Mental Illness in the Criminal Justice System
Updated October 13, 2026
In many places, a 911 call about a mental health crisis still gets a patrol officer, not a clinician, though mobile crisis teams and co-responder programs are expanding in some jurisdictions. NAMI has long estimated that roughly two million people with serious mental illness are booked into jail each year, and many don’t receive treatment while they’re there.
In a lot of jurisdictions, a 911 call for a person in crisis still routes to patrol by default, though a growing number of cities now dispatch mobile crisis teams, behavioral-health responders, or co-response units instead of, or alongside, police. Which one you get depends entirely on where you’re standing.
You won’t get much warning about which kind of call you’re walking into. The same radio call that reads “disturbance” or “welfare check” can turn out to be a psychotic episode, a manic break, or someone off medication for a week. Crisis response and de-escalation training are increasingly part of police academy curricula in a number of states, but the content, the hours required, and whether it’s mandated at all vary by state and by the certifying body that oversees training there.
Why Officers End Up as First Responders
Officer discretion on whether to make an arrest for a minor, nonviolent offense like trespassing depends on state law, department policy, and the specifics of the call, not on a single national rule. The CSG Justice Center’s Police-Mental Health Collaboration (PMHC) guidance recommends building that discretion into department policy so an arrest isn’t the default response to a mental health crisis.
A 2015 Treatment Advocacy Center study found that people with severe, untreated mental illness were 16 times more likely to be killed in a police encounter than other civilians, and estimated that roughly one in four fatal police shootings nationwide involved someone with a mental illness. It’s an older study, but it remains the most frequently cited figure on this question, and no comparable national study has replaced it since.
What the Numbers Look Like From the Jail Side
NAMI has estimated for years that roughly two million people with serious mental illness are booked into jail annually. The organization’s current figures put the share of people with a history of mental illness at nearly 2 in 5 in state and federal prisons, and 44% in local jails, and say less than half of people with a history of mental illness receive mental health treatment while incarcerated in jail, per NAMI.
A Bureau of Justice Statistics report published in 2017, drawing on its 2011–12 National Inmate Survey, found that only 36% of prisoners and 30% of jail inmates who showed signs of serious psychological distress were currently being treated for it at that time. Those figures reflect the survey period they were drawn from, not current conditions. In some jails, medication access at intake can be delayed while someone waits on a psychiatric evaluation, though how long that takes varies by facility.
Part of the pressure behind these numbers is a shrinking supply of psychiatric hospital beds. The Treatment Advocacy Center’s 2024 “Prevention Over Punishment” report put the number of state psychiatric hospital beds at a historic low of 10.8 per 100,000 people as of 2023, and found that a majority of the beds that remain are now occupied by people referred through the criminal legal system rather than civil patients. The same report found inmates waiting for one of those beds spent a median of two months in jail first.
Training Requirements Vary by State
Whether you get real preparation for crisis response depends heavily on where you’re hired. A National Conference of State Legislatures database, last updated in 2024 with data collected in August 2023, counted at least 38 states and the District of Columbia with statutory requirements for officer training on physical and mental health conditions. A state that doesn’t show up in that count may still require training through its POST commission, academy curriculum, or other state-specific standards body, since NCSL’s database tracks statutory mandates only, not every regulatory or administrative requirement.
Crisis Intervention Teams: A Widely Adopted Model
The most established response to the training gap is the Crisis Intervention Team (CIT) model, which pairs specially trained officers with mental health providers and people with lived experience of mental illness. CIT isn’t a license or a certification; it’s a training model that departments adopt voluntarily, and implementation and training length vary by program. The original Memphis-model course is commonly associated with roughly 40 hours of instruction, though individual programs differ.
Memphis’s original CIT program is still the one most frequently cited by name, and the figure usually attached to it is an 80% drop in officer injuries during mental health crisis calls in that specific program, according to NAMI’s tracking of Department of Justice data. That result describes Memphis’s own experience and shouldn’t be read as a guarantee of what any individual CIT program will produce.
CIT is one piece of a broader framework the CSG Justice Center calls Police-Mental Health Collaboration, which also includes co-responder teams (an officer paired with a clinician on the same call), mobile crisis teams (clinicians who respond without an officer), and case management teams that follow up with people who have frequent contact with police. CSG has built out the full PMHC framework for departments deciding which pieces fit their call volume. NAMI says CIT programs now operate in more than 2,700 communities nationwide.
What Happens After the Arrest
The criminal justice system’s approach to people with mental illness has a long, unsavory history. The CSG Justice Center’s 2002 Consensus Project Report was the first national effort to map where this system breaks down, from the 911 call through release and back again.
Diversion and Mental Health Courts
Some states allow pretrial diversion for defendants with mental illness, meaning a case can be steered toward treatment instead of jail before trial, per the NCSL, though availability, eligible charges, and procedures vary substantially by state and locality. Some jurisdictions also run dedicated mental health courts, which supervise treatment in ways that differ considerably from one court to the next depending on local structure and eligibility rules.
The federally funded Justice and Mental Health Collaboration Program has funded local diversion and training efforts since the Consensus Project Report. The Stepping Up Initiative, a national effort led by the CSG Justice Center, the National Association of Counties, and the American Psychiatric Association Foundation, works with counties to reduce the number of people with mental illness held in local jails. The CSG Justice Center’s County Justice and Behavioral Health Improvement Project gives counties a framework for weighing an individual’s criminal risk, illness severity, and substance use so officers, judges, and parole staff can calibrate a response.
Supervision and Reentry
CSG Justice Center guidance, drawing on SAMHSA data, has long put the share of people on probation or parole with a serious mental health disorder at an estimated 7 to 9%. For release planning, CSG recommends the APIC framework, a transition-planning approach rather than a nationwide requirement: assess mental health needs at intake, plan treatment while someone’s in custody, identify community programs before release, and coordinate with those programs so care doesn’t lapse the day someone walks out. CSG’s guidelines cover the model in more detail.
A Lower-Cost Complement Inside the Walls
Some correctional facilities have added structured yoga and meditation programs, including those run by organizations like Prison Yoga Project. A 10-week Oxford University study of UK prisoners found improvements in mental well-being and impulse control among participants compared with a control group. It’s a single study of one program, not evidence that yoga is a broadly effective correctional mental-health intervention, and it isn’t a substitute for clinical treatment.
Frequently Asked Questions
Why do police respond to mental health crises instead of clinicians?
Many communities don’t yet have a crisis-response system built to send a clinician instead of, or alongside, police, so a 911 call for a mental health crisis often routes to patrol by default. A growing number of cities run co-responder or mobile crisis programs that change this, but coverage is uneven nationwide.
What is a Crisis Intervention Team, and will I get that training?
A CIT is a group of specially trained officers who partner with mental health providers and people with lived experience to handle crisis calls. It’s a training model, not a license or certification. Whether you get it, and how much of it, depends on your state and your department; at least 38 states and D.C. have some statutory training requirement on mental and physical health conditions, but the depth and format vary.
Can someone with mental illness avoid jail through diversion?
In some states and jurisdictions, yes, through pretrial diversion or a mental health court, both of which can route a case toward supervised treatment instead of incarceration. Eligibility depends heavily on the charge, the state, and whether a program exists locally, so this isn’t available everywhere or for every case.
What happens to someone with mental illness after they’re convicted?
Outcomes vary, but untreated symptoms can make it harder to follow facility rules, and treatment access inside varies widely by facility. Corrections agencies that follow the APIC framework plan for treatment and release before someone is discharged, but that planning isn’t required everywhere.
Does Crisis Intervention Team training make a measurable difference?
The clearest evidence comes from Memphis’s original CIT program, which is credited with an 80% drop in officer injuries during mental health crisis calls in that specific program. CIT has since spread to more than 2,700 communities nationwide, though individual program outcomes vary.
Key Takeaways
- Who responds to a mental health crisis depends on where it happens. Many places still default to patrol, but mobile crisis and co-responder programs are expanding in a number of cities.
- Training requirements vary by state. At least 38 states and D.C. have a statutory mandate for training on mental and physical health conditions as of 2023 data, but the hours and content differ, and states without a statutory mandate may still have other training standards.
- CIT is a training model, not a credential. Memphis’s original program is credited with an 80% drop in officer injuries during crisis calls; that’s Memphis’s result, not a guarantee for every program.
- Jail access to treatment is inconsistent. NAMI reports less than half of jail inmates with a history of mental illness receive treatment while incarcerated.
- Diversion exists, but isn’t automatic. Pretrial diversion and mental health courts can route people toward treatment, but availability and eligibility differ by state and program.
If you’re considering a role in law enforcement or corrections, this is a part of the job worth understanding before you’re hired, since exactly how it’s handled depends on where you work. The Police-Mental Health Collaboration (PMHC) Toolkit has practical checklists for officers, program managers, and agency leaders building crisis response into how a department operates.