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Mental Health & Reincarceration

Written by Dr. Sarah Anderson
Published on November 18, 2022
Research Highlights

Homelessness, addiction, and mental illness are overrepresented in the incarceration system.

Access to rehabilitation and reentry programs varies between prisons and jails.

Reentry programs for people with mental illness can reduce reincarceration rates; the efficacy of Missouri’s mental health rehabilitation and reentry programs has not been well studied.

Mental illness is overrepresented in incarcerated individuals.

Jails incarcerate people convicted of misdemeanors or low-level felonies for up to one year; prisons incarcerate people convicted of high-level felonies for at least a year (RSMO 558.011).

Incarcerated individuals in the U.S. are more likely to have a mental health disorder (44% in jails; 37% in prisons) and/or recently experienced psychological distress (26% in jails; 14% in prisons) compared to the total population (23% and 5% respectively) (KFF, 2022; DOJ, 2017).

  • Missouri's reincarceration rate is similar to the national rate- 45% for all releases, 37% for first-time releases (CCJ, 2021; PPI, 2021; MO DOC, 2016).

Healthcare access, educational attainment, county size, and the likelihood of interacting with the police influence jail incarceration rates. Specific healthcare contributors to a higher per capita jail population include (Ramezani et al., 2022):

  • fewer psychiatrists
  • less Medicaid coverage
  • higher healthcare costs
  • more physically unhealthy days


Access to rehabilitation and reentry programs varies between prisons and jails.

Rehabilitation and reentry programs provide health, education, employment, addiction and other services for individuals who are currently incarcerated or near release, respectively.

Funding for services within jails comes from cities, counties and grants from Missouri Department of Public Safety. Each jail is unique in how much they spend on community corrections services.

The Missouri Department of Corrections (DOC) funds prisons. Around a third ($421 million) of their FY22 budget is spent on rehabilitative services; about 0.4% ($5 million) is spent on reentry programs (HB 3009).

  • The Missouri Reentry Process Steering Team supports reentry through education, health, safety, and job training services during or after incarceration. The interdisciplinary team consists of representatives from communities and ten state departments.

Examples of MO DOC programs that decrease reincarceration rates are (MO DOC, 2016):

Program Service Reincarceration Rate
Community Apprenticeship (US DOL) job readiness 5%
Second Chance Risk Reduction Center job readiness, housing, probation/ parole needs 5%
Beauty for Ashes Reentry substance use disorder, ministry 11.5%
Transitional Housing Unit temporary housing 38% (overall), 35% (high-risk parole violators)

Other DOC reentry programs: Pathway to Change, Impact of Crime on Victims, Anger Management, and Parenting classes resulted in a minor (5%) decrease in reincarceration, but when offenders participated in all four programs there was a 23% decrease in reincarceration. However, research is needed to understand if the benefits of participating in multiple programs are specific to the characteristics of these four programs (Figure 1).


Mental health programs for at-risk individuals can decrease reincarceration.

MO DOC offers several mental health pro-grams: Community Mental Health Treatment, the Seriously Mentally Ill Offender Program, and Im-proving Community Treatment Success (MO DOC, 2016).

  • There is no data measuring reincarceration rates after participation in these programs.

Washington runs the Offender Reentry Com-munity Safety (ORCS) Program, a long-standing (20+yr) resource for people with mental illness that is one of the most effective programs in the Crime Solutions database to reduce reincar-ceration.

  • ORCS offers mental health care, housing assistance, and job training up to five years after release for qualified offenders.
  • There was a 42% reduction in reincar-ceration in ORCS participants.
  • The state saved $1.82 for every dollar spent on ORCS compared to reincarceration (WSIPP, 2019; NIJ, 2015; Mayfield, 2009; Theurer and Lovell, 2008).

Functional Family Therapy (FFT) is a short-term family counseling program that addresses behavioral and emotional problems in youth by strengthening the family unit. FFT operates in 45 different states and is used in the juvenile justice system in WA, FL, PA, GA, SC, and NC (Elliot et al., 2020).

  • In NJ and PA, FFT decreased reincarceration for drug offenses (35%), property offenses (10%), and technical violations (5%) (Celinska et al., 2019; Thornberry et al., 2018; NIJ, 2011).
  • FFT reduced criminal justice costs in PA, WA, FL, and NC. No data was reported in GA or SC (Elliot et al., 2020).
    • In NC, FFT costs about $6,000 per youth compared to $110,000 per youth in juvenile detention facilities annually.
    • Reduced reincarceration rates led to about $22 million in savings in FY17 (NC DPS, 2019).



Bronson, J., & Berzofksy, M. (2017). Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12. Bureau of Justice Statistics of the U.S. Department of Justice.

Celinska, K., Sung, H.-E., Kim, C., & Valdimarsdottir, M. (2018). An outcome evaluation of Functional Family Therapy for court-involved youth. Journal of Family Therpay, 251-276.

Elliott, D. S., Buckely, P. R., Gottfredson, D. C., Hawkins, J. D., & Tolan, P. H. (2020). Evidence-based juvenile justice programs and practices: A critical review. Criminology & Public Policy, 1305-1328.

Greitens, E. R., & Precythe, A. L. (2017). Missouri Reentry Process Report to the Governor. Missouri Department of Corrections.

Mayfield, J. (2009). Dangerous Mentally Ill Offender Program: Four-Year Felony Recidivism and Cost Effectiveness. Retrieved from National Criminal Justice Reference Service: https://www.ojp.gov/ncjrs/virtual-library/abstracts/dangerous-mentally-ill-offender-program-four-year-felony-recidivism

Offender Reentry Community Safety Program (for individuals with serious mental illness) Adult Criminal Justice. (2022, November 28). Retrieved from Washington State Institute for Public Policy: http://www.wsipp.wa.gov/BenefitCost/ProgramPdf/8/Offender-Re-entry-Community-Safety-Program-dangerously-mentally-ill-offenders

Offender Reentry Community Safety Program. (2019, August). Retrieved from Department of Corrections Washington State: https://www.doc.wa.gov/docs/publications/600-BR001.pdf

Program Profile: Functional Family Therapy (FFT). (2011, June 14). Retrieved from National Institute of Justice Crime Solutions: https://crimesolutions.ojp.gov/ratedprograms/122#summary

Program Profile: Offender Reentry Community Safety Program. (2015, November 16). Retrieved from National Institute of Justice Crime Solutions: https://crimesolutions.ojp.gov/ratedprograms/438#eb

Ramezani, N., Breno, A. J., Mackey, B. J., Viglione, J., Cuellar, A. E., Johnson, J. E., & Taxman, F. S. (2022). The relationship between community public health, behavioral health service accessibility, and mass incarceration. BMC Health Services Research, 966.

Saunders, H., & Rudowitz, R. (2022, June 6). Demographics and Health Insurance Coverage of Nonelderly Adults With Mental Illness and Substance Use Disorders in 2020. Retrieved from kff.org: https://www.kff.org/medicaid/issue-brief/demographics-and-health-insurance-coverage-of-nonelderly-adults-with-mental-illness-and-substance-use-disorders-in-2020/

Section, D. o. (2019). Annual Evaluation of Community Programs and Multipurpose Group Homes Report. North Carolina Department of Public Safety.

Theurer, G., & Lovell, D. (2008). Recidivism of Offenders with Mental Illness Released from Prison to an Intensive Community Treatment Program. Journal of Offender Rehabilitation, 385-406. Retrieved from ERIC Journal of Offender Rehabilitation: https://eric.ed.gov/?id=EJ841705

Thornberry, T. P., Kearley, B., Gottfredson, D. C., Slothower, M. P., Devlin, D. N., & Fader, J. J. (2018). Reducing Crime Among Youth at Risk for Gang Involvement. Criminology & Public Policy, 953-989.

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