The United States Criminalizes People Who Need Health Care and Housing

Why we should spend more on public health and less on jails and prisons.
Erica Bryant Associate Director of Writing
Oct 17, 2023

Gaping holes in the social safety net and health care systems leave many without access to health care and housing in the United States. Yet, too often, people in need of these resources end up in jail and prison instead.

Criminalizing people who have health care and housing needs is counterproductive, harmful, and wasteful. People facing these challenges are disproportionately incarcerated and could be better served by systems designed to aid rather than punish.

People experiencing mental health conditions

Inadequate investment in infrastructure for mental health services has left many people unable to access sufficient care. In the United States, people must wait an average of 48 days to access mental health or substance use services, and many struggle to afford needed services that are inaccessible without insurance.

While waiting lists for community-based psychiatric and mental health services grow longer, jails and prisons fill up with people experiencing treatable mental health conditions. Nonviolent behaviors associated with mental illness that could be avoided with adequate support—like loitering, disorderly conduct, and trespassing—are criminalized, resulting in the incarceration of people who need treatment, not punishment.

This has turned jails and prisons around the country into de facto mental health care providers. As of September 12, there were more than 5,300 people with mental health needs in the Los Angeles County jail system—making it the largest mental health care provider in the United States.

Yet carceral settings are simply not conducive to the delivery of high-quality mental health care. Nearly two-thirds of people with mental illnesses in jails and prisons do not receive any mental health treatment. Instead, they are often subjected to harsh treatment that can exacerbate their symptoms.

People with mental illness also often face challenges navigating life behind bars and are more likely to receive additional punishment. Solitary confinement, for example, is routinely used for people experiencing severe mental health symptoms, even though extreme isolation is known to worsen mental illness and can cause long-term damage, leaving incarcerated people unprepared to successfully reenter communities after their release. Indeed, suicide is the leading cause of death in local jails; a person in jail is more than three times as likely to die by suicide than a person in the overall U.S. population.

Mental health treatment in community settings is not only a far better alternative to treat people with mental illnesses than incarceration, but also a more responsible use of public resources. In Los Angeles, it costs approximately $180 per day to provide community-based housing and clinical care for people with serious mental health needs—versus $445–$650 per day to hold them in the city’s jails.

People with substance use disorders

Using incarceration to combat the negative impacts of substance use has been a failed strategy. Still, the United States continues to overinvest in jails and prisons that incarcerate people who would be better served with treatment in the community. Forty percent of people in state prison met the criteria for a substance use disorder in the 12 months prior to their admission to prison. The Bureau of Justice Statistics National Inmate Survey suggests that, from 2007 to 2009, more than 20 percent of people incarcerated were convicted for crimes related to obtaining drugs or obtaining money for drugs.

Little is done to help people with substance use disorders once they are incarcerated. Despite evidence that shows prison-based drug treatment can help people break the cycle of incarceration and prevent overdoses post-release, many people with substance use disorders do not receive treatment while behind bars.

Meanwhile, there is also underinvestment in community-based drug treatment programs that can help prevent drug-related behaviors that can result in incarceration. A 2022 study of Missouri Certified Community Behavioral Health Clinics that treat mental health and substance use disorders found that, of the clients who engaged in care and had some prior law enforcement involvement, 70 percent had no further law enforcement involvement following six months of treatment. It is clear that we need to expand evidence-based approaches to problems caused by substance use rather than rely on failed strategies that simply punish.

People experiencing homelessness

People experiencing homelessness are often criminalized for essential behaviors associated with their lack of housing. As tenants and homebuyers nationwide continue to endure an acute affordable housing crisis, some cities have passed laws prohibiting people from living in vehicles and sitting and sleeping in public spaces. Cities with limited public restrooms make public urination a crime. Texas has criminalized public camping. Bans on “loitering” and “vagrancy” give law enforcement latitude to target unhoused people. Dozens of cities in the United States have even made feeding people experiencing homelessness illegal.

As a result of laws that attach criminal penalties to survival activities, unhoused people are 11 times more likely to be arrested than those who have housing. Yet, incarceration is no solution to the problem of homelessness. Clearly, more investment in affordable housing would help people who are priced out of permanent, quality shelter. More public and affordable housing providers should rent to people who have conviction histories. Bans on renting to formerly incarcerated people contribute to the cycle of incarceration by making it difficult for them to readjust to public life, as being unable to provide a stable address creates barriers to employment and self-sufficiency.

More resources are also needed for the estimated 16 percent of people experiencing homelessness who have serious mental health conditions. New York City spends an appalling $556,539 annually to jail people in hellish conditions on Rikers Island. In contrast, it costs about $42,000 to house someone in a supportive housing program that provides individualized services for people with behavioral health needs that can lead to incarceration.

The past decades of mass incarceration have shown that punishment does not improve public health, yet the United States continues to spend more than $80 billion a year on corrections. The overcriminalization of people with health and housing needs doesn’t make us safer. Instead, we need greater investment in solutions that are proven to improve outcomes for people experiencing mental illness, substance use disorders, and homelessness. Greater investment in services that aid, rather than punish, will help build a healthier, safer society.