The below resources provide an overview of the issue, current practices and recommendations, transitioning from incarceration to the community, and recommendations for incarceration alternatives.
Last updated February 2023
Individuals with mental health needs are over-represented in jails and prisons across the United States. While incarcerated, per the ruling set forth in Ruiz vs. Estelle, individuals with serious mental illness (SMI) are entitled by law to mental health treatment that includes standard mental health screening, as well as crisis and suicide intervention. More specialized mental health treatment varies across the prison system depending on type of facility (e.g., jail versus prison), level of security (e.g., minimum versus maximum) (AHRQ), and region and funding. There are also often barriers to basic care including lack of staff retention and training, difficulty maintaining continuity of care, and the environment of most prisons and jails, which often further harm individuals with SMI and continue the cycle of arrest and incarceration (CWRU). Due to these limitations, barriers, and inconsistencies, there is difficulty in both generating and implementing best practices for SMI treatment with the prison system, though there are basic recommended practices. In recent years there has been more emphasis on diversion and re-entry treatment practices which have often been found to be more effective (CWRU).
Key recommendations identified by experts at a 2020 National Institute of Justice national workshop to address the mental health crisis in correctional environments included:
Research in the area of inmate rehabilitation continues to provide more clarity around the key issues to addressed in order to provide a comprehensive model of care for persons with mental health needs in prison. These include:
A 2018 Virginia Department of Behavioral Health & Developmental Standards workgroup developed the following recommended standards for mental health in local regional jails:
1. Access to Care: Inmates have access to care to meet their mental health needs.
2. Policies & Procedures: The facility has a manual or compilation of policies and defined procedures regarding mental health care services which may be part of larger health care manual.
3. Communication of Patient Needs: Communication occurs between the facility administration and treating mental health care professionals regarding inmates’ significant mental health needs.
4. Mental Health Training for Correctional Officers: A training program established or approved by the responsible health authority in cooperation with the facility administration guides the mental health related training of all correctional officers who work with inmates.
5. Mental Health Care Liaison: A designated, trained mental health care liaison coordinates the health services delivery in the facility on those days when no qualified health care professionals available for 24 hours.
6. Medication Services: Medication services are clinically appropriate and provided in a timely, safe and sufficient manner.
7. Mental Health Screening: Mental health screening is performed on all inmates on arrival at the intake facility to ensure that emergent and urgent mental health needs are met.
8. Mental Health Assessment: All inmates receive mental health screening; inmates with positive screens receive a mental health assessment.
9. Emergency Services: The facility provides 24 hour emergency mental health services.
10. Restrictive Housing: When an inmate is held in restrictive housing, staff monitor his or her mental health.
11. Continuity & Coordination of Health Care During Incarceration: All aspects of health care are coordinated and monitored from admission to discharge.
12. Discharge Planning: Discharge planning is provided for inmates with mental health needs whose release is imminent.
13. Basic Mental Health Services: Mental health services are available for all inmates who need services.
14. Suicide Prevention Program: The facility identifies inmates at risk for suicide and intervenes
Several approaches to divert individuals with mental illness from jails and into treatment programs are gaining traction in communities. Overall, the strategies promote treatment over indictment.
Pre-Arrest Intervention
Crisis Intervention Teams, which are formal partnerships between police departments and mental health providers, ensure that personnel responding to a call are trained to identify, assess, and de-escalate mental health crisis situations. According to NAMI these teams lead to reduced arrest rates, increased used of diversion programs, and reduced number of injuries to responding officers.
Mental Health Courts
The first appearance in court presents an opportunity to route defendants with mental health needs away from the traditional criminal justice process. Mental health courts address defendants’ mental health needs by coordinating the expertise of judicial officers, prosecutors, defense counsel, and treatment and supervision personnel. Still holding an individual accountable for their actions, these courts can be used prior to or after a guilty plea, and a successful completion of the program may result in clearing of defendants’ criminal records.
Therapeutic Diversion Units
These multi-disciplinary treatment units are a promising alternative to restrictive housing and are designed to enhance the care and custody of individuals with mental illness. They use evidence based approaches to help participants develop emotional regulation and self management skills, understand their symptoms, and prepare for re-entry into less restrictive environments. With these units, an offenders’ housing, treatment, and advancement through the program are guided by a manual, along with individualized treatment plans and interventions.
Also known as reentry, this transition involves unique needs and challenges for those with mental health needs.
Reentry needs include:
Examples of interventions provided when transitioning to the community include:
Reentry Principles
Evidence shows that using the three principles of risk, need, and responsibility increase the likelihood of success.
Adapted from Bonta, J., & Andrews, D. A. (2007). Risk-need-responsivity model for offender assessment and rehabilitation. Ottawa, Canada: Her Majesty the Queen in Right of Canada. Retrieved from https://icjia.illinois.gov/researchhub/articles/an-overview-of-evidence-based-practices-and-programs-in-prison-reentry
SAMHSA has developed eight principles for community mental health providers serving people with mental and substance use disorders who are currently involved with or have a history of involvement in the adult criminal justice system:
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