Episode 6 (Part I): Jail 101
In the previous series, we examined how economic forces have driven rising rates of mental illness—especially among young people. Now we can start digging into the role of jail in all of this. My plan is to explain the nuts and bolts of jails and jail mental health, and after we’ve been through the basics, we can get into some of the more complicated, convoluted, and backwards issues that prevent the mental health system from working.
First, we need to understand what jail actually is. This episode is part one of a two-part crash course on jails and mental health. Here, we will focus on the basics of jails. In the next episode, we will shift to the clinical side and discuss mental illness inside these facilities.
Jail Is Not What Movies Show You
In movies and television, someone is arrested for a serious crime and appears in court almost immediately for a jury trial. In reality, this is wildly inaccurate. In the United States, it often takes a year or more for a felony case—especially something like murder—to go to trial. I have personally seen cases take five years to resolve. During that entire time, the person may be sitting in jail.
Crimes and Sentencing: Three Tiers
Felonies are the most serious offenses and can carry sentences of one year or more in jail or prison.
Misdemeanors are less serious and typically carry sentences ranging from 30 days to one year in jail.
Ordinance violations rarely involve jail time and usually result in a fine.
One important point is that the severity of a charge does not always reflect how dangerous a behavior is. Driving under the influence is extremely dangerous and often classified as a misdemeanor, while possession of marijuana is charged as a felony in some states.
Another important point is that people do not always serve the amount of time suggested by sentencing guidelines. I have seen individuals plead guilty to felonies and receive no jail time, and I have seen people with mental illness fight misdemeanor charges and remain detained—between jail and the state hospital system—for over a year. Technically, no judge sentenced them beyond the statutory limit, but functionally, they were incarcerated longer than the maximum sentence.
Jail vs. Prison
Jails and prisons are often conflated, but they serve very different purposes.
Jails are short-term facilities. They primarily hold people who have been charged with a crime and are presumed innocent until their case is resolved.
Prisons are long-term facilities for people who have been convicted of felonies.
The defining feature of jails is rapid turnover. In the jail where I work, the average length of stay is about 48 hours. In a single day, we may book and release 100 people. This rapid turnover is partly due to constitutional requirements. After an arrest, prosecutors must establish probable cause—basic evidence justifying the arrest—within roughly 48 hours. If they fail to do so, the person must be released. This becomes critically important later when we discuss people with severe mental illness who cycle in and out of jail every two days.
From a mental health standpoint, the jail environment is extraordinarily difficult. Jails are noisy, chaotic, confusing, stressful, and sometimes dangerous. Diagnosing and treating mental illness under these conditions is a major challenge, both for patients and for staff.
How Bail Works
Bail functions much like collateral at a pawn shop. A judge assesses how dangerous someone is and how likely they are to return to court. Based on that assessment, the court sets a dollar amount. If the person—or someone on their behalf—pays that amount, they are released. If they fail to appear in court, the money is forfeited. Judges can also deny bail entirely if they believe someone is a serious danger or flight risk.
The implication is: it is easier to get out of jail if you have money.
Many people in jail are indigent or homeless, and even a $500 bail is out of reach. This disproportionately affects people with mental illness, who are far more likely to be poor or unhoused. As a result, they remain incarcerated far longer than others charged with similar offenses.
Why Almost No One Goes to Trial
Television gives the impression that trials are the norm. In reality, they are exceedingly rare. Nationally, only about 2% of criminal cases go to trial. In my jurisdiction, that number is closer to 0.5%. Almost all cases are resolved through plea deals. There are two main reasons for this.
Trials Are Expensive
Trials cost taxpayers tens of thousands of dollars. Judges must clear their schedules, prosecutors and defense attorneys must prepare extensively, and jury trials consume enormous resources—sometimes over minor charges.
From the state’s perspective, trials are risky. Spending large sums only to lose the case is politically damaging for prosecutors.
Jail Is Too Costly for Ordinary People
Most people cannot afford to sit in jail for weeks or months while fighting a charge. Employers will not tolerate extended absences. Rent, car payments, childcare, and caregiving responsibilities do not pause because someone is incarcerated.
Roughly 60% of Americans cannot afford $500 in emergency expenses, which means many people are functionally coerced into plea deals. For some, pleading guilty to a crime they did not commit is the rational choice for survival. This pressure is even greater for people with mental illness.
Probation, Parole, and Holds
Probation allows someone to remain in the community under supervision instead of serving a jail sentence.
Parole allows someone to leave prison early under supervision.
Holds occur when a person is arrested in one jurisdiction for charges pending in another.
If a person has an out-of-state warrant, the jail may detain them while the originating jurisdiction decides whether to extradite. These holds typically last up to 30 days. For minor offenses, extradition is often deemed too expensive, and the person is released. Again, the system runs on money.
Why Jails Have a Mental Health Crisis
Jails were never designed to be mental health treatment facilities. Yet there are ten times more people with serious mental illness in jails and prisons than in all long-term psychiatric hospitals combined.
This happened because mental health services are chronically underfunded at every level. The United States has eliminated approximately 96% of its state psychiatric hospital beds. Community mental health centers are overstretched, and insurance reimbursement rates are so low that many clinicians refuse to take insurance (insisting on cash payments only).
As a result, jails—never intended for this role—have become the largest mental health providers in the country. Police officers and correctional staff are now the most common first responders to psychiatric crises.
In a 50-mile radius of where I work, only two facilities house more mental health patients than my jail. One is a prison. The other is another jail.
Treating Mental Illness in a Jail Environment
Consider the conditions:
High noise and constant disruption
Extremely high patient turnover
More psychiatric patients than a hospital
Fewer mental health staff than a hospital
Little to no medical history available for many very sick patients
Patients often restrained during evaluations
Housing environments filled with people who are nefarious or psychotic
It is difficult to imagine meaningful recovery under these circumstances. In the next episode, I will explain how jails attempt to provide care despite these constraints.
Two Concepts That Will Matter Later
Recidivism
Recidivism refers to being convicted of a crime, serving a sentence, and later being convicted again. High recidivism rates signal a mismatch between people’s problems and the system’s responses.
Competence to Stand Trial
In the U.S., a person cannot be tried or accept a plea if they are legally incompetent—that is, if they cannot understand their charges, the consequences, or assist in their defense.
Determining competence requires evaluations by independent clinicians. If a person is found incompetent, they must undergo competence restoration, usually at a state psychiatric hospital. This process is slow. From identification to evaluation, hospital waitlists, restoration, and return to jail, the timeline often exceeds seven months, even when everything goes smoothly. In some cases, it takes far longer.
Simply being mentally ill can result in longer incarceration than the sentence for the underlying offense.
What Comes Next
In the next episode, we will shift to discussing basic mental health care. We will examine what mental illness looks like inside a jail, who provides care, and what treatment is realistically possible under the conditions we have discussed.