Almost half of all incarcerated people are in rural jails and prisons and at risk of losing access to hospitals

The Trump administration's One Big Beautiful Bill Act will result in the closure of many rural hospitals, leaving people in the surrounding communities — including those in prisons and jails — facing elevated healthcare costs and limited access to necessary healthcare.

by Emily Widra, October 28, 2025

Nearly a million incarcerated people depend on rural hospitals for routine off-site and emergency medical care.¹ Almost 60% of people in prisons and 25% of those in local jails are confined in rural counties, which are home to 3,000 of the nation’s correctional facilities. Following massive cuts to Medicaid passed by Congress this year, many rural hospitals will be forced to scale back operations or close entirely. As a result, critical, lifesaving healthcare will be further out of reach for huge swaths of the incarcerated population and those who live and work nearby, making an already bad situation far, far worse.

Rural and jail prison population estimates are based on an analysis of Vera’s Incarceration Trends jail data and the Bureau of Justice Statistics’ Census of State and Federal Correctional Facilities, 2019. The percentage of rural hospitals at risk of closure in each state as of August 2025 comes from the Center for Healthcare Quality and Payment Reform’s report, Rural Hospitals At Risk of Closing. See the methodology for more details.

The divisive “One Big Beautiful Bill Act” imposes significant cuts to Medicaid that slash funding for rural hospitals,² which are largely dependent on federal subsidies to stay afloat.³ Closing rural hospitals has disastrous consequences for entire communities, but especially for incarcerated people who have no choice about where they receive medical care. Rural communities can expect limited access to emergency care, higher costs for healthcare, and less-timely and more geographically distant medical treatment. The resulting loss of jobs and healthcare providers risks escalating poverty, unemployment, and disability rates, exacerbating an already dangerous cycle that often leads to incarceration.

Policy TrackerHow Trump is making the criminal legal system worse

In this briefing, we present our estimates of the number of people in prisons and jails who are locked up in rural counties and explain how rural hospital closures would spike healthcare and incarceration costs while worsening public health. We are also making these state-by-state estimates available in an appendix. Additionally, we examine how a weakened rural hospital system can make healthcare delivery even worse than it already is for people on the inside. Finally, we highlight ways in which the consequences of rural hospital closures — unemployment, inadequate healthcare access, poverty — are felt across entire rural communities, not just behind bars.

The incarcerated population is disproportionately sick, aging, and locked up in rural areas

With more than half of prisons and around a quarter of local jails situated in rural counties, rural hospital closures pose real risks to incarcerated people’s health and wellbeing.⁴ Incarceration has a negative impact on the health of people behind bars and shortens life expectancies — a state of affairs that is especially worrisome given the increasingly elderly and sick incarcerated population.⁵ Researchers warn that closing rural hospitals “can increase the risk of bad outcomes for conditions requiring urgent care, including that for high-risk deliveries, trauma, and heart conditions.” These bad outcomes are particularly likely among the incarcerated population, where some of these conditions are common: for example, about 2% of women entering jail are pregnant and many jail births are high risk. Additionally, heart conditions are the second leading cause of death in prisons and jails. Many correctional facilities already struggle to provide basic healthcare to incarcerated people and have disturbingly high mortality rates. These issues will inevitably worsen with the loss of important medical infrastructure nearby.

The impact on state prison systems

In almost every state, thousands of people in prison who need emergency and routine off-site medical care (such as imaging and x-rays, surgeries, and specialist care) rely on nearby rural healthcare systems that are now threatened by Medicaid cuts. This is particularly alarming in states that almost exclusively hold incarcerated people in rural areas, like Idaho, where 91% of people in prison are in rural counties.⁶ But the scale of the problem is worse in states with some of the largest prison systems — like Texas, Florida, California, Georgia, Pennsylvania, Arizona, and New York — where between 30,000 and 117,000 people in rural prisons rely on those hospitals in each state. Nationally, more than 783,000 people are in prisons in rural counties.⁷

People in prison already have to contend with delayed referrals to medical specialists, which (along with understaffing) contribute to higher mortality (death) rates on the inside. The carceral system is notorious for denying and slow-walking medical care, and for the convoluted, lengthy process required to be seen by a healthcare provider — practices that undoubtedly contribute to higher mortality rates on the inside.⁸ In rural facilities, these conditions are often exceptionally bad.

Prisons vs. jails Learn more about the difference.

In Louisiana — where 42% of the state prison population is incarcerated in rural counties — the prison mortality rate is more than double the national rate in state prisons, according to the most recent national data. From 2001-2019, Louisiana had the highest prison mortality rate overall, as well as for deaths related to heart disease, cancer, AIDS-related illnesses, and respiratory disease. Such severe healthcare needs require ready access to emergency and specialist care at a nearby hospital, and yet the Center for Healthcare Quality and Payment Reform estimates that 46% of Louisiana’s rural hospitals are at risk of closure, with at least nine at immediate risk of closure due to federal funding cuts.

Impact on local jails

Nationally, almost 170,000 people are incarcerated in rural jails. In 19 states, more than one-third of the statewide jail population is confined in rural counties. Six of those states confine more than half of their entire jail population in rural counties.⁹ Even in states with large rural populations overall, the share of the jail population in rural counties still stands out: for example, in Mississippi, where about half of the statewide population lives in rural areas, almost 70% of people in jail are held in rural counties. In Kentucky, where around 40% of the state lives outside of metropolitan areas, a disproportionate 67% of the statewide jail population is confined in rural jails.

Each year, more than five million people are arrested and booked into jail and they are more likely to have serious health needs — including mental illness, substance use disorders, HIV, Hepatitis B or C, cirrhosis, and heart conditions — than people who are not jailed. Troublingly, small, predominantly rural jails consistently report the highest jail mortality (death) rates in the country.¹⁰

The medical care that people receive inside jails is terrible in most places, but it is particularly bad in states with mostly rural jails and prisons. These facilities compete with community healthcare systems for limited resources, including qualified staff, and their failure to provide adequate medical care on the inside puts additional strain on local hospitals. When patients arrive from the jail or prison, their care has often already been delayed, making their health issues more severe and likely to require emergency or specialized treatment.

For example, in Virginia, where about 40% of the state’s prison and jail facilities are in rural areas, there have been at least three civil rights cases related to healthcare in prisons and jails since 2010. In U.S. vs. Piedmont Regional Jail Authority (2013), the U.S. Department of Justice alleged that the rural regional jail in Prince Edward County was permitting unqualified staff to evaluate medical conditions, inadequately screening for medical issues on admission, and providing subpar mental healthcare. The lawsuit resulted in the appointment of a court monitor to oversee the jail’s efforts to address these issues, but subsequent jail deaths suggest problems persisted. Similarly, in West Virginia — where 53% of the jail population is in rural counties — formerly incarcerated people already report serious healthcare issues on the inside, including delays in cancer screenings, lack of access to insulin, and abrupt discontinuation of prescription medication. Accordingly, West Virginia also had the second highest jail mortality rate in the nation at last count in 2019.

Rural hospital closures are associated with rising healthcare and incarceration costs, and worse public health outcomes

In the past decade, more than 100 rural hospitals have closed and more are at risk: the Center for Healthcare Quality and Payment Reform reports that in most states, over 25% of rural hospitals are at risk of closing, and in 10 states, at least half are at risk as of August 2025. Aside from providing crucial emergency care, inpatient medical care, and laboratory testing and diagnostics, rural hospitals are often where the community receives routine primary care and inpatient rehabilitation services. These closures can “wreak irreparable havoc on rural communities” and will, in turn, make it harder to reverse local population declines, threatening to turn these communities into “ghost towns.”

Beyond the community-wide effects of hospital closures – including unemployment (including in non-healthcare industries), lower income levels, and slower economic growth – the tendency of police to target poor and chronically ill populations means that people who fall through the cracks as a result of these cuts to crucial federal subsidies risk being swept into the system. With evidence that high county jail incarceration rates are associated with a rise in county-wide deaths, Medicaid cuts risk accelerating a dangerous cycle of poverty, illness, incarceration, and death in rural communities.

Medicaid cuts also stand to make already-costly medical care for incarcerated people far more expensive by placing services further out of reach. People living in rural areas live an average of 10.5 miles from the nearest hospital (roughly twice the distance in other areas), and over one-third of rural hospitals that closed between 2013 and 2017 were more than 20 miles from the nearest hospital. States, counties, and municipalities are ultimately on the hook for the high and steadily rising costs associated with medical care for incarcerated people. In Cheshire County, New Hampshire, for example, the county jail already budgets $50,000 for healthcare outside of the facility, which is expected to cover medical care for 100 people in jail, including one person who requires dialysis to the tune of $6,000 every month. In Virginia, 27% of the prison healthcare budget in 2015 was spent on off-site hospital care.

In particular, the costs of transporting incarcerated people to hospitals for off-site or emergency care are already extreme. In Michigan, the cost for 224 ambulance trips to the rural Chippewa County Correctional Facility is upwards of $430,000.¹¹ Meanwhile, in New Hampshire, Department of Corrections expenditures on ambulances rose by 176% from 2022 to 2023. Requiring transport to hospitals that are further away will cause these costs to climb even higher, and will incentivize corrections departments to avoid doing so as much as possible.¹² Prisons and jails already engage in this practice because of untenably high transport and staffing expenses.¹³ In Allegheny County, Pennsylvania, (which is not even a rural county), medical transport from the jail “takes two correctional officers out of the jail for up to 10 hours.” In a survey of jail staff in southeastern states, one jail employee reported that they “try and get rid of dialysis patients as quickly as [they] can, too, because they don’t wanna have to transport them three days a week to dialysis.” In addition to delaying offsite transportation as much as possible, corrections authorities may also try to deflect rising costs onto their (typically poor) incarcerated patients. As the National Consumer Law Center notes, jails in at least 25 states already engage in such practices:

“When an incarcerated person suffers from an acute medical issue that requires care that the jail cannot provide in-house, some sheriffs will release the person on “medical bond” before transporting them to a hospital so that the jail will not have to pay the medical bills. Once the person receives treatment and recovers, the sheriffs then often quickly move to rearrest and book the person back into jail.”

The failure to address people’s health needs while incarcerated exerts pressure on the remaining healthcare infrastructure as sick people leave correctional facilities and return home. For example, people on probation and parole face higher rates of substance use disorders, mental health diagnoses, chronic conditions, and disabilities than the general population, and over a quarter of people on community supervision have no health insurance, further limiting their access to adequate healthcare in the community.

Conclusion

The latest cuts to Medicaid pose substantial risks to both rural communities and the people who are incarcerated within them. Healthcare for incarcerated people is already abysmal, and jails and prison systems have been complaining about the rising medical costs for years. Medicaid cuts will pour fuel on this fire by forcing many rural hospitals to close. Further restricting timely access to routine off-site and emergency medical care will stoke worse health outcomes and higher mortality rates for an aging confined population. Given that most incarcerated people will eventually return to the community, these problems will exacerbate larger public health issues, impact community-wide mortality, and further burden the existing, limited emergency medical services in rural communities. Taken together, these factors paint a grim picture of the future for all people in rural communities as the combination of poor health and poverty makes rural communities more of a target for policing and incarceration. The destruction of rural public health infrastructure is a policy choice that inevitably favors using jails and prisons to manage increasingly poor, sick, and neglected populations through punishment rather than care.

Highlights from a busy year at Prison Policy Initiative

In our new annual report, we share examples of how we are building on the foundations of our research and visualizations to meet the challenges of this moment

by Danielle Squillante, October 23, 2025

We wrapped up another productive year at the Prison Policy Initiative, and are thrilled to share our 2024-2025 Annual Report with you. We released 5 major reports, 24 research briefings, 2 new resources as part of our Advocacy Toolkit, and several briefings related to our campaign to end prison gerrymandering. We also provided technical support to advocates at the state and local levels working on issues such as fighting jail expansion, making prison visitation a right, and water contamination in prisons.

Here are a handful of accomplishments we’re particularly proud of:

• We published an update to our flagship Mass Incarceration: The Whole Pie report detailing the scale of mass incarceration in the U.S.
• We released reports tackling two of the most consequential issues for incarcerated people — prison disciplinary systems and prison health care. Using a combination of deep analysis and first-hand accounts of these systems, we peeled back the curtain to show how these systems traumatize incarcerated people both physically and mentally.
• As part of our campaign to end prison gerrymandering, we produced 5 reports that highlight the scale and impact of prison gerrymandering in Oklahoma, North Carolina, Louisiana, West Virginia, and Kansas.
• Through our partnership with the Jail Data Initiative, we published 3 briefings utilizing present-day data from roughly 900 jails to provide a better understanding of those who are criminalized and locked up. Our briefings focused on the criminalization of unhoused people, the demographics of people booked into jails multiple times, and offense data for people in local jails.
• We expanded our focus on federal criminal legal system policy and launched our new federal tracker that connects the dots of the Trump administration’s actions to show its larger strategy of doubling down on the failed policies that created the nation’s mass incarceration crisis in the first place.
• Our Policy & Advocacy team hosted 3 webinars on organizing legislative testimony from incarcerated people, pushing back against unproductive and inaccurate uses of recidivism stories and statistics, and fighting back against jail expansion.

This is only a snapshot of what we produced this past year. We are proud of our accomplishments and look forward to sharing new projects with you in the year to come.

How to get started reporting on issues with parole release in your state

We explain how to use our 35-state report Parole in Perspective to jumpstart investigations into your state's parole system.

by Wanda Bertram, October 20, 2025

Frustratingly little data exists about discretionary parole systems in the U.S. — a gap that hinders policymakers, incarcerated people, advocates, and journalists attempting to navigate the system, assess its effectiveness, and champion meaningful reforms.

To fill the gap, the Prison Policy Initiative released a new report, Parole in Perspective, designed to pull back the curtain on how discretionary parole works in 35 states (the states that still use it to release people serving a wide range of sentences). Part one of this report explores the makeup of parole boards and how they conduct hearings. Part two dives into the data on parole hearings and grant rates in these states, and the criteria that boards use in determining whether someone will be released.

If you are a journalist reporting on parole, our report can help — whether you’re just looking for an introduction to these systems or trying to investigate them in depth.

Parole in Perspective answers basic questions like:

• Which states still have discretionary parole?
• Who is making parole decisions in your state?
• How many people are granted parole in your state every year? How has this changed over time?
• How much data does your state publish about parole release, compared to other states?

Our report can also serve as a starting point for answering more complicated questions about parole, such as:

• How are parole boards making decisions? Our appendix table breaks down which criteria boards are required to take into account in each state. For instance, some boards are required to consider a person’s age — a relevant factor as prison populations get older and as a growing number of states recognize youth under 25 as less culpable for their actions. Importantly, most boards place a lot of weight on factors that the applicant has no control over, such as the original crime for which they are locked up.
• Are punitive sentencing reforms forcing people to wait longer for parole hearings? While our report does not discuss such reforms directly, we show that in almost every state, parole boards are holding significantly fewer hearings today than they did several years ago — suggesting that various factors, including “Truth in Sentencing”-style reforms, are having an impact.
• How much time is the board likely spending on each individual case? Our report shows how many people have parole hearings in an average year, by state; as well as how many members each state’s parole board has. States vary widely in the size of their parole boards and how many members are required to hold a hearing.
• Is the availability of housing and programs shaping parole grants? For example, our report shows which parole boards take someone’s reentry plan into account, which depends on housing and other services. The availability of in-prison programming also influences grant rates in states that consider someone’s accomplishments behind bars.
• How is the format of parole hearings affecting decisions? As we explain in the report, a growing number of states are transitioning to virtual hearings — and a handful do not allow applicants to be present at their hearing at all.

Questions about discretionary parole can come up on a wide range of stories: It is a key aspect of timely issues such as the aging prison population and the “tough-on-crime” creep among elected officials. We hope this report serves as a useful tool for reporters seeking to shine much-needed light on these systems. And for any questions about parole systems that the report does not answer, we’re here to help. Reporters can reach out to us through our contact page for quick assistance exploring these and other issues.

New report, Parole in Perspective, shines a light on how parole boards work and how parole decisions are made in 35 states

Despite their differences, all discretionary parole systems have serious design flaws and most are steadily releasing fewer people, a new report shows.

October 7, 2025

A new report from the Prison Policy Initiative pulls back the curtain on parole release systems, providing the most accessible and comprehensive source to date for comparing how these essential — and often dysfunctional — release mechanisms are set up in 35 states. The report, Parole in Perspective, reveals that parole releases are on the decline in nearly every state that uses discretionary parole, highlighting elements of the process that contribute to this urgent problem.

Parole in Perspective comprises two parts, each honing in on different elements of parole release. The first explores the makeup of boards and how they conduct hearings. The second dives into new data on hearings and grants, and the factors that boards consider — including their discretion — in determining whether someone will be released.

The report contains four essential data tables showing:

• How parole boards in 35 states are composed and how they hold hearings;
• The number of parole hearings and grants in every state from 2019-2024;
• How parole boards compare on the criteria they use to determine release;
• The exact statutory text guiding parole boards’ decisionmaking in every state.

Parole in Perspective coincides with the Prison Policy Initiative and MacArthur Justice Center’s release of their Principles for Parole Reform, a guiding “North Star” document designed to help activists and policymakers identify priorities for reform in their states.

Both the new report and the Principles for Parole Reform identify crucial flaws in parole systems today, including:

• Relying too heavily on factors outside of applicants’ control — such as “the severity of the offense” or a perception that release would “diminish the seriousness of the crime”;
• Making irrational parole decisions in favor of keeping applicants locked up, often flying in the face of what risk assessment tools recommend;
• Stacking boards with law enforcement professionals, while ignoring the perspective of people with experiences of incarceration;
• Increasingly holding virtual rather than face-to-face hearings, or worse, not affording parole applicants a hearing at all.

“Despite their differences, all discretionary parole systems have serious design flaws that lead to an unfair preparation and hearing process for incarcerated people,” said report author Leah Wang. “By shining a light on boards and their practices, we hope to lay a path toward making these systems real tools for decarceration.”

The full report is available at https://www.prisonpolicy.org/reports/parole.html.

In 2025, every U.S. state outranks most democratic countries in women’s incarceration, new report shows

The number of imprisoned women globally has grown 60% since 2000. The United States remains a major driver of this population, a new report shows.

September 23, 2025

Every U.S. state incarcerates more women per capita than most independent nations of the world, a new report from the Prison Policy Initiative shows. Collectively, the United States accounts for 4 percent of the world’s women, but holds one-quarter of women who are incarcerated worldwide.

States of Women’s Incarceration: The Global Context 2025 provides a comprehensive women’s incarceration rate for every U.S. state — including prisons and jails, youth confinement facilities, tribal jails, immigrant detention centers, and other types of incarceration — comparing states to each other and to countries of the world. The report offers a crucial lens through which to view the criminalization of women, who are a small minority of all incarcerated people in the U.S., but whose incarceration rates today are at near-historic highs.

The Prison Policy Initiative’s report allows viewers to observe that, for example:

• South Dakota — with the highest incarceration rate in the U.S. — as well as Montana and Idaho have higher women’s incarceration rates than any country in the world.
• Women in Kentucky face almost the same incarceration rate as women in El Salvador, a country that has been described as an authoritarian police state.
• New Jersey — which has one of the lowest women’s incarceration rates in the U.S. — is on par with the United Arab Emirates, a nation where nonmarital sex can result in a prison sentence of six months for women.

States of Women’s Incarceration homes in on some of this country’s closest international allies to show just how starkly the U.S. stands out globally. Most states, the report shows, incarcerate women at more than double the rates of these “peer” countries.

“Women’s mass incarceration is a global concern — the number of imprisoned women has grown nearly 60% since the year 2000,” said report author Emily Widra. “With this country’s war on drugs, our treatment of mental illness as a problem for police to deal with, and our criminalization of poverty, it is no wonder that the U.S. continues to drive this problem and to account for a quarter of the world’s incarcerated women.”

The full report is available at https://www.prisonpolicy.org/global/women/2025.html.

New report, Youth Confinement: The Whole Pie 2025, shows racial disparities in youth confinement worsening as total numbers go down

New report explains how many system-involved youth are confined, where they are held, under what conditions, and for what offenses.

August 25, 2025

A new Prison Policy Initiative report provides the most up-to-date picture of how many youth are detained and committed in the U.S., highlighting the persistent overincarceration of Black and Indigenous youth in a system that, in recent decades, has made great strides in reducing youth confinement overall. Youth Confinement: The Whole Pie 2025 explores the conditions facing 31,900 kids today — most of whom are held in youth prisons and jails — and offers data on youth confinement by offense type in all 50 states.

Over the past 25 years, the number of youth in confinement in the U.S. has fallen by more than 70 percent — impressive progress compared to the adult criminal legal system, whose populations have changed very little overall in that same period. Nevertheless, the U.S. still confines youth at a rate more than twice the global average, and its juvenile legal system mirrors the adult system in many alarming ways:

• Severe racial disparities. 47% of boys and 39% of girls in juvenile facilities are Black — a level of disparity that has actually worsened in recent years. And even excluding youth held in Indian country facilities, Indigenous children make up 3% of girls and 2% of boys in juvenile facilities, despite comprising less than 1% of all youth nationally.
• Large numbers of youth held pretrial or for minor offenses. Nearly 9,000 youth today are locked up before they’ve had a trial, and thousands are in detention for minor, low-level offenses. Select states — such as Indiana, which accounts for almost one-quarter of kids locked up for running away; and Texas and California, which hold 26% of kids confined for technical violations of parole — contribute heavily to this problem.
• Prison-like conditions. While the number of kids in large facilities (holding 100 youth or more) has fallen steeply in the last few years, nearly 4 out of every 5 confined kids are held in youth or adult prisons and jails — an increase since 2017, when 65% of confined youth were held in such places.

“States have made astonishing progress in the last 25 years in reducing youth incarceration, but the fact remains that prisons and jails are not places for kids,” said report author Brian Nam-Sonenstein. “Confinement is still a traumatizing experience for youth — most of whom already have histories of trauma — and one that leaves them worse off than before their incarceration.”

Youth Confinement: The Whole Pie 2025 includes a first-of-its-kind, 50-state table showing the number of youth confined for various types of offenses, shining particular light on “status offenses” (behaviors that are not law violations for adults). Other key features of the report include:

• Sidebars breaking down the different types of youth confinement facilities, and terminology around youth incarceration that differs from the adult system;
• Infographics “zooming in” on certain slices of the pie, such as youth held for low-level offenses and youth in highly restrictive facilities;
• A section highlighting some of the reforms that have led to a more than 70% drop in confined youth populations, and noting how these same reforms could be applied to the adult criminal legal system.

“Disturbingly, some states today are threatening to double down on failed policies that created the youth confinement crisis in the first place,” Nam-Sonenstein said. “Seeing the full picture of this system should remove any doubt that it casts far too wide a net, one that disproportionately ensnares Black and brown youth. State policymakers would do well to emulate the reforms that have shrunk this system and apply these lessons to adult prisons and jails.”

The full report is available here: https://www.prisonpolicy.org/reports/youth2025.html

New study finds confined neurodivergent youth of color are particularly vulnerable to physical assault by staff

A new study analyzing a national survey of youth in custody reveals stark disparities in rates of staff physical assault among Black and neurodivergent youth.

by Emily Widra, August 19, 2025

Even though the rate of youth incarceration is more than three times lower than it was twenty years ago, youth of color and youth with disabilities are still overrepresented in custody — and these disparities are getting worse.¹
These children were already among the most vulnerable to involvement in the juvenile legal system, but as the system decarcerates, their vulnerability is compounded by the fact that they are also among the most likely to suffer abuse while confined, including being violently victimized by adults.

New research underscores the extent to which staff violence against incarcerated neurodivergent youth of color is substantially worse than it is for white neurotypical youth.² Brianna Suslovic and her colleagues at the University of Chicago Crown Family School of Social Work, Policy, and Practice, identified significant disparities in the likelihood of staff physical assault between confined youth of different racial identities, and between neurodivergent and neurotypical incarcerated youth. They found that the odds of Black youth reporting staff physical assault are 79% higher than the odds of white youth reporting assault, and the odds of neurodivergent youth reporting staff assault are 59% higher than the odds of neurotypical youth reporting assault. Even more alarmingly, for neurodivergent youth of color, the odds of reporting staff physical assault are more than twice the odds of their white, neurotypical peers.

These findings, forthcoming in the Journal of the Society for Social Work and Research, are based on data collected by the federal government in the 2018 National Survey of Youth in Custody. Suslovic and her co-authors have made a useful contribution to existing research because they use self-reported data to examine how structural forces and marginalization — in this case, racism and ableism — shape experiences of youth confinement. The evidence they present underscores the need to keep those at the highest risk of abuse at the forefront of decarceration efforts, and to ensure they don’t enter youth jails and prisons in the first place.

Confined youth of color and neurodivergent youth disproportionately experience violence at the hands of facility staff

The study finds that children of color and neurodivergent children are disproportionately confined in juvenile facilities, and that neurodivergent children of color in particular are more likely to report being physically assaulted by staff than white, neurotypical children.

Among white, Black, and Hispanic confined youth, those identified as neurodivergent — meaning they’ve ever been diagnosed with ADD/ADHD, dyslexia, a learning disability, Autism or Asperger’s Syndrome — are more likely to have been physically assaulted by staff, based on self-reporting in the 2018 National Survey of Youth in Custody. Source: Suslovic, B., Shankar, S., & Gottlieb, A. (2025). Race/Ethnicity, Neurodivergence, and Odds of Staff Physical Assault in Youth Carceral Settings. Journal of the Society for Social Work and Research. https://doi.org/10.1086/734616.

Overall, more than 1 in 10 incarcerated youth report being assaulted by staff. However, among neurodivergent confined youth, a greater proportion (15%) reported being assaulted by staff. In fact, the odds of neurodivergent youth reporting violent victimization by staff were 59% higher than the odds of their neurotypical peers. In the analysis across race, the researchers found that Black youth have odds of reporting staff physical assault that are 79% higher than white youth, with almost 1 in every 6 Black youth reporting assault, compared to 1 in 9 white youth.

The researchers also found that across almost all racial categories, staff physical assault is more prevalent among neurodivergent youth.¹⁰ Neurodivergent youth of color experience a distressing 120% higher odds of reporting being assaulted by staff than their white, neurotypical peers. This is particularly alarming, as it indicates the extent to which the children most vulnerable to involvement in the juvenile system are made additionally vulnerable to violence at the hands of adults in power.

Despite great strides in youth decarceration, longstanding disparities in confinement are getting worse

The great strides made in youth decarceration over the past twenty years have not been evenly distributed. People of color and those with disabilities, who have often been primary targets for surveillance, policing, and incarceration,¹¹ still represent a greater portion of the dwindling confined youth population than their white and neurotypical peers. In fact, their overrepresentation in the system is growing, and they continue to face the very kinds of abuses that have motivated decarceration of youth jails and prisons in the first place.

The conditions in youth jails and prisons — which can include solitary confinement, physical abuse, sexual abuse, a lack of programming and services, and excessive use of force — make juvenile confinement particularly dangerous for youth with disabilities, and can exacerbate mental and behavioral health concerns.¹² Overall, confined youth face exceptional risk of victimization by facility staff: systemic maltreatment — including physical abuse and excessive use of force by staff — has been reported in juvenile facilities in 29 states since 2000, and a 2010 survey found 22% of confined youth reported that they were afraid that a staff member will physically attack them.¹³

The data from this newest study support these concerning trends, further quantifying the overrepresentation of youth of color and neurodivergent youth in confinement, and characterizing their mistreatment in a shrinking system.

Youth with disabilities are disproportionately locked up

More than two-thirds of confined youth met the study’s criteria for neurodivergence, which the researchers defined as any diagnosis by a doctor, counselor, or other professional of ADD/ADHD, dyslexia, a learning disability, Autism, or Asperger’s Syndrome. The prevalence of many of these diagnoses is much higher among children in custody than in the national youth population:¹⁴

• ADD/ADHD: 60% of youth in custody compared to 11% of youth nationally;
• Learning disabilities: 27% of youth in custody compared to 8% of youth nationally; and,
• Autism: 4% of youth in custody compared to 1.7% of youth nationally.

In addition, more than half (55%) of neurodivergent confined youth were Black, Hispanic, American Indian or Alaska Native, Asian, or Native Hawaiian or Pacific Islander.

While youth with disabilities represent 17% of national K-12 enrollment, they represent almost one quarter (24%) of confined youth.¹⁵ Children with disabilities face some of the highest rates of arrest in schools, in part because police are often called to respond to youth who have challenges with processing emotions and information, communication, and disability-related behaviors. Youth of color with disabilities are arrested at even higher rates in schools, with Native Hawaiian and Pacific Islander boys and Black boys with disabilities facing rates four to six times the average arrest rate.¹⁶

Racial disparities are increasing in youth confinement

Racial disparities have long been a feature of youth incarceration, and they’re only getting worse. In 2003, Black youth accounted for 38% of youth detained or committed, and in 2023, this increased to over 46%. In addition, youth of more than one race accounted for only 1% of confined youth in 2006 (the first year juvenile data included that race category), and that proportion has more than doubled as of 2023.

Some of these disparities can be traced back to differences in the policing of kids of different races and ethnicities. As is the case with Black adults, Black children are particularly targeted with overcharging and harsher treatment, making them far more likely to be incarcerated than white children. Black children, and especially Black girls, are also subject to an added burden of adultification: when a child is perceived as older, more culpable, and more responsible than their peers. Similar to the racist “super predator” myth that was used to rationalize harsh punishments in the 1990s by portraying Black youth as more violent and unruly than their white peers, adultification leads to harsher consequences within the juvenile legal system.

Conclusion

The findings from Brianna Suslovic and her colleagues represent important contributions to the existing research, highlighting how some of the most vulnerable children are funneled into the juvenile legal system, where they face a number of dangers, including physical assault by staff.

Violent victimization is the product of several factors in youth confinement. Almost one-third of the study sample reported physical abuse by an adult prior to confinement, and we know that prior victimization is a strong indicator of subsequent victimization while in custody. Research also shows that the quality of relationships with facility staff can influence the likelihood of victimization — and other positive and negative outcomes for incarcerated youth and adults — and the vast majority (89%) of confined youth reported that they were assigned a case manager or counselor. Educational access and engagement have been identified as protective factors against maltreatment for children as well. Despite evidence that people who achieve higher levels of education while incarcerated are more likely to experience positive outcomes after release, less than one-third of confined youth have completed high school, even though more than 60% of confined youth are over 17 years old.¹⁷ Many of the same factors that make children more vulnerable to criminal legal system involvement also make them more vulnerable to suffering abuse while confined, and this study calls particular attention to some of the youth most disproportionately at risk of violent victimization by adults.

While the number of confined youth has been declining for years, the confined population still reflects the racist and ableist trends of the nation’s criminal legal system: children with histories of abuse, lower education levels, learning disabilities, cognitive disorders, disabilities, and children of color are disproportionately locked up. Those are the children who remain in juvenile facilities where they are at heightened risk of physical assault at the hands of the people charged with their safety and wellbeing. Given the pronounced failure of youth incarceration to significantly reduce “delinquent” behaviors and the dangers they experience behind bars, the findings from this recent study signal a need to reevaluate our nation’s use of incarceration for children.

WEBINAR: Taking the Lede: How advocates can shape news coverage of the criminal legal system

How small organizations can make the most of their resources to build relationships with the media.

by Wanda Bertram, August 18, 2025

With every sheriff’s office, department of corrections, district attorney, and police department armed with its own media relations team, the news cycle is all too often stacked toward the status quo when it comes to criminal legal system issues. How can advocates for system reform have their voices amplified — and their priority issues covered — without overworking themselves to get the media’s attention? And how can advocates frame issues in ways that resonate with journalists?

On September 18th, the Prison Policy Initiative and the Center for Just Journalism hosted a webinar to help advocacy organizations home their media strategies and get attention on critical issues. Panelists Wanda Bertram of the Prison Policy Initiative and Hannah Riley of the Center for Just Journalism provided guidance on how small organizations can make the most of their limited resources and staff capacity. They covered:

• The lay of the contemporary news media landscape and basic tips for interacting with journalists;
• The strategic benefits of building relationships with reporters, and how advocates should select reporters to reach out to;
• How to have informal conversations with the media that can influence the news cycle, as well as write formal pitches that can lead to news clippings.

Watch the full webinar:

Additional resources:

• Webinar slides
• Freedom of the Press Foundation’s guide to interviewing incarcerated people
• Institute for Nonprofit News’ publications directory
• Ad Fontes’ media bias chart

Prison Policy Initiative supports Safety Bound’s bold new platform to reimagine the sheriff

The policy demands are designed to challenge the unchecked power of sheriffs and improve jail conditions for people in custody.

by Danielle Squillante, August 11, 2025

One out of every three people behind bars is being held in a local jail, yet the 3,000+ sheriffs that control them operate with little to no oversight — and the consequences are deadly. Hundreds of people, many of whom are held pretrial and have not been convicted of a crime, die each year in local jails from suicide, overdoses, violence, and neglect.

Safety Bound, an organization that works to reimagine the role of sheriffs, has created a policy platform with seven demands that advocates can use to curb the unchecked power of sheriffs, reduce jail populations, and improve conditions inside these facilities. We helped to support this effort by providing insights and research on the health harms of incarceration and ways communities can avoid costly and ineffective jail construction projects.

The seven demands are listed below, and are explained in more depth on Safety Bound’s website.

1. Towards Accountability — Sheriffs should improve jail operations and conditions to prevent injuries and deaths.
   • People in jails have high rates of mental illness, chronic health conditions, and substance use, which jails are not equipped to provide care for.
2. Towards Freedom — Sheriffs should reduce jail populations and oppose jail expansions
   • Investing in jail construction is not a solution to social problems but rather doubles down on old policies that caused these problems to begin with.
3. Towards Immigrant Justice — Sheriffs should end all voluntary cooperation with any and all immigration enforcement.
   • Local jails play an important role in enabling federal agencies like ICE and the U.S. Marshals to detain people for immigration reasons.
4. Towards Racial Justice — Sheriffs should end pretextual traffic stops.
   • Traffic stops are not only the most common type of police-initiated contact, but are common sites of police violence, impacting Black drivers more than any other racial group.
5. Towards Health — Sheriffs should advocate for alternative emergency response for mental health and substance use crises.
   • Despite how sheriffs repackage incarceration as care to justify jail expansion or budget increases, jails are not a substitute for treatment. A better solution is community-based support systems that address challenges before they become crises that result in incarceration.
6. Towards Democracy — Sheriffs should not take campaign donations from jail contractors.
   • Nationwide, sheriffs have received countless dollars in campaign donations from security and investigative companies, construction firms, medical services providers, telecom and tech companies, bail bonding companies, and even apparel and uniform manufacturers.
7. Towards Election Integrity — Sheriffs should act to protect election officials and voters from threats and violence that undermine the right to vote.
   • Elected officials, particularly at the local and state level, significantly shape the criminal legal system and elections are an important tool in the fight against mass incarceration.

Learn more

You can learn more about Safety Bound’s 7 Demands to Reimagine the Sheriff at: https://www.safetybound.org/demands

The organization is also hosting a webinar on Thursday, August 14th, to explore each demand in depth. The organization’s partners — including our Policy & Advocacy team — will discuss how we can build a movement rooted in care and accountability.

Trump’s executive order targeting unhoused people will leave everyone worse off

The harsh reality is that this order will criminalize already-vulnerable people who are in need of care, putting our communities in danger.

by Regan Huston, August 5, 2025

Last month, President Trump signed an executive order aimed at forcibly locking unhoused people experiencing mental health crises or substance use disorder in involuntary commitment in state psychiatric hospitals.¹ Here’s the issue with that measure: it is nothing more than an attempt to disguise criminalization as care.

As the number of people experiencing homelessness in the U.S. soars and social supports are stripped away, this move will undoubtedly expand the criminal legal system.

The truth about involuntary commitment

The order directs the federal government to find ways to encourage and empower states to force unhoused people experiencing mental health or substance use issues into involuntary commitment facilities.

Jails & homelessness The moral & fiscal costs of failed policies

These state psychiatric hospitals aren’t typically run by departments of correction, but they are in reality much like prisons. At least 38 states also allow involuntary commitment for substance use disorder treatment, and evidence suggests that these supposed “treatment facilities” are not effective. Notably, it can be extremely difficult for these “forensic patients” to be released as they may remain hospitalized for decades or for life.

Involuntary commitment is not only legally and ethically dubious, but it also fails to deliver on the very objectives that justified its creation.

Contradicting cuts

Notably, in the first five months of his second term, Trump has gutted social programs that have been proven to reduce crime and keep people off the street.

First, the administration slashed $11 billion from addiction and mental health programs, a move that will lead to increasing prison and jail populations. Then, it targeted Housing First programs, a method that has been proven effective at getting and keeping people off the street, by giving them access to housing without conditions. And, last month, Trump’s “big, beautiful bill” came with an ugly reality: Steep cuts to Medicaid that will leave 10 million people uninsured, making it nearly impossible for them to access mental health care or substance abuse treatment.

At the same time, it has tried to end harm-reduction strategies that aim to reduce overdoses and the negative health effects of drug use. The administration’s actions are contrary to public health research that shows that harm-reduction work.

With the safety net shredded, what will happen to the people who desperately need care? In many cases, they’ll be put straight into actual prisons and jails, which are never appropriate places for treatment.

Shuffled into the system

The administration has made it clear that it would rather shift money away from care and turn toward expanded criminalization.

Prisons and jails are often viewed as de facto mental health and substance abuse treatment providers, but the reality couldn’t be further from the truth. Rates of mental illness are exceptionally high among incarcerated people, and these facilities fail to meet the demand for help. More than half of the people in state prison reported having a mental health problem, yet only 26% received professional help since entering prison.

Based on 2019 data from the National Survey of Drug Use and Health (NSDUH) from SAMHSA, approximately 8% of people over the age of 12 met the criteria for a substance use disorder, and 41% of people who had been arrested in the last year met the criteria for a substance use disorder. In 2016 (the most recent year for which the Bureau of Justice Statistics published national prison data), 47% of people in state and federal prisons met the criteria for a substance use disorder in the 12 months prior to their most recent prison admission.

Not only are prisons and jails unable to treat mental health problems, but they can also create them. Incarceration itself is traumatizing and can inflict serious mental damage on people. Violence behind bars is inescapable and can result in post-traumatic stress symptoms, like anxiety, depression, avoidance, hypersensitivity, hypervigilance, suicidality, flashbacks, and difficulty with emotional regulation.

Prisons and jails are not treatment centers for substance use disorders, either. In fact, these facilities punish drug use far more than they treat it. People who have been arrested or incarcerated have higher rates of substance use disorder than the general population. And, disturbingly, only 1 in 10 people in state prisons with substance use disorders received treatment.

Jails, which tend to have even fewer resources, are also not suited to offer care. The most effective treatment options are the least accessible for people with opioid use disorder: Just 19% of jails initiate medication-assisted treatment for people with opioid use disorder.

Behind bars, people don’t have access to the care they need – and upon release, they’re often left worse off than before incarceration. Formerly incarcerated people are almost 10 times more likely to be homeless than the general public. And, being homeless makes formerly incarcerated people more likely to be arrested and incarcerated again, creating a revolving door.

Attacks on people experiencing homelessness

The reality is that there is an inextricable link between housing, mental illness, drug use, and criminalization. Yes, people experiencing these vulnerable situations often need care — but forcibly hospitalizing them is not the solution.

Instead, the U.S. must embrace Housing First. This method offers housing with no strings attached. It recognizes housing as the first step in responding to homelessness, rather than something to work toward. It also does more than simply put a roof over people’s heads; it gives people the space and stability necessary to receive care, escape crises, and improve their quality of life. Research shows that this approach keeps people housed and improves attitudes and outlook on life.

Conclusion

In the last year, there have been rampant attacks on people experiencing homelessness – and this executive order is the latest example. It’s a bad move that will result in far more people locked up simply because they’re experiencing homelessness, mental health crises, or substance use issues. Gutting proven solutions that make communities safer — like community-based care, Housing First, and harm-reduction efforts — seems to be a pattern with the administration.

The good news is that state and local governments don’t have to help this misguided effort. The federal government will certainly dangle funding to entice them to implement these policies, but they have the ability to say no. If the money comes with these types of strings attached, it isn’t worth the cost.