What should be a route to care becomes another barrier between people in prison and the help they need. For many, a grievance is the only way to ask for help at all. Yet in U.S. federal prisons, that request is often met with rejection, bureaucracy or silence. That is troubling for any medical complaint. When the complaint involves mental health, it is more troubling still.
What the numbers show
According to the Prison Policy Initiative, between 2014 and 2024, 98% of medical grievances were rejected or closed, with less than 1% resulting in relief. For mental health the picture is worse. The analysis found that 83% of mental health grievances were rejected or closed for administrative reasons, rather than being assessed on the substance of the complaint.
Behind every grievance is a person
These are not simply statistics. Behind each one is someone who may already be living with depression, trauma or suicidal thoughts. They finally ask for help, and the request is returned over paperwork. It is not hard to understand why someone might stop asking.
What repeated rejection does
Being turned away again and again has psychological consequences of its own. It creates hopelessness, frustration, anger and the sense that nobody is listening. For someone already struggling, it confirms the worst thing they already suspect: that their situation is not going to improve. Instead of encouraging people to seek help, the system teaches them that seeking help is pointless.
Why there is no alternative
Outside prison, a person who is dismissed by one doctor can find another. Inside, that option does not exist. A grievance may be the only available route to care. When it closes, there is nothing behind it.
Rejected on procedure, not on merit
What makes this harder to accept is how the rejections happen. The Prison Policy Initiative found that grievances were turned down over paperwork: the wrong form, the wrong number of copies, a complaint submitted to the wrong office. If someone is in a mental health crisis, the priority should be getting them help. Not determining whether they filed correctly.
Mental health is not an afterthought
People who are struggling with mental illness need access to care, particularly in an environment where they have almost no control over their own circumstances. A system that makes it difficult to have a complaint considered at all leaves people without the support they need, and without any way to say so.
The right to be heard
People in prison have lost their freedom. They should not lose their right to be heard. When someone says they are struggling, the response should be to find out what is wrong and how to help. Not to find another reason to close the file. Being heard is not a courtesy in a secure setting. It is the first condition for any care to work at all.
Sources
Nam-Sonenstein, B. (2026, March 24). In federal prisons, the grievance system is designed to reject nearly all complaints about medical care. Prison Policy Initiative.
Thompson, C., Mahajan, I., Flagg, A., & Shapiro, J. (2026, June 17). How federal prisons stonewall complaints and deny care. The Marshall Project.
