criminal legal history groups identified as Hispanic/Latino (34% and 44%, respectively).
The authors acknowledge that the study may not fully represent the national population and that its results show correlation rather than causation. They also note the reliance on self-reported data, which may impact the transparency of the findings, especially regarding recent criminal legal history in individuals not currently incarcerated.
The Need for Better Mental Health Care and Support
The findings emphasize the urgent need for appropriate and informed mental health care for individuals involved in the criminal justice system. Better support for those with psychiatric conditions could help reduce the high rates of incarceration and offer more effective treatment for people in crisis within communities.
Lead author Jeffrey Swanson, who is also affiliated with the Wilson Center for Science and Justice at Duke Law School, emphasized the significance of the study, noting, “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.” Swanson added that the study provides more specific diagnostic information to better address the U.S. mental health crisis where it is most needed.
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