90% of Jail Inmates Have Dual Diagnosis Officials Say

Officials at an Oregon county jail say 90% of the people in their custody live with co-occurring mental illness and addiction. The statistic alone makes the case that dual diagnosis treatment, not incarceration, is the only lasting solution to this crisis.

For broader context, Oregon has performed admirably in the opioid crisis. The Beaver State offers a wide range of substance use disorder treatment programs, ranging from residential sober living to inpatient hospitals. However, one population that tends to be overlooked are inmates—those whose mental and behavioral conditions have played a role in criminal activities. 

Inside the Deschutes County Jail in Bend, a facility that holds people awaiting trial has quietly become a front-line behavioral health crisis center. Captain Michael Gill, who has worked there for nearly 30 years, says the shift is staggering. When he started, roughly 20% of inmates had mental health or substance use challenges. Today, that number is 90%.

“Those are very, very challenging populations to care for,” Gill noted.

Dual Diagnosis Behind Bars

The majority of inmates arriving at Deschutes County Jail aren’t hardened criminals. Many are booked on low-level offenses like trespassing, disorderly conduct. But when they arrive, their conditions are already at an acute crisis level. They may be withdrawing from alcohol or drugs, experiencing symptoms of severe mental illness or both.

Having co-occurring mental health and substance use disorders at the same time is the clinical definition of dual diagnosis. It requires a fundamentally different level of care than either condition alone.

Holly Harris leads Deschutes County’s behavioral health department and is unsparing in her assessment of where these individuals end up. Jails are “the absolute worst place a person with a mental health condition should be,” she asserted.

Incarceration leaves inmates isolated, controlled, and often highly stressful. These conditions can intensify psychiatric symptoms that, in turn, strengthen addiction tendencies. Even with behavioral health specialists, nurses, and limited medical beds onsite, the facility was never designed to provide mental health treatment. “It’s a jail cell,” Harris pointed out. She added, “It’s not a hospital. It’s not a treatment facility.”

Connecting Mental Health with Addictions

Harris points to several forces driving the rise in co-occurring disorders: more potent drugs, rising social and economic stress, and a growing population without access to adequate behavioral health resources. “We’re seeing more severity,” she said. “And more co-occurring conditions—mental health, substance use, trauma, all at once.”

That combination is notoriously difficult to treat when addressed in isolation. Treating only the addiction without addressing underlying mental health conditions leaves individuals highly vulnerable to relapse. The same goes when only addressing the mental illness without addressing substance use. 

Integrated, comprehensive care is essential. To be sure, many local efforts to increase dual diagnoses treatment in the state have borne fruit.

Yet Deschutes County has faced a persistent shortage of professionals and residential treatment beds for years. People who need intensive inpatient care often can’t access it. “We all know they should be in a residential facility,” Harris said. “There just isn’t one available.”

That gap fuels a destructive cycle: untreated individuals deteriorate, interact repeatedly with law enforcement, and cycle back through the jail — often in worse condition than before.

Jail as a Last Resort

Deputies at Deschutes County Jail now function as something far beyond corrections officers. On any given shift, a deputy might spend an hour calmly guiding a person in a psychiatric crisis through the booking process, then respond to a medical emergency, then act as an informal counselor for someone struggling to communicate with their attorney.

“One minute they’re mentoring someone, the next they’re responding to a fight, then a medical emergency,” Gill said. “It takes a unique person to work in this building.”

For individuals too mentally ill to assist in their own legal defense, the situation becomes even more complicated. These individuals may need transfer to the Oregon State Hospital for stabilization, but limited capacity there creates lengthy delays. People sit in jail, untreated and waiting.

“It becomes a hamster wheel,” Harris said. “There’s a piece of the system that’s broken.”

Finding Treatment Approaches

Both Gill and Harris agree on what the real solutions look like, even if they remain out of reach for many communities.

More residential treatment beds. Earlier access to comprehensive behavioral health care. Expanded crisis response teams. Diversion programs like Deschutes County’s stabilization center, where law enforcement can bring people in crisis as an alternative to arrest, can intercept individuals before they reach the jail.

Harris also acknowledges the difficulty of staging interventions for individuals too ill to seek help on their own. “There comes a point where not intervening is more harmful,” she said. Without intervention, people cycle endlessly through emergency rooms and jails. “It’s incredibly disheartening,” she said. “And costly.”

The situation in Deschutes County is not unique. Communities across the country are grappling with the same reality. Behavioral health treatment centers are the appropriate setting for people with co-occurring disorders.

For those who are impacted by a mental illness and addiction, act now. Delaying treatment can worsen a condition. Call [NUMBER] to speak with an expert or glance through our comprehensive directory to find dual diagnosis treatment programs and mental health treatment facilities.

Author

Courtney Myers, MS

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Courtney Myers has more than 15 years of experience in online writing and editing. Since graduating from N.C. State University with an MS in Technical Communication, she’s helped clients improve their visibility and reach through expert-level content creation. She specializes in addiction recovery and behavioral healthcare topics.

Editor

Peter Lee, PhD

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Peter W.Y. Lee is a writer and historian of American history during the Cold War. His primary focus is the relationship between youth and popular culture and its impact on U.S. society during the twentieth century. He has published widely on how the public has used popular culture as a mechanism to address political and social shifts throughout time