Introduction

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The U.S. criminal justice system has increasingly served as a default institution for individuals with disabilities, especially those with psychiatric or cognitive impairments, to be confined in. Rather than providing the promised rehabilitation, prisons in the U.S. by nature intensify existing disabilities and can at times cause them. This has been seen to occur through practices such as solitary confinement, inadequate access to care, as well as physical, verbal and mental abuse. These environments are inherently disabling. A 2017 BJS Special Report found that about half of state prisoners and two-thirds of local jail inmates reported either recent serious psychological distress or a history of mental illness, yet only about one-third received treatment while incarcerated.[1] This paper argues that the mass incarceration of the mentally ill seen in the U.S is not only failing disabled individuals but actively harming them. This harm has reinforced ableist ideologies that are rooted in the history of institutionalization, eugenics, and exclusion.  

     This paper will engage with disability bioethics, critical disability studies, and public health literature to explore how incarceration criminalizes disability and deepens social exclusion. It will challenge the 2005 PBS Frontline documentary narrative that prisons are merely "the new asylums" which Ben-Moshe (2017) brings up in her article and instead argue that they are spaces of active disablement, designed more for control than for care. [2]Through analysis of the justice system's structure, its historical ties to eugenics and institutionalization, and the lived experiences of incarcerated people with psychiatric disabilities, I will show that the current model reinforces harmful stigma. 

     Disability bioethics, especially as outlined by scholars like Rosemarie Garland-Thomson, emphasizes dignity and autonomy.[3] Disabled individuals tend to be stripped of agency and treated as problems to manage rather than people to support (the medical model of disability). The carceral system does an unfortunately excellent job at further confirming this statement by undermining these individuals and treating them in a completely dehumanizing light.  

     To move forward, this paper will examine the development and implementation of alternative models like Mental Health Courts and community-based treatment programs. These models provide an ethical and practical framework for addressing the needs of disabled individuals in ways that prioritize support, inclusion, and healing. Although not perfect, they offer a path toward a justice system rooted in care rather than punishment. Ultimately, this project advocates for a shift from a system that disables and excludes to one that uplifts and rehabilitates, a system that truly accomplishes what it says to do. In dismantling the ableist foundations of incarceration and reimagining justice through a disability-centered lens, we can build a more humane and ethical approach that honors the dignity and rights of all individuals

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I. Prisons as Spaces of Active Disablement 

 

     To understand how mass incarceration functions today, we must acknowledge the reality that prisons do not passively contain people with disabilities, instead, they actively disable them. According to Roth (2018) disabled individuals enter prisons with mental illnesses, cognitive impairments, or psychiatric conditions that are then exacerbated by the environment they are placed in.[4] Conditions like solitary confinement, inadequate access to care, and excessive force are all disabling practices. These are not incidental, but institutionalized. 

     There has been a rise in the concept that prisons are “the new asylums” for those mentally ill. Ben-Moshe (2017) critiques the idea that prisons, institutions meant to punish and detain individuals, have simply replaced psychiatric hospitals.[2] She argues that such comparisons disregard a pivotal aspect which is the role that incarceration plays in producing disability. Living without access to basic care, being caged for 23 hours a day, and being treated with suspicion or force by prison guards leads to trauma, physical deterioration, and long-term psychological harm. This is not rehabilitation, it is active harm.  

     Institutions are intrinsically disabling. Andrea Roth’s book, Insane, offers a heartbreaking example of this in the story of Bryan Sanderson, a man with bipolar disorder and psychotic features. After being arrested during a manic episode, rather than receiving care, he was jailed. The hallucinations persisted, and inside his cell, Sanderson scraped off one pupil and fully removed the other, in an effort to comply with the commands of the voices (a manifestation of his psychosis), effectively blinding himself. Even after this self-mutilation, Sanderson was returned to the same unit that had failed him. The justice system had multiple opportunities to intervene with care and instead responded with punishment. His story reveals the cruel reality of what happens when care is replaced with confinement and when responses to mental illness prioritize control over compassion.  

     Yang et al. (2009) shows that even long-term prisoners without a psychiatric diagnosis report suffering and deterioration, but the experience is significantly worse for those with mental illness.[5] These individuals often react to incarceration with severe psychological distress. The conditions they face are not neutral, they are designed to enforce compliance, and for those with disabilities, like mental illness, compliance is much more difficult. Treating someone in a state of psychosis, experiencing hallucinations or paranoia forcefully is inhumane, as they are not competent in those moments. Their inability to comply is responded to with violence or further isolation. In this way, prisons themselves function as spaces that fails to support disabled people, specifically those with mental illness, by not understanding their psychiatric needs.  

     Prisons may offer "treatment," but that word becomes nearly meaningless in context. The quote from Ben-Moshe’s article, Why Prisons Are Not ‘The New Asylums. (2017) where she articulates, “ If incarceration disables and exacerbates mental health conditions as I have suggested, then ‘treatment behind bars’ is an oxymoron” holds power in this argument.[2] She defends this idea using real examples from the PBS Frontline film, “The New Asylums” of what said treatment looks like. The film portrays a group therapy session where the participants sit in a row in individual cages with chains around their ankles. While a guard circles around the cages, a therapist examines them physically and mentally. It is institutional violence masked by clinical language. Ben-Moshe describes these practices as not only unethical, but also ineffective. Incarceration disables. Prisons worsen the very conditions they claim to manage.  

     Beyond that, the entire structure of carceral logic views difference as a threat to be neutralized. For individuals whose disabilities interfere with behavior regulation or communication, this creates constant risk. Non-compliance, confusion, or emotional distress can be interpreted as aggression. This leads to further punishment, compounding harm and solidifying the perception that disabled individuals are violent or uncontrollable. This cycle, once initiated, is difficult to break.

 

II. Stigma and Refusal to Recognize Disability

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     Beyond the physical and psychological harm inflicted by carceral spaces, there exists a more insidious mechanism: the refusal to recognize disability at all. Society often fails to understand the nature of psychiatric and cognitive disabilities, and that failure is deeply reflected in our society and carceral systems. When people with mental illness display behavior that falls outside of societal norms, they are more likely to be criminalized than supported.  

     Reynolds (2018) emphasizes the importance of "disability humility" (p.1182), the practice of acknowledging that clinicians and other authority figures do not know everything about a person’s experience.[6] This concept is entirely absent from most aspects of the criminal justice system. Police, prosecutors, and judges often treat disability as a threat rather than a context. The assumption is that people with mental illness are dangerous and unmanageable. This fear justifies excessive use of force, wrongful incarceration, and prolonged confinement.  

     Sanderson’s story again highlights this refusal. Even when diagnosed and clearly in crisis, he was placed in jail, not a hospital. He blinded himself, and still, the system returned him to the same environment that had failed him.[4] When society fails to recognize mental illness as real and valid, this is the result: disabled people are punished for their symptoms and left without resources to recover.  

     Bixby et al. (2022) argue that the cycle of incarceration and exclusion for disabled individuals is a form of structural violence.[7] This goes beyond individual mistreatment, our laws, policies, and institutions are structured in a way that makes it nearly impossible for disabled people to find stability. This includes housing, health care, even transportation. Once they are pulled into the carceral system, the stigma only grows. With a criminal record, individuals face more exclusion and less support. Referring to Sanderson’s case from Roth’s book (2018), despite every sign that the jail environment was retraumatizing for his mental illness, the system locked him back up.[4] Eventually the charges were dropped. But by then, Sanderson was blind. He now lives in an inaccessible area with no sidewalks and is ineligible for paratransit because he lives too far outside the city.[4] His story reveals how society doesn’t just fail to accommodate disability; it actively creates it. His blindness wasn’t only medical; it was the result of a justice system that punished his symptoms and a culture that refused to meet his needs. With proper diagnosis and support, his life could have looked entirely different.  

     This stigma is deeply rooted in historical ideologies. Since as early as the twelfth century, mental illness was poorly understood. For a very long time, people who suffered from mental disabilities were believed to be possessed by the devil. In the 17th century, the mentally ill were seen as insane and a threat to civilians, so they were incarcerated to protect the public. In colonial times, mentally ill individuals were associated with “dangerous and disturbing behaviors” that the community ought to be protected from.[8] There was still a belief at this time that mental illness was contagious, and it would send you to damnation.[8] Although these ideologies are from centuries ago, the repercussions remain today. Mental institutions were born from the belief that the mentally ill were undesirable to societies. The existence of the institutions is not stemmed from a place of interest towards the patients, it is not a system set up on facts of what mentally disabled folk need, instead it was born out of a need to obscure people, neglecting them out of society. Knowing this to be true, wanting to bring asylums back sounds like an absurd idea.  

     The modern prison system continues this legacy, masking it in new language but carrying forward the same fear and rejection of difference. Even the suggestion from some scholars like Sisti et al. (2015) to reinstate asylums reflects how deeply ingrained this logic remains.[9] It reveals the default assumption that disabled individuals should be isolated rather than supported. This refusal to recognize the full humanity of disabled people also feeds into how policy is made. People with psychiatric disabilities are rarely consulted about their own needs or involved in designing systems of care. Instead, their experiences are interpreted and filtered through able-bodied, neurotypical perspectives. This removes their agency, reinforcing the idea that they must be managed rather than empowered.

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III. Development and Implementation of Alternative Models 

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     If incarceration actively harms disabled people and stigma perpetuates that harm, then the obvious question is: what is the alternative? The answer begins with rejecting institutions as the default response to disability and instead investing in care-centered, community-based models. However, to do so it is crucial to understand the underlying roots of the cause of having so many mentally ill individuals incarcerated. This includes dismantling society’s fear of mental disabilities as well as addressing the issue regarding the American criminal justice system.  

     Roth offers several solutions, including Crisis Intervention Team (CIT) training for police and the broader creation of alternative crisis response systems; she provided proof supporting the positive outcomes of implementing CIT.[4] Still, CIT alone is not enough. While it helps mitigate harm, it fails to address the root issue: police officers are not, and should not be expected to function as, mental health professionals. Instead, a separate emergency hotline and response system should exist for mental health crises, just as 911 serves fire, medical, and police emergencies. This system should dispatch trained mental health professionals or mobile crisis teams equipped to de-escalate and connect individuals to care. 

     Another powerful alternative Roth discusses in her book is introduced by judge Steve Leifman of Florida called the Criminal Mental Health Project.[4] This is a diversion program connecting people with treatment and housing rather than jail. Roth notes that the program has saved Miami-Dade County $12 million and led to the closure of a jail wing.[4] I found this profoundly moving. Leifman recognized the weight of the problem and used his position to act. Given the program’s success, one might wonder why it hasn’t been widely replicated. The answer, I believe, lies in fear. Fear of the “mentally ill criminal,” of what it means to treat rather than punish, and of reintegration. Society has long treated mental illness as something to be locked away. The alternative of care and not incarceration still feels threatening to many. But that fear is misplaced. What we should fear is the long-term damage caused by incarceration: trauma, neglect, and the worsening of illness  

     Mental Health Courts (MHCs) have emerged as another potential solution. Harbison outlines how MHCs divert people with psychiatric disabilities away from jail and into treatment.[1] These courts operate on principles of therapeutic jurisprudence, which means they view the law not as a blunt instrument of punishment, but as a potential force for healing. MHCs connect participants with housing, medication, therapy, and support. While not perfect, they offer a meaningful contrast to the violence of prison. Still, MHCs are not without challenges. Harbison acknowledges the inconsistency in funding and availability across states.[1] Eligibility criteria vary widely, and some courts may still operate with underlying ableist assumptions about who deserves care. Nonetheless, they represent an attempt to integrate rehabilitation into the justice system in a way that is sensitive to the realities of mental illness. Beyond courts, we must invest in long-term care models that support independent living, like supervised group homes, supportive housing, and peer-led mental health services. These alternatives help individuals remain integrated within their communities, rather than isolating them in institutions. Housing-first programs, access to social services, and crisis intervention teams are all part of a more compassionate model that prioritizes human dignity.  

     Roth (2020) argues that society must move away from the reactive model of jailing people after a crisis and instead focus on early intervention, education, and prevention.[10] This requires a cultural shift, not just in policy, but in how we think about disability and our moral responsibilities. We must train police and first responders to recognize signs of mental illness, respond without force, and refer individuals to care rather than custody.  

     Garland-Thomson (2017) urges us to shift our bioethical thinking away from fixing or erasing disability and toward supporting people in their full humanity.[3] This means embracing interdependence, dignity, and autonomy. The justice system must reflect these values, not as an afterthought, but as its foundation. Community-based approaches should be developed in collaboration with disabled individuals themselves, centering their voices and lived experiences.  

     It is also vital that society confronts the fear and discomfort it has historically projected onto disabled people. The push to confine and segregate stems not just from ignorance but from an existential anxiety, an unwillingness to acknowledge that we are all vulnerable, all interdependent. Disability is not a defect to be hidden but a natural and valuable part of human diversity. Our systems must reflect that understanding.

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Conclusion

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     The mass incarceration of mentally ill and disabled individuals in the U.S. is not simply a failure; it is a form of systemic violence rooted in a deep history of stigma and fear. Prisons actively disable people, especially those whose conditions make compliance and conformity difficult. The refusal to recognize disability and accommodate it leads to abuse and neglect which has had tragic endings. This paper has shown how historical practices like eugenics still echo in our institutions, and how our current systems uphold those same ableist beliefs.  

     But it doesn’t have to be this way. Models like Leifman’s Criminal Mental Health Project, Mental Health Courts, community care, and disability-informed ethics provide blueprints for change. True justice means dismantling the structures that harm and exclude, and building new ones rooted in care. We owe that to Bryan Sanderson, to every person failed by this system, and to the future we hope to build. We must educate ourselves, listen to the disabled community, and remember that any one of us could one day need the very support systems we either strengthen or ignore today.