I agree—the title is a mouthful! But it’s an important concept in psychiatry practice. “Transinstitutionalization” is a single-word description of the movement of individuals with serious mental illness (SMI) in the 1960s and beyond from psychiatric hospitals to prison. The term was coined by Lionel Penrose in 1939, who recognized that as the number of long-term residents in psychiatric hospitals decreased, the number of seriously mentally ill inmates in prisons increased.
There are numerous studies that both support and contradict Penrose’s hypothesis about the correlation between those numbers, but everything I’ve found supports the fundamental concept that the population of SMI inmates in prisons is indeed increasing. The numbers are startling.
According to a 2016 background paper from the Office of Research and Public Affairs titled “Serious Mental Illness (SMI) Prevalence in Jails and Prisons,” 20% of jail inmates and 15% of state prison inmates have SMI. These percentages represented approximately 383,000 individuals in 2014 in the US, or roughly 10 times the number of individuals with SMI in state psychiatric hospitals.
While these numbers are alarming, they have risen even more dramatically in the last decade. A 2025 Prison Policy Initiative report estimates that 45% of state prison and 44% of local jail populations have SMI. Of these individuals, about a third have not had any treatment since their incarceration. Two thirds report having no mental health care at all.
These statistics are very disturbing. While some sources disagree on reasons for this trend, nearly all agree that this trend began with deinstitutionalization in the 1960s and the call for “community-based” mental health services.
Last week, I posted a piece about the contract for mental health services between Williamson County in central Texas, where I live, and Bluebonnet Trails Community Services. While the report I found did not disclose the amount of the contract, it stated that it had saved the county $14 million in the past year. Clearly, this represents a substantial investment of county funds.
I applaud the county for recognizing its role in providing mental health services for residents. But I’m also troubled by the amount of resources necessary to divert inmates who experience mental health crises to BTCS’s Diversion Center for nonviolent criminal conduct and to operate a program that restores jail inmates to competency for trial. Both seem to point to the inadequacy of community-based mental health services in the first place. Other services offered are more encouraging, however.
Bluebonnet Trails funds private psychiatric beds for patients with SMI—403 Williamson County residents last year. Their adult and youth respite programs served 259 adults and 116 youths. I’m also encouraged by their programs to prevent homelessness. They assist individuals in securing independent housing or refer individuals to Community First Village, an Austin organization that provides housing for chronically unhoused individuals.
Probably the best news is that there are more services planned for the coming year, including residential beds for youth in crisis, services for uninsured or underinsured residents, recovery support groups, and child welfare and veteran court support.
It’s heartening to realize that local organizations are working toward ameliorating the effects of transinstitutionalization. It’s too early to say how cuts in federal and state funding might impact their goals. However, with utilization of best psychiatric practices, a sense of compassion, and vital financial investment prior to engagement with law enforcement, community-based programs like Bluebonnet Trails can help curb the rate of incarceration for those with serious mental illness.
Janice Airhart 