By Devin A. Giordano
This article was originally published by Truthout
I watched men in jail desperately ask for help, only to be turned away. Many had no formal diagnosis before they were incarcerated, so their pain went unnoticed.
In a mental health unit at the Orange County Jail in Goshen, New York, I observed a counselor dismiss a man’s distress simply because it wasn’t documented in his file. I was just 19 at the time, already grappling with mental health issues of my own. I expected some support for the man in the cell, but I soon learned that in many jails, help is only for those with the right paperwork.
When I arrived at jail in 2014, I carried a psychiatric diagnosis—things like anxiety and depression. Because of that documentation, I was placed on the mental health caseload. I was one of the lucky ones. My family’s health insurance had allowed me to see a psychiatrist and get treatment, a privilege many don’t have. Yet, the help I received felt inadequate. I had monthly check-ins and medication but no therapy or meaningful support. The unit felt more like a storage space for troubled individuals than a healing environment.
In 2017, after being sentenced, I moved to a state facility expecting better care, but it was worse. Treatment was reduced to a checklist—you needed to already have a diagnosis to get help. Stories from fellow inmates revealed a grim reality: those who struggled with conditions like schizophrenia but had no prior diagnosis were often dismissed. Their suffering went unrecognized, as untreated mental health issues broadly affected many inmates.
It’s estimated that 29% of incarcerated individuals in New York are on the mental health caseload, up from 26% the previous year. Yet, almost 50% of those in jails nationwide have some form of mental illness. This shows a significant gap. Many enter prison already suffering but go unseen because they lack the necessary records.
I stopped taking medication in 2018 due to unbearable side effects. When I reported feeling worse, the staff dismissed my concerns. Incarcerated people often receive medication as the sole treatment. Counseling and support are almost nonexistent. This leads to a cycle where medication acts as a substitute for real healing, treating symptoms without addressing underlying issues.
A 2023 study from Harvard’s Kennedy School highlights that just one day in jail can cause lasting psychological damage. The trauma from surveillance, violence, and separation from families contributes to an already stressed environment. When someone starts breaking down, they often face punishment instead of care, with unresolved issues piling up in their files as disciplinary reports.
This system not only fails those in need; it protects the institutions. If someone suffers but lacks a diagnosis, the state can shift blame away from itself, claiming there was no record. This bureaucratic approach prioritizes liability over real solutions and perpetuates neglect. New York spends billions on prisons yet minimizes mental health care as though acknowledging suffering is too costly.
To effectively support those in prison, mental health treatment should be available to everyone, regardless of their paperwork. Screening should occur during intake and at regular intervals, conducted by independent professionals. Prisons must offer therapy, group support, and trauma-informed care. Staff should learn to respond to distress with compassion, not punishment, recognizing incarceration itself as a source of trauma.
Untreated mental health issues lead to higher rates of reoffending and deeper cycles of poverty and despair. People leave prison more fragile than when they entered. Families and communities bear the brunt of this neglect.
We need to change the approach. Inside these walls, there are real people hurting. Medication is not the only answer; healing requires genuine care and a system that values people, not just paperwork. What isn’t documented still matters, and we cannot afford to ignore it any longer.
This article was originally published by Truthout and is licensed under Creative Commons (CC BY-NC-ND 4.0). Please maintain all links and credits in accordance with our republishing guidelines.
