Research Highlights Featured Chart

March 12, 2025

Prisons and mental health

Norway’s rehabilitation-oriented correctional system is a case study for improving the mental health outcomes for the incarcerated.

Tyler Smith

Source: f8grapher

Previous research has found that incarceration is associated with higher levels of mental health disorders, suggesting that correctional systems may exacerbate mental health problems. However, these studies are often marred by selection bias, as individuals are likely to differ significantly along unobservable dimensions.

In a paper in the American Economic Journal: Economic Policy, authors Manudeep Bhuller, Laura Khoury, Katrine V. Løken provide causal evidence that rehabilitation-oriented sentencing can actually improve defendants’ mental health conditions, contrary to some correlational studies. 

The researchers drew their conclusions from Norway's comprehensive administrative records. By linking court cases to health care visits, they were able to track approximately 12,300 incarcerated defendants who were sentenced between 2011 and 2014. Every health care visit was recorded with detailed diagnosis codes, allowing researchers to distinguish between mental and physical health issues.

Figure 1 from the authors’ paper tracks the probability of a health care visit five years before and after sentencing, indicated by the red dashed vertical line at zero.

Figure 1 from Bhuller et al. (2025)

Panel A shows all health care visits, panel B shows mental health visits, and panel C shows physical health visits. The horizontal axis represents the time in months before and after the court decision, while the vertical axis shows the estimated percentage point change in the probability of having a health care visit in a given month. The vertical bars are 95 percent confidence intervals.

Before sentencing, health care visit patterns remain stable. After sentencing, there is a significant drop in mental health-related visits, leading to a 30 percent reduction in the probability of a visit by the five-year mark. Physical health visits, by contrast, show only a temporary decline during the first year of incarceration, followed by a slight increase afterward.

The authors argue that Norway’s emphasis on rehabilitation is largely responsible for the improved mental health outcomes. Prisons in Norway are typically more humane than prisons in similar countries and provide a greater focus on support services designed to improve educational skills, mental health, and de-addiction, both during incarceration and after release.