By Taylor Knopf

People with mental health issues intersect with the criminal justice system all the time. In the past several decades, jails and prisons have become the largest de facto places for housing people with mental health disabilities in the country.

As the nationwide discussion of what to do about opioid addiction continues, the North Carolina legislature established a task force to look at the problem of people with drug addiction and mental illnesses in county jails and state prisons.

Because often addiction and mental health issues go hand-in-hand.

36578 total prisoners in 55 facilitiesThe task force held its first meeting at the General Assembly on Tuesday; it was well-attended by members of the criminal justice system, including judges and district attorneys.

“A few years ago, I attended a national event about addiction and prescription drug use,” Joe Prater, secretary of administration for adult corrections and juvenile justice for the state Department of Public Safety, told the committee. “At that event, I found myself as the only person from corrections in the room.”

“We’ve made great strides and that’s not true today,” he said. “(Now) we play a big role in public health.”

A numerical breakdown of NC prisons

Prater went on to give the latest North Carolina prison statistics.

As of February, there were 36,578 inmates in the state’s 55 prison facilities, down from a peak of 40,406 in 2011. The inmate population is 92 percent male and 8 percent female. About 52 percent are black, 40 percent white and 8 percent other.


The total state corrections budget is $1.27 billion, and the average cost per inmate is about $85 per day at minimum custody and $114 a day at higher security facilities.

North Carolina has the 13th highest total number of prisoners compared to the rest of the country with an incarceration rate is 339 inmates per 100,000 people.

Twenty-nine states have higher rates of incarceration.

While 97 percent of inmates are between 20 and 55 years old, the number of older inmates has increased greatly in recent years.

“That population brings with it unique health needs,” Prater said. “They have three to 10 times the health costs of the younger population.”

17% of the prison population has a mental health diagnosisIn the past 10 years, Prater said there has been a 118 percent increase in inmates 55 years or older.

“We are an aging society, and prisons are a microcosm of society,” he noted.

Additionally, over the past decade, there has been a 60 percent increase of inmates diagnosed with chronic illnesses and a 65 percent increase of those diagnosed with a mental illness.

That is 17 percent of the total prison inmate population, Prater said. And the majority of inmates with these illnesses have more than one diagnosis.

And almost all of these inmates – 95 percent – will eventually return to society, shopping at the grocery stores and walking the streets with everyone else. Every year, about 24,000 prisoners are released at the ends of their sentences.

Substance abuse within inmate population

In North Carolina, drug possession is the number one crime that lands a person in prison.

In 2017, about 19 percent of folks that entered prison were locked up due to drug possession or intent to sell. Breaking and entering (12 percent) was the second most frequent crime last year. Down the list is drug trafficking, at 4 percent.

pie chart shows that 40 percent of incarcerations are for possession, about 20 percent are for possession with intent to sell and 25 percent "other"
Non-Trafficking Drug Convictions. Data source: NC Sentencing and Policy Advisory Commission, FY 2017 Felony Statistical Report Data

Of 17,366 North Carolina inmates screened for substance abuse during the 2016-17 fiscal year, the majority (71 percent) need long-term substance use disorder treatment, Prater said.

He added that addiction treatment within the prison system is provided by the Alcoholism and Chemical Dependency Programs (ACDP) Section, and the average cost per inmate is about $17 a day.

Rep. Craig Horn (R- Weddington) said that incarcerating people for drug use is “neither a deterrent or a solution.”

“By the same token, there has to be deterrents,” he added. “If you break the law, there has to be a downside. It’s not just ‘Gee, I’m sorry.’”

He urged his colleagues to remember that the policy they make affects real people.

“Some of them we can help. Some of them we probably can’t… We need to use our heads and our hearts for what’s best for North Carolina.”

Also during the Tuesday meeting, Judge Marion Warren, director of the North Carolina Administrative Office of the Courts, made a plug for drug treatment courts.

“There has to be responsibility and accountability, and the easiest and quickest way to deal with this is lock folks up,” he said. “It’s much more difficult to get involved in their lives.”

Mental health meets the criminal justice system

The number of incarcerated people with serious mental illnesses (17 percent) is almost four times greater than in the general population, according to Robert Kurtz, program manager at the Department of Health and Human Services, who works to divert people with behavioral health disorders from the criminal justice system.

95% of prisoners will eventually be releasedAbout 25,000 people with serious mental health conditions enter into North Carolina’s jails every year, Kurtz added. And the rate of women in jail with mental health issues is twice the rate of the men.

Kurtz noted that mental illness and substance abuse are often seen together. Nationally, about 72 percent of people in jail with a mental illness also have a substance use problem.

The cost of jailing people with mental illnesses can be very high. He told the story of a man named Matt in Mecklenburg County. Matt was a homeless panhandler with schizophrenia, a cocaine addiction and a low IQ. He had no family, insurance or income.

Kurtz said that in one year, Matt ran into the police 43 times and spent 189 days in jail. The estimated costs of his many re-arrests over a four-year period was almost $230,000. Someone eventually intervened in his life and now Matt receives a Social Security Disability check, is on Medicaid, and has a guardian and housing. He attends a day program and has stayed “clean and sober.”

“Intervention can make a difference,” Kurtz said. “Doing nothing can be very expensive.”

The intangible costs of someone with a mental illness going through incarceration are also difficult to overcome.

“Recovery is halted by going to jail,” Kurtz said. People lose their jobs, apartment and sometimes their lives.

“Suicide is the most significant cause of death in jail,” he added.

And a criminal record can make a person ineligible for public housing and can cause trouble getting a job when they get out.

Kurtz told another story of an unnamed man with schizophrenia who lost everything that was important to him while in jail. He was on Social Security Disability and was living out of his car with his two dogs. He fell asleep parked in a Starbucks parking lot. When the manager called the police, they knocked on his car window and startled him. The man jumped out and crawled under his car.

Kurtz said the police took him to jail. The man’s Social Security checks stopped coming.The car was impounded and racked up expensive fees that he was unable to pay.

“Now that he’s in jail, his two dogs, who were his only source of love and support, ended up being euthanized,” Kurtz said. “So imagine what that does to his recovery when he leaves jail.”

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Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...

2 replies on “By the Numbers: Incarcerating Mental Illness and Addiction”

  1. YOU HAVE CONTRIBUTED TO THE STIGMATIZATION OF PEOPLE WITH MENTAL HEALTH ISSUES IN YOUR VERY FIRST SENTENCE. “People with mental health issues intersect with the criminal justice system all the time.”

  2. Estimations are that approximately 50% of those incarcerated have been exposed to alcohol in utero. We also know that about 90% of those with such alcohol exposure have not been properly evaluated Fetal Alcohol Spectrum Disorder (the umbrella term used for the variety of diagnoses that result from exposure to alcohol in utero.

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