By JT Santana | jtwb768
Stigma, incarceration, and what Johnson County’s jail debate reveals about America’s treatment of psychiatric illness
There is a sentence in Scott J. Carpenter’s Facebook post that should make us stop and examine what we have normalized in this country. Carpenter writes that county jails house more people with mental illnesses than hospitals. He then points to jail-diversion programs and Assisted Outpatient Treatment, acknowledges that placing people with mental illness in jail is unacceptable, and pivots to his central message: taxpayers have a responsibility to provide a modern and safe jail, followed by an appeal to vote for the Johnson County Jail and Sheriff’s Office bond issue.
Johnson County voters will consider Public Measure LY on November 3, 2026. The measure asks whether the county may issue up to $94.5 million in general-obligation bonds to acquire land and construct, equip, and furnish a new sheriff’s office and jail. It requires at least 60% voter approval. Those are the actual terms of the ballot question, and voters deserve to examine that proposal on its merits.
The existing jail has serious limitations. Nothing in this article requires pretending otherwise. A deteriorating correctional facility can create legitimate health, safety, staffing, privacy, accessibility, and operational concerns for incarcerated people and employees alike. A society that incarcerates human beings has an obligation to maintain humane conditions for those people during their confinement.
My objection begins at a different point.
Mental illness should never become rhetorical scaffolding for a jail-construction argument.
If our evidence tells us that extraordinary numbers of Americans with psychiatric conditions are ending up behind bars, the first question should not be how comfortably we can accommodate that reality. The first question should be why we continue allowing jails to function as one of this country’s default destinations for people whose primary unmet needs may include psychiatric care, medication management, substance-use treatment, housing, crisis intervention, disability services, or community support.
The distinction is enormous.
A new jail may solve infrastructure problems. It does not cure schizophrenia. It does not stabilize bipolar disorder. It does not treat post-traumatic stress disorder simply by installing newer doors, better ventilation, improved plumbing, or more modern surveillance systems.
A cell remains a cell.
I have spent years writing about stigma: HIV stigma, sexual stigma, disability stigma, criminal-justice stigma, stigma attached to addiction, poverty, incarceration, trauma, and mental illness. Few subjects expose the mechanics of stigma more clearly than what happens when mental illness collides with the judicial and correctional systems.
I know that collision from the inside.
The Statistic Is Serious. The Framing Deserves Scrutiny.
Carpenter is correct about the underlying national emergency: people experiencing significant mental-health problems are dramatically overrepresented in American jails.
The Bureau of Justice Statistics reported that approximately 26% of jail inmates surveyed in 2011–2012 met the threshold for serious psychological distress during the preceding 30 days. The comparable standardized general-population figure was approximately 5%. Forty-four percent of jail inmates reported having previously been told by a mental-health professional that they had a mental disorder (Bronson & Berzofsky, 2017).
Those figures come from an older national survey, which limits their ability to describe every jail population in 2026. They remain significant federal evidence documenting the scale of psychiatric need within American correctional institutions.
Carpenter’s statement that county jails house more people with mental illness than hospitals is harder to verify as written. The sentence sounds like a straightforward statistical comparison, yet the categories are undefined. Does “hospitals” mean state psychiatric hospitals? Dedicated psychiatric facilities? Psychiatric units inside general hospitals? Every inpatient facility treating a patient with a psychiatric diagnosis?
Those definitions change the comparison substantially.
The defensible point does not require an imprecise slogan. American jails have become major custodial institutions for people with mental-health conditions, many of whom arrive with substantial treatment needs. The Bureau of Justice Statistics data alone make that problem difficult to dismiss.
Johnson County itself recognizes the value of alternatives to incarceration. Its Jail Alternatives Program describes diversion as collaboration among criminal justice, health-care, mental-health, and social-service systems aimed at connecting people with community services and reducing unnecessary justice-system involvement. The county lists connections to organizations involving mental health, health care, housing, veterans’ services, sexual-assault advocacy, substance-use treatment, and other supports.
That is exactly the direction communities should be examining.
Yet acknowledging diversion immediately before appealing for jail construction creates a rhetorical tension that deserves scrutiny. If psychiatric illness is evidence that our current model has failed people, then psychiatric illness should not quietly become evidence supporting greater reliance on correctional infrastructure.
Those are separate public-policy questions.
One question asks whether Johnson County needs a replacement correctional facility.
Another asks why people with serious psychiatric needs enter the jail system at such extraordinary rates.
Conflating them risks accepting incarceration as the natural administrative destination for mental illness.
It is not.
A Jail Is Not a Psychiatric Hospital
There is a reason we use different words for a hospital and a jail.
A hospital exists primarily to diagnose illness, provide treatment, manage disease, reduce suffering, promote recovery, and protect patient health.
A jail exists primarily to maintain custody.
That distinction remains true when a jail employs doctors, nurses, social workers, therapists, or psychiatric professionals. Providing health care inside a jail is necessary. It does not convert the institution itself into a therapeutic environment.
Correctional institutions are structured around security, classification, movement restrictions, count procedures, contraband control, staffing requirements, court schedules, surveillance, discipline, and custody status. Clinical care exists inside those constraints.
That institutional structure becomes particularly important when psychiatric medication is involved.
Someone living independently can usually keep prescribed medication in a home, carry permitted medications, contact a pharmacy, call the prescriber, request clarification about dosage, seek another physician, visit an emergency department, or ask family members to help resolve a medication problem.
An incarcerated person loses much of that control immediately.
Once the institution controls medication access, the patient becomes dependent upon the institution’s systems for medication verification, dosage accuracy, administration, monitoring, clinical reassessment, documentation, and continuity.
The National Commission on Correctional Health Care states that people entering correctional facilities while taking prescription medication should receive that medication in a timely manner as prescribed, or receive an appropriate substitute when clinically indicated. Its guidance stresses continuity of care and warns that medication delays, failures to review medication histories, prescribing breakdowns, and abrupt interruption of drugs such as antidepressants can cause serious adverse health effects.
That standard sounds obvious.
It should be.
Yet incarceration creates a profound imbalance of control. The patient cannot simply walk away from a pharmacy error, call an Uber to another hospital, choose another nurse, retrieve a forgotten prescription bottle, or schedule an appointment across town.
The jail controls the environment.
That control creates responsibility.
Mental illness does not become less medical when the patient is booked into custody.
My Experience Inside the Johnson County Jail
This is the point where the subject stops being abstract for me.
I have been incarcerated in the Johnson County Jail in Iowa City. I entered that facility taking prescribed psychiatric medication, including an SSRI. I did not enter custody asking the jail to create a new psychiatric treatment plan for me. I arrived with medication that had already been prescribed by a physician.
At some point during medication reconciliation, the dosage was recorded incorrectly.
According to the medication records later reviewed in connection with what happened to me, I was administered three times the SSRI dosage my physician had prescribed.
I cannot state from memory whether that continued for five days or six days, and I will not invent precision where I no longer have it. I can describe what followed.
My condition began changing.
What I experienced was not initially treated as a possible medication problem. My behavior was interpreted through a correctional lens.
I was accused of acting aggressively toward a deputy and attempting to reach through a pass-through associated with a meal tray and grab him. I denied that allegation then, and I deny it now. The allegation made little sense within the operational routines surrounding food service in that facility.
I filed a grievance.
I was placed in segregation.
The medication administration continued.
On the fourth day of segregation, I hit my head against the wall hard enough to bleed.
An ambulance transported me to the hospital.
The emergency evaluation connected what was happening to a toxic reaction involving the SSRI. The medication records obtained from the jail revealed the dosing discrepancy: I had been receiving three times the amount that had been prescribed.
Think about the institutional sequence.
A person enters custody taking a medication prescribed by a physician.
The institution assumes control over that medication.
A dosage error occurs.
The person begins deteriorating.
The deterioration becomes interpreted as a behavioral or disciplinary problem.
The person is placed into greater isolation.
The clinical deterioration continues until an injury results in emergency hospital treatment.
That sequence captures one of the central dangers created when psychiatric illness enters a correctional environment.
Symptoms can stop looking like symptoms.
They begin looking like misconduct.
When Symptoms Become “Behavior”
Mental-health stigma inside correctional systems does not always announce itself through slurs or explicit discrimination. Institutional stigma can operate through categories, procedures, assumptions, and language.
A psychiatric symptom becomes “noncompliance.”
A panic response becomes “agitation.”
Paranoia becomes “refusal.”
Disorganized speech becomes “disrespect.”
Mania becomes “disruptive behavior.”
Trauma responses become “failure to follow orders.”
A medication reaction becomes “aggression.”
Self-harm becomes a security problem.
Once that linguistic shift occurs, the institutional response can change with it. The person moves conceptually from patient to problem.
That shift is dangerous inside an environment where disciplinary responses can include loss of privileges, movement restrictions, restraints, segregation, observation status, cell restrictions, or escalating encounters with correctional staff.
Consider how differently we conceptualize many physical diseases.
If someone in jail experienced a seizure, most people would recognize that involuntary movements were not disobedience.
If a diabetic person became confused during severe hypoglycemia, competent staff should recognize a medical emergency rather than punish confusion.
If someone suffered chest pain from myocardial ischemia, society would not consider the symptoms evidence of weak character.
Psychiatric illness deserves comparable clinical seriousness.
Mental-health conditions can alter cognition, perception, impulse control, emotional regulation, sleep, judgment, communication, fear responses, concentration, memory, and a person’s ability to interpret the environment.
Those manifestations may create real management challenges. Some situations can create legitimate safety risks. None of that transforms the underlying health condition into a moral defect.
The problem becomes acute in institutions built around compliance.
Correctional systems depend heavily on predictable behavior. People are told when they may leave a cell, where they may stand, when they may shower, when they may use telephones, how they must request medical care, how quickly they must follow instructions, what objects they may possess, where they may sit, when they may eat, and how they must interact with staff.
Many psychiatric conditions interfere directly with the cognitive processes required to function smoothly within such a system.
That creates an environment ripe for misunderstanding.
Isolation Can Make Psychiatric Distress Worse
The relationship between mental illness and restrictive housing deserves serious attention.
Research has associated solitary confinement and restrictive housing with adverse psychiatric outcomes, including psychological deterioration and self-harm. Meta-analytic research has identified significant concerns involving mental-health symptoms and mortality among people exposed to solitary confinement, with suicide and self-injury among the major areas of concern (Luigi et al., 2020).
Researchers have found another disturbing pattern: incarcerated people with mental-health problems have elevated odds of placement in solitary confinement compared with those without such problems (Dellazizzo et al., 2020).
That produces a vicious institutional cycle.
A person experiences psychiatric symptoms.
Those symptoms create conduct that correctional staff find difficult to manage.
The person receives a restrictive placement.
The restrictive environment may intensify psychiatric distress.
The resulting deterioration can generate more behavior requiring management.
At some point the system begins responding to consequences partly generated by the system itself.
This is one reason my own experience remains so significant to me. I was experiencing what was later identified as a toxic medication reaction. My deterioration was followed by segregation rather than an immediate recognition that the medication regimen itself might require urgent examination.
That is not merely a story about one dosage error.
It illustrates how easily medical events can become correctional events once a person loses control over the environment.
Taking Away a Medication Bottle Creates an Obligation
There is a simple principle here that should transcend ideology.
If the state takes control of someone’s ability to obtain medication, it assumes responsibility for administering that medication safely.
Jails routinely restrict people from independently possessing many prescription medications. There are understandable security reasons for controlled medication distribution. Pills can be traded, misused, hoarded, stolen, crushed, or used in self-harm.
Security restrictions do not erase the medical need.
They intensify the institution’s responsibility for meeting it.
The comparison I keep returning to is cardiac medication.
Suppose someone enters jail with significant heart disease and a valid prescription. Nobody should consider it acceptable to say, “You cannot keep your medication here, so your cardiac condition will have to wait until release.”
We would recognize the absurdity immediately.
The same principle applies to epilepsy.
It applies to diabetes.
It applies to asthma.
It applies to hypertension.
It applies to psychiatric illness.
The brain is an organ.
Psychiatric medications are medications.
Psychiatric disease is disease.
Yet American culture still places mental illness into a separate moral category far too often. People are expected to control symptoms through character, discipline, obedience, prayer, determination, or will.
When they cannot, society may treat the resulting behavior as evidence that they are dangerous, unreliable, manipulative, irresponsible, or criminal.
That is stigma.
Putting bars around it does not transform it into medicine.
Diversion Should Mean Fewer People Entering Jail
Johnson County’s own Jail Alternatives Program reflects an institutional recognition that incarceration is not always the appropriate response. The county states that the program connects people with community agencies and services, addresses physical and mental-health needs, and seeks to reduce unnecessary justice-system involvement.
That philosophy deserves greater attention.
Successful diversion does more than save a jail bed.
It can preserve housing.
It can protect employment.
It can prevent treatment interruption.
It can maintain relationships with psychiatrists, therapists, case managers, pharmacies, family members, peer-support networks, and community organizations.
It can prevent someone from emerging from a relatively minor criminal case with a new layer of trauma, unemployment, eviction, interrupted benefits, unpaid bills, lost possessions, or fractured family relationships.
Those downstream consequences matter.
Jail can destabilize people who entered custody already living close to the edge.
A person arrested during a psychiatric crisis may miss work and lose employment. Missing rent can lead to eviction. Medication may change or become interrupted. Benefits paperwork can go unanswered. A phone may be disconnected. Transportation disappears. A treatment appointment is missed. A pet may be surrendered. Family relationships deteriorate.
Then the person leaves jail facing fewer stabilizing resources than existed before the arrest.
We call this a criminal-justice problem when much of it may have begun as a health, housing, poverty, addiction, disability, or social-support problem.
Diversion interrupts that cycle.
It should never become a small humane program sitting beside a continually widening pipeline into incarceration.
Building a Better Jail Does Not Build a Better Mental-Health System
Johnson County’s bond proposal is a real infrastructure question.
The county formally approved placing a $94.5 million bond referendum on the November 3 ballot, and the proposal would fund land acquisition and construction, furnishing, and equipment for a new sheriff’s office and jail facility.
Voters can assess the condition of the existing facility, projected population needs, operating costs, financing, design, staffing, alternatives, and public-safety considerations.
Mental illness should not serve as an emotional shortcut within that decision.
Saying that many people with mental illness end up in jail does not tell us how large a jail should be.
It does not tell us how many beds Johnson County needs.
It does not tell us whether every current category of detainee should remain detained.
It does not tell us how many people could safely enter community treatment programs.
It does not tell us how psychiatric crises are being handled before arrest.
It does not tell us whether enough crisis beds exist.
It does not tell us whether people can obtain outpatient psychiatric appointments before symptoms become emergencies.
It does not tell us whether affordable supportive housing exists for people whose psychiatric stability depends partly on having somewhere safe to live.
Those questions require separate evidence.
A community can need a replacement jail and still incarcerate too many people.
Both propositions can be true.
A community can improve correctional health care and still fail to provide adequate community psychiatry.
Both can be true.
A county can operate worthwhile diversion programs and still need to examine whether diversion reaches enough people soon enough.
Both can be true.
The intellectual mistake occurs when the presence of mentally ill people inside jail begins functioning as justification for accepting that presence as inevitable.
It is not inevitable.
It is partly the product of policy choices.
Mental Illness Should Never Become a Corrections Workforce Strategy
One of the most damaging effects of institutional stigma is normalization.
Once a society accepts that large numbers of people with psychiatric illness will live in jails, entire administrative systems grow around that expectation.
Correctional officers receive mental-health training.
Jails hire clinicians.
Facilities create suicide-watch cells.
Architects design behavioral-health units.
Sheriffs negotiate medical contracts.
Counties purchase suicide-resistant fixtures.
Policies govern psychotropic medication.
Emergency departments receive jail transports.
These measures can reduce harm, and many are necessary under present conditions.
Yet there is a profound difference between mitigating harm and accepting the system that produces the harm.
We should train correctional staff to respond appropriately to psychiatric crises.
We should provide competent psychiatric care to every incarcerated person who needs it.
We should build facilities that reduce suicide risk.
We should maintain humane spaces for people who must remain in custody.
None of those measures should diminish the urgency of asking why so many people with serious mental-health needs are entering correctional institutions at all.
That question must remain uncomfortable.
The day jail-based psychiatry becomes an accepted substitute for community psychiatry is the day we have surrendered to institutional failure.
Accountability Does Not Require Dehumanization
Nothing in an anti-stigma position requires pretending that mental illness excuses every criminal act.
People with mental-health conditions remain capable of agency, responsibility, harmful conduct, kindness, cruelty, good judgment, poor judgment, and every other aspect of human behavior.
A psychiatric diagnosis does not automatically erase criminal responsibility.
It does not automatically make incarceration unlawful.
It does not automatically establish incompetence.
It does not mean every person can safely remain in the community.
Those distinctions matter.
The anti-stigma position is more demanding than simply declaring that everyone with mental illness belongs outside jail.
It asks institutions to distinguish illness from misconduct whenever possible.
It asks courts to consider treatment when treatment can safely address the underlying problem.
It asks correctional systems to provide real health care rather than treating psychiatric symptoms as disciplinary inconveniences.
It asks communities to build treatment systems strong enough that police officers and jailers are not forced into roles that psychiatrists, social workers, crisis clinicians, housing programs, and community-support systems should have filled earlier.
Public safety and humane psychiatric treatment are not opposing concepts.
Competent mental-health care can serve public safety.
Stable housing can serve public safety.
Medication continuity can serve public safety.
Crisis intervention can serve public safety.
Substance-use treatment can serve public safety.
Suicide prevention can serve public safety.
Keeping someone connected to treatment rather than repeatedly cycling through emergency rooms and jail bookings can serve public safety.
Punishment is one tool of government.
It should never become our substitute for medicine.
We Need Better Measures of Success
A county serious about reducing the criminalization of mental illness should be able to tell the public far more than how many jail beds it has.
We should know how many people entering custody screen positive for serious psychiatric needs.
We should know how quickly prescribed medications are verified.
We should know how often medication errors occur.
We should know how many psychiatric emergencies require hospital transport.
We should know how many incarcerated people engage in self-harm.
We should know how many people experiencing psychiatric crises are placed in restrictive housing.
We should know how many people are referred to diversion.
We should know how many qualify but cannot participate for lack of treatment, housing, transportation, insurance, or program capacity.
We should know how many people return to jail after being unable to obtain community mental-health services.
Those are meaningful indicators of whether a system is changing.
A declining jail population among people whose primary needs can safely be handled through treatment would represent progress.
Shorter treatment delays would represent progress.
Fewer medication interruptions would represent progress.
Fewer psychiatric emergencies inside custody would represent progress.
Fewer suicides and self-harm incidents would represent progress.
More successful community placements would represent progress.
A newer jail may improve conditions for people who remain incarcerated. That is worthwhile.
It is not the same achievement.
The Stigma Begins Long Before Booking
Mental-health stigma within the justice system does not begin at the jail door.
It begins when someone cannot find a psychiatrist accepting new patients.
It begins when an insurance network lists clinicians who no longer accept the plan.
It begins when a person in crisis waits months for an appointment.
It begins when supportive housing is unavailable.
It begins when families are told to call police during psychiatric emergencies.
It begins when addiction treatment is inaccessible.
It begins when people lose Medicaid coverage or cannot obtain medication.
It begins when homelessness and psychiatric illness intersect in public places and the response becomes enforcement.
By the time someone reaches a jail booking desk, multiple systems may already have failed.
Then America performs a strange institutional transformation.
The person who could not obtain adequate treatment yesterday becomes an inmate today.
The psychiatric symptoms remain.
The trauma remains.
The medication needs remain.
The substance-use disorder remains.
The intellectual disability remains.
The developmental disability remains.
The housing problem remains.
The poverty remains.
Only the institutional label changes.
Yesterday: patient.
Today: inmate.
That label can transform how society interprets every subsequent action.
That is one of the most dangerous forms of stigma I know.
What We Choose to Build Says What We Believe
Scott Carpenter’s Facebook post begins from a disturbing truth: American jails contain enormous numbers of people experiencing mental-health problems. Johnson County maintains programs intended to divert some people from unnecessary criminal-justice involvement, and the county has placed a $94.5 million sheriff’s office and jail bond before voters.
Those facts deserve separate, serious examination.
What I reject is the cultural assumption hiding underneath so many conversations about mental illness and incarceration: that large-scale psychiatric suffering inside jails is simply a reality we must accommodate.
No.
It is a reality we should be trying to dismantle.
My experience in the Johnson County Jail permanently changed the way I look at this subject. I entered custody on prescribed psychiatric medication. I lost control over its administration. A major dosing error occurred. I deteriorated. My deterioration became entangled with a disciplinary response. I landed in segregation and later in an emergency room.
I survived that experience.
I learned from it.
I refuse to romanticize it.
I refuse to accept the idea that incarceration should become one of America’s routine answers to psychiatric illness.
I refuse to accept a society where someone can wait months for psychiatric care but enter a jail cell in hours.
I refuse to accept a system capable of spending enormous sums incarcerating people after crisis yet incapable of consistently reaching them before crisis.
I refuse to accept psychiatric symptoms being recoded as moral failure the moment somebody is placed in handcuffs.
A humane correctional facility is better than an inhumane one. A safe jail is better than an unsafe jail. Competent correctional health care is better than negligent correctional health care.
Those statements set the floor.
They should never become the ceiling.
The larger objective must be reducing the number of people whose psychiatric illness intersects with incarceration in the first place.
Mental illness is not a crime.
Mental-health treatment is not a privilege reserved for people who behave perfectly.
Medication safety does not become optional behind bars.
Human dignity does not disappear at booking.
If we truly intend to end mental-health stigma, then our commitment has to survive contact with people at their most frightened, symptomatic, difficult, traumatized, addicted, impoverished, angry, confused, or unstable.
That is where anti-stigma work becomes real.
America has spent generations building places to confine people after systems fail them.
Perhaps the harder question now is whether we are prepared to build enough treatment, housing, crisis care, psychiatric capacity, community support, and human connection to keep preventable illness from becoming another booking number.
That is the measure I care about.
Not how well we incarcerate mental illness.
How rarely we need to.
References
Bronson, J., & Berzofsky, M. (2017). Indicators of mental health problems reported by prisoners and jail inmates, 2011–12. Bureau of Justice Statistics, U.S. Department of Justice.
Dellazizzo, L., Luigi, M., Giguère, C.-É., Goulet, M.-H., & Dumais, A. (2020). Is mental illness associated with placement into solitary confinement in correctional settings? A systematic review and meta-analysis. International Journal of Mental Health Nursing, 29(4), 576–589.
Johnson County, Iowa. (2026). Jail Alternatives Program. Johnson County Sheriff’s Office.
Johnson County, Iowa. (2026). November 3, 2026 General Election: Public Measure LY.
Johnson County, Iowa. (2026, August 6). Johnson County approves bond referendum for November 3 election.
Luigi, M., Dellazizzo, L., Giguère, C.-É., Goulet, M.-H., & Dumais, A. (2020). Shedding light on “the hole”: A systematic review and meta-analysis on adverse psychological effects and mortality following solitary confinement in correctional settings. Frontiers in Psychiatry, 11, 840.
National Commission on Correctional Health Care. (2025). Standards for health services in jails and prisons.
National Commission on Correctional Health Care. (n.d.). Medication services.
