Listening to the sounds and activity above has given me insight into the terrible state of mental healthcare in prison and how badly we need changes. In the United States, roughly 40% of people in state prisons and local jails have a history of mental illness, but less than half of those folks receive treatment, according to the National Alliance on Mental Illness (NAMI). Individuals with signs of mental health issues can face additional risks and discipline while inside, including prison misconduct charges, longer solitary confinement periods and barriers to accessing medication.