Opinion — Rebranding punishment as care: Examining Fulton County’s recently approved mental health jail plan

In a frightening scene of deja vu, a nightmare unfolded on August 20 as Fulton County Commissioners unveiled plans for a new $1.2 billion jail project. Back in June 2024, Fulton County sought a $2 billion new jail, which failed to materialize as commissioners balked at the tax increases required to fund the project. As members of the Community Over Cages coalition, we were vocally opposed to the idea that spending $2 billion on a new building would solve any of the structurally-driven dysfunction, neglect or abuse taking place in Fulton’s criminal legal system. The same remains true for the current proposal.

With these new plans came new marketing. The $1.2 billion is to be split between renovations at Fulton’s main jail—currently at the center of a Department of Justice consent decree—and a new “special purpose facility” designed to treat “mental health and medical needs.” As a current physician and future psychiatrist who research the criminal legal system’s impact on health, we reject this framing and see a missed opportunity to reorient county policy away from reactive, punitive responses towards preventive, care-centered ones. This plan exemplifies carceral humanism, which tries to paint punitive institutions as humane social service providers and frames jail as an environment well-suited for care.

This new facility is simply a jail by another name. It is to be built with the explicit purpose of incarcerating those with mental health conditions. These rhetorical tricks should not distract from the fact that real solutions lie far outside the walls of a jail, old or new.

Care doesn’t happen in a cage: Mental health and incarceration today

The idea that a jail will aid those with mental health diagnoses ignores both history and context. It’s such a contradiction that it echoes Secretary of Health Robert F. Kennedy Jr.’s desire to “Make America Healthy Again” by shredding public health institutions and vaccine infrastructure or President Donald Trump’s “support” for the working class by removing access to food and medical care.

Many people’s lives before incarceration are defined by poverty and trauma, contributing to high rates of mental distress prior to jail entry. Once inside, rather than healing, incarcerated individuals are further driven into crisis, with suicide being the number one cause of death in jails. In addition, institutional and medical neglect combine to produce premature death at horrifying rates.

There is no guarantee an incarcerated patient will get medication or therapy. Oftentimes, treatment looks like isolation and oversedation. Many receive no treatment at all, pharmaceutical or otherwise.

In 2019, the Southern Center for Human Rights sued Fulton County over the “unsanitary and degrading conditions” women with mental illness were experiencing in Fulton’s South Annex Jail, located in Union City. Many were held in solitary confinement for 23 hours a day. Prolonged solitary confinement, legally defined as torture, is commonplace for incarcerated people with severe mental health conditions. In August of 2025, the sheriff’s department was found in contempt of court for the second time. Time and additional resources have not markedly improved conditions for these women, why should we expect something different with the new jail proposal?

Over thirty people have died in Fulton custody since 2022.

In September 2022, Lashawn Thompson died in Fulton County Jail from a combination of dehydration, malnutrition, untreated schizophrenia, and bedbug infestation. This all took place in the supposed “psychiatric wing” of the jail.

In another Fulton-run facility, the Atlanta City Detention Center, 19 year old Noni Battiste-Kosoko, who allegedly experienced untreated symptoms of psychosis, died in custody in 2023.

The problem isn’t the building, but the endemic characteristics of jails as death-producing institutions. Thousands die in custody around the country each year. There is no “model” that Fulton should seek to replicate, as being slightly less harmful is not the same as being therapeutic.

In order to manage depression, PTSD or a psychotic disorder, there must be trust between the patient and the provider. The conditions of carceral spaces undermine this relationship as they strip away privacy, consent, autonomy and choice. Even in inpatient psychiatric facilities, where patients are often present involuntarily and have restricted freedoms, outcomes are suboptimal.

Jails as de facto mental health centers implies a level of therapeutic intervention that cannot exist. This goes beyond the issues with carceral medical provision, which is often substandard, privatized and lacks transparency. Security is prioritized over everything, including health, putting an environment conducive to care out of reach.

The political origins of mental distress

Viewing a clinical intervention as a solution to a social problem is fundamentally misguided. The plan to construct a mental health jail ignores evidence that mental wellbeing is influenced by structural factors. With mental health conditions on the rise in America—despite the United States spending more on psychiatric treatment than peer nations—it is not clinical interventions, but social ones, that can turn this tide.

Over 40% of incarcerated people have a mental health diagnosis, not because they are inherently violent, but due to the interconnectedness of poverty, trauma, mental health and exposure to policing. The stereotype of a dangerous mentally ill person ignores that these individuals are more likely to be victims of violence than perpetrators.

These and other variables, the social determinants of mental health, are driven by policy decisions and are experienced by many as chronic poverty, stress and a constant struggle to meet basic needs. This persistent social marginalization results in distressed individuals at higher risk of criminalization, often for quality-of-life offenses and actions committed in crisis.

Trauma is all too common among marginalized individuals and is a known driver of poor mental health. Carceral facilities are profoundly dehumanizing and traumatizing. Just one day in jail can cause lasting trauma; these negative effects then reverberate out to the incarcerated person’s loved ones.

Parental incarceration increases the risk of children developing mental health conditions, and has been classified as an adverse childhood experience (ACE). ACE’s, in turn, are directly correlated with future incarceration, thus contributing to the trauma-to-jail pipeline.

This is all highly predictable given the dearth of life-affirming resources funded by the county. 

Over the past 15 years, Fulton County has dedicated upwards of $186 million to behavioral health initiatives. In that time, the sheriff’s department alone received over $1.5 billion, eight times the funding for mental health. If courts, the district attorney’s office and additional carceral investments are accounted for, the number is well north of $3 billion, or 16 times the amount committed to mental health in that time.

It wasn’t until 2024 that Fulton opened its first full-time crisis center. Following release from a crisis center, hospital or jail, there are few supportive services to connect individuals to.

The Policing Alternatives and Diversion Initiative program is still not available for 24 hours and receives only a few million dollars a year in funding, and there’s only a single diversion center that remains under-utilized and reliant on policing, which is a risky and ineffective way to help those in distress.

Fulton County has set the stage for disproportionately Black and low-income communities to experience high levels of trauma, mental health conditions and, ultimately, crisis. Instead of investing in systems to prevent and address these concerns, Fulton has built a sprawling system of carceral control and seems set to continue on this path of despair.

A new paradigm of mental health support

Fulton’s misguided proposal is framed as necessary and without alternatives. There are more options than just sinking billions into a harmful system or doing nothing; this binary is a pernicious lie driven by ideological bedfellows including the district attorney, sheriff and some commissioners who view punishment in a positive light and are unswayed by their mounting failures.

Any intervention in a jail is far downstream. We’re calling for upstream interventions that address the root causes of trauma, mental health, crisis and criminalization. Investments in social housing, poverty reduction, non-coercive community care and policing alternatives are more cost-effective, health-promoting and reduce substantial harm.

Inside the jail, the staffing ratio must be fixed by improving system efficiency and lowering the number of people in custody through diversion, decriminalization and decarceration. Fulton County should end the contract with private, for-profit carceral healthcare providers and integrate into a publicly overseen health system coupled with external, independent medical oversight.

The investments needed to turn the tide of decades of structural neglect are substantial. Yet, the commissioners and their consultants creatively find funds for new ways to punish over and over again.
As we continue towards a carceral fascist dystopia, we should look to the past as our guide. History makes clear that carceral solutions to carceral problems are not solutions at all. Justice will not be found in carceral competency restoration programs, “problem-solving courts,” or “special purpose facilities.” Fulton residents should have no interest in a kinder, gentler cage.