Topic: Disabilities

Research Report

Behavioral Health Disabilities June 23, 2025

Reducing Arrest and Jailing of People with Mental Health Disabilities, Including Those with Intersectional Identities

This paper will explore the intersectional identities of people with mental health disabilities involved with the criminal legal system, including the added challenges they face, and the community-based, person-centered solutions that better serve us all, including by embracing, rather than stigmatizing, diversity. Throughout, we provide examples of initiatives that communities across the country, including the MacArthur Foundation’s Safety + Justice Challenge network cities and counties, are undertaking to better serve a diverse population and reduce their exposure to law enforcement and incarceration. These community initiatives are not only more effective and humane than using criminal enforcement mechanisms to address mental health challenges, but also help communities comply with civil rights laws and federal protections for people with mental health disabilities by providing services in the most integrated setting and ensuring everyone has an equal opportunity to benefit from public programs and services.

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Research Report

Behavioral Health Disabilities Housing June 23, 2025

Overrepresentation of People With Disabilities and Deaf People in Local Criminal Justice Systems

Every year, over seven million admissions occur in the 3,116 local jails across the United States. Local mass incarceration disproportionately impacts the most marginalized communities—especially Black, Latinx, and Indigenous individuals; LGBTQ+ people; those living in poverty; and survivors of violence. A significant number of these individuals also have at least one disability, yet this critical aspect of their identities is often overlooked in analyses of mass incarceration and by the criminal legal reform movement. While the prevalence of psychiatric disabilities (often referred to as mental illnesses) is well known, the prevalence of other disabilities—including those that are cognitive, physical, and sensory and Deaf individuals—remain largely absent from mainstream discussions and reform efforts.

This paper begins by discussing disability and Deaf communities and their overrepresentation in the criminal legal system. By tracing the history of involuntary institutionalization and incarceration of people with disabilities, we can better understand the deep disparities of today. We explore the complex, interrelated systems that increase the likelihood of individuals with disabilities encountering the criminal justice system, as well as the systemic features within that system that perpetuate these disparities. Finally, we present policy and practice recommendations aimed at reducing the high incarceration rates and harm experienced by people with disabilities within the criminal legal system. Because well over half of people in jails have a disability, we cannot address local mass incarceration without centering these communities in our collective efforts.

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Research Report

Behavioral Health Disabilities June 23, 2025

Expecting Difference: Reorienting Disability Strategy for Jail Decarceration

Among disabled people in jails, certain groups require disability access that cannot be readily addressed by generalist understandings of “ADA compliance” or by disability as a medical condition. Consequently, failure to fully consider disability dynamics within jails and reentry can lead to negative health impacts, decreased jail safety, and recidivism. It is time to see disability not as a checklist of disability rights compliance tasks, but as a breakthrough lens that can advance the work of making all communities safer, and thus to support all people to achieve their true potential.

As a type of nonprofit service and advocacy organization known as a Center for Independent Living, led by and for people with all kinds of disabilities, Access Living has spent more than forty years changing society so that everyone, disabled or not, can thrive. In the last six years, with the support of the MacArthur Safety and Justice Challenge, we have sought to intentionally rethink disability strategies for decarceration through reducing the use of jails. We have done this through the lived experience of our staff, as well as through rooting our work in relationships with all kinds of people with disabilities, including those who are system-involved.

This report reviews problems faced by specific under-addressed disability groups whose experiences highlight systems failures. We then identify systemic gaps created by a misalignment of philosophic approaches toward people with disabilities. The report benefits from the insights of system-impacted Access Living community members with disabilities over the years, some of whose anecdotal observations are shared in this paper. We then highlight disability-centered strategies from both jail- and community-based disability programs that offer disability justice-oriented pathways to reducing jail use and over-incarceration of people with disabilities.

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Research Report

Disabilities LGBTQ Pretrial June 23, 2025

An Intersectional Approach to Advocacy on Prison and Jail Conditions

This paper examines the profound and disproportionate harms caused by mass incarceration in the U.S., with a focus on pretrial detention and the experiences of multiply marginalized individuals, particularly disabled people, people of color, LGBTQIA+ individuals, and those at the intersections of these identities. Pretrial detention impacts nearly a million people daily, many of whom are held without conviction, leading to severe physical, psychological, and social consequences. Although reform efforts have brought attention to the broader harms of incarceration, they often fail to account for the unique and compounded risks faced by people with intersecting marginalized identities. For example, incarcerated women, particularly women of color and survivors of sexual violence, are disproportionately affected by trauma and mental health conditions like PTSD and depression. Similarly, disabled people, especially those who are Black, Latinx, or Indigenous, are overrepresented in jails and face exacerbated health conditions due to poor carceral environments.

Using intersectionality theory as a framework, this paper highlights how various identities—race, gender, disability, and class—interact to intensify the harms of incarceration. It discusses the structural inequalities that contribute to the over-policing and over-incarceration of marginalized communities and explores how the conditions of confinement can both worsen and produce disabilities. Furthermore, the paper reviews current data on the demographics of incarcerated populations, highlighting the overrepresentation of people with disabilities, transgender individuals, and people of color. This report argues for an intersectional approach to criminal justice reform, advocating for systemic change that includes reducing reliance on pretrial detention, improving conditions within carceral institutions, expanding alternatives to incarceration, and addressing the unique needs of multiply marginalized populations. In addition, it offers key action steps such as improving data collection, promoting harm reduction strategies, increasing access to mental health services, and ending the use of solitary confinement.

The paper concludes that real reform requires a shift from punitive to restorative justice models, ensuring that advocacy efforts center the voices and lived experiences of those most affected by the criminal legal system. Through a comprehensive intersectional lens, this paper seeks to contribute to a broader conversation about decarceration and the abolition of pretrial detention, while addressing the structural inequities embedded in the U.S. criminal justice system.

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Research Report

Behavioral Health Disabilities Reentry October 3, 2024

Implementing the Medicaid Reentry Waiver in California

Lore Joplin, Justice System Partners, Maureen McDonnell, TASC’s Center for Health & Justice, Kimberly Richards, Justice System Partners, Miriam Popper, Justice System Partners, Vikki Wachino, Health and Reentry Project, Margot Cronin-Furman, Health and Reentry Project, John Sawyer, Waxman Strategies, Silicia Lomax, Waxman Strategies, David Ryan, Health and Reentry Project

In January 2023, California became the first state in the nation to receive approval from the federal Centers for Medicare and Medicaid Services (CMS) for a Medicaid Section 1115 demonstration request to amend Medicaid’s inmate exclusion. People detained in jails and prisons have high rates of chronic and acute health needs, including physical, mental health, and substance disorders and reentry is a high-risk time. A key to addressing these reentry risks is addressing people’s health needs while they are incarcerated and building continuity of care from jail to community when they are released.

California’s waiver, called California’s Advancing and Innovating Medi-Cal (CalAIM), and the specific component focused on individuals who are transitioning out of the criminal justice system, the Justice Involved (JI) initiative, will for the first time provide a targeted set of Medicaid-covered services right before someone is released from prison or jail. These services aim to smooth reentry transitions from jail and prison to the community, establish better connections to community-based providers at release, and enhance access to necessary care and support. California’s approach is designed to reduce the high risk of post- release mortality, morbidity, and other adverse outcomes, including repeat contact with the criminal justice system, by bringing Medicaid financing and coverage standards to bear.

The work to implement California’s waiver and make these changes a reality is demanding, involving multiple partners at the state, county, and local level who have not previously worked together at this level of vital cross-system collaboration. Implementation of these changes is well underway, and county-level changes will roll out over the next two years, starting in October 2024. This paper highlights California’s implementation approach, focusing on the county-level impacts on jails, health care providers, and reentry processes. It also explores several implementation challenges and the steps the state and the counties have taken thus far to implement this change.

The John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge Initiative provides funding for this project, including technical assistance conducted by Justice System Partners (JSP) and the Health and Reentry Project (HARP). As part of the project, JSP and HARP conducted interviews and group discussions with representatives from 11 California counties and the California Department of Health Care Services (DHCS) who offered insights into implementation challenges and promising approaches to maximize the benefits of these important changes.

Companion Paper: Using a Learning Collaborative to Facilitate Broad Systems Transformation

In this paper, we explore the process and impact of convening a cross-sector peer learning network to foster coordination and collaboration between criminal justice, health care, behavioral health and community parters in support of this new Medicaid and criminal justice initiative.

Read more on our blog.

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