Cuffed, forcibly kept from her parents for twenty-three days, and sentenced to eleven years. Under the Coos County Juvenile Court in Oregon, the punishment fit the crime. The crime? Psychosis stemming from improper handling of depression by her doctor. Thirteen year old Saraya Rees needed behavioral health resources. Yet, when, as instructed, her parents called a privately owned crisis call center, the police were on the other end of the line (Fraiser, 2020). Saraya’s situation was made possible through systemic failures in crisis response systems and the absence of effective behavioral health infrastructure. 

While the picture of an “insane asylum” may be shrouded in Victorian ash, current justice systems are more similar than some prefer to believe (Mankins, 2022). One in seven incarcerated persons worldwide suffer from a behavioral health condition, a figure that increases substantially when considering only low-to-middle income countries. Moreover, incarcerated persons with a 

behavioral health condition are put at greater risk for self-harm, suicide, homelessness, and recidivism (Emilian et. al, 2025). Responding to behavioral health crises with incarceration is both a policy failure and a moral one. Even so, because of the extreme stigma that behavioral health conditions face worldwide, cases go unreported, undiagnosed, and subsequently mishandled (Mason et. al, 2023). Prisons cannot continue to serve as de facto behavioral health facilities. 

A step toward a solution must include universally accepted expectations for crisis call centers. To ensure individuals experiencing behavioral health crises have safe and reliable pathways to seek help, crisis phone lines must be kept confidential and accessible. Similar to the precedent of countless countries, effective crisis help lines are often three digits or less for maximal accessibility (“988 Suicide Hotline”, 2022). To draw further distinction between prison and behavioral health support, the presence of law enforcement in response to calls to crisis centers must be mitigated unless absolutely necessary.  

Equally important in changing the lens through which behavioral crises are interpreted are supportive, effective, and accessible behavioral health units. Investing in humane and accessible behavioral health treatment produces measurable social and economic benefits.  Estimates put the global cost of incarcerations in the hundreds of billions, but effective treatment reduces recidivism, lowers incarceration rates, and decreases long-term correctional spending (Hirshberger, 2020). When behavioral health goes untreated, recidivism increases, demonstrating how incarceration is not a solution but instead further perpetuates criminality. Providing effective treatment for substance-abuse and mental health disorders allows individuals to reintegrate into society. Moreover, pathways for currently incarcerated individuals to access these resources should be prioritized. 

Addressing this issue also requires confronting societal perceptions of behavioral health. Raising accessibility of about information of behavioral health disorders will help to mitigate the social stigmas surrounding them. Schools that meet their students’ mental health needs show significant decreases in suicide, depression, and anxiety rates and employing constructive and engaging drug prevention programs has been shown to lower the rate of substance-abuse disorders, preventing unnecessary strain of behavioral health units in the long term (Hollins, 2021;“Student Mental Health and Education”, 2025). 

Treating the world’s prisons as a vehicle to punish suffering is inhumane and ineffective policy. Recognizing behavioral health crises as medical—not criminal—issues is essential to building a system that prioritizes care over punishment and prevention over incarceration.

References

Columbia University Irving Medical Center. "988 and the Research behind Suicide Hotlines." Columbia University Irving Medical Center. Last modified July 13, 2022. Accessed December 30, 2025. 

https://www.cuimc.columbia.edu/news/988-and-research-behind-suicide-hotlines. 

Emilian, Christina, Noura Al-Juffali, and Seena Fazel. "Prevalence of Severe Mental Illness among People in Prison across 43 Countries: A Systematic Review and Meta-analysis." The Lancet. Lancet Group. Last modified February 2025. Accessed December 30, 2025. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00280-9/fulltext?__ cf_chl_tk=WUFZ8OTep1zHBDj0ssnmutYA6VeOsTa0Cl.55GgJPDs-1767129904-1.0.1.1 -qS5O8FtWDjrKMPpETXlIaapRNtQfZHCuT22PefvIpbI. 

Fraiser, Paul, R. Letter, "Statement Regarding the Juvenile Deliquency Matter Involving Saraya Rees," July 6, 2020. 

Hirshberger, Jeanne. "'Imprisonment Is Expensive' – Breaking down the Costs and Impacts Globally." Penal Reform International. Last modified July 24, 2020. Accessed December 30, 2025. 

https://www.penalreform.org/blog/imprisonment-is-expensive-breaking-down-the-costs-a nd/. 

Hollins, Adriana Ana. "Testing the Efficacy of Drug Prevention Programs: A Case Study Testing the Efficacy of Drug Prevention Programs: A Case Study of the King County Alcohol and Other Drugs Prevention Program of the King County Alcohol and Other Drugs Prevention Program." Golden Gate University Digital Law Commons. Golden Gate University of Law. Last modified June 29, 2021. Accessed December 30, 2025. https://digitalcommons.law.ggu.edu/cgi/viewcontent.cgi?article=1141&context=capstone s. 

Mankins, Jeanna. "Insane Asylums in Britain during the Nineteenth Century." PhD diss., The University of Texas at Tyler, 2022. Accessed December 30, 2025. 

https://scholarworks.uttyler.edu/cgi/viewcontent.cgi?article=1013&context=history_grad. 

Mason, Joyce, Audrey Laporte, James T. McDonald, Paul Kurdyak, and Claire de Oliveira. "Health Reporting from Different Data Sources: Does It Matter for Mental Health?" The Journal of Mental Health Policy and Economics 26, no. 1 (2023): 33-57. 

https://pubmed.ncbi.nlm.nih.gov/37029904/. 

"Student Mental Health and Education." Learning Policy Institute. Last modified July 2025. Accessed December 30, 2025. 

https://learningpolicyinstitute.org/media/4745/download?inline&file=Student_Mental_H ealth_Education_FACTSHEET.pdf.