Ahmed F. Alanazi
The overrepresentation of people with mental illnesses in prison systems worldwide constitutes a public health crisis and a failure of community psychiatry. This paper provides a comprehensive, critical synthesis of research at the intersection of mental health, prisons, and psychiatry. It first establishes the epidemiology of psychiatric disorders among incarcerated populations, then traces the historical path from asylum to prison, a phenomenon termed transinstitutionalization. Next, it examines the iatrogenic effects of incarceration on mental health, including solitary confinement, violence, and inadequate treatment. The paper then analyzes current psychiatric care within prisons, screening, medication, therapy, and crisis intervention, highlighting systemic barriers to quality care. The principle investigator (PI) explores the overuse of psychotropic medications and the ethical quagmire of coercive treatment. Finally, the paper proposes evidence-based reforms: diversion programs, specialized mental health courts, prison-based therapeutic communities, and reentry support. The paper also argues that meaningful reform requires dismantling carceral logics within psychiatry and investing in community alternatives. This review aims to guide researchers, clinicians, and policymakers toward a just and effective mental health system.