Community mental health under routine detention: jail reliance, pretrial custody, and frequent mental distress

Most evidence on the criminal legal system as a structural determinant of population mental health concerns police killings and prison incarceration rather than the local jails and pretrial custody through which most criminal-legal contact occurs. We examined whether U.S. counties that rely more heavily on jail confinement and pretrial custody have a higher prevalence of frequent mental distress.

We linked county-year frequent mental distress estimates from CDC PLACES (2018-2023) to jail population, pretrial custody, and jail admissions rates from the Vera Institute, law-enforcement incident rates from the FBI Crime Data Explorer, fatal police shooting rates from the Washington Post, and state-level jail mortality rates from the Bureau of Justice Statistics. Ecological associations were estimated with population-weighted least squares models with state and year fixed effects, county-clustered standard errors, and analysis windows matched to each source's coverage.

A one-standard-deviation higher jail population rate was associated with 1.17 percentage points higher frequent mental distress (95% CI 0.88 to 1.46; n = 6, 719). In 2018-2019, pretrial custody (b = 0.40) and jail admissions rates (b = 0.39) were independently associated with higher distress (n = 3, 289); law-enforcement incident (b = 0.47) and fatal police shooting rates (b = 0.25) showed smaller positive associations. After adjustment for county poverty, median income, racial and ethnic composition, population density, and urbanicity, all coefficients attenuated to near zero (jail population rate b = 0.06, 95% CI -0.03 to 0.15).

Counties that rely heavily on jail and pretrial detention carry a substantially higher community mental-health burden, but that burden is largely inseparable from the socioeconomic disadvantage of the same counties; routine detention practice is best treated as a marker of structurally disadvantaged community environments rather than as an isolated exposure.