U.S. Department of Justice

Mentally Ill Persons in Corrections

Mentally ill persons increasingly receive care provided by correctional agencies. In 1959, nearly 559,000 mentally ill patients were housed in state mental hospitals (Lamb, 1998). A shift to "deinstitutionalize" mentally ill persons had, by the late 1990s, dropped the number of persons housed in public psychiatric hospitals to approximately 70,000 (CorrectCare, 1999). As a result, mentally ill persons are more likely to live in local communities. Some come into contact with the criminal justice system.

In a 2006 Special Report, the Bureau of Justice Statistics (BJS) estimated that 705,600 mentally ill adults were incarcerated in state prisons, 78,800 in federal prisons and 479,900 in local jails. In addition, research suggests that "people with mental illnesses are overrepresented in probation and parole populations at estimated rates ranging from two to four times the general population" (Prins and Draper, 2009). Growing numbers of mentally ill offenders have strained correctional systems.

Special Publication: White Paper on Behavioral Health Needs

"Adults with Behavioral Health Needs under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery" is a white paper prepared by the Council of State Governments Justice Center with support from, and in partnership with, the National Institute of Corrections (NIC) and the Bureau of Justice Assistance (BJA).

The framework is designed for state and local correctional administrators (institutional, probation, and parole) and community-based mental health and substance abuse agency leaders to plan and develop service responses that make efficient use of resources. Although by itself, it is not suitable for practitioners to use for clinical decisionmaking, or for decisionmaking regarding youth in the juvenile justice system, it is meant to facilitate clear and consistent communication among system administrators. It can help professionals in each system target the right individuals, ensure responsible and effective practices, and improve matches between responses to needs.

The framework can help professionals in the criminal justice and behavioral health systems in the following ways:

  • Ensure that scarce resources are spent effectively.
  • Advance collaboration and communication.
  • Encourage responsible and effective practices.

Available in the Key Resources section of this page.

New Project: Evaluating Early Access to Medicaid as a Reentry Strategy

Prison and jail inmates with physical health, mental health, and substance use problems experience more reintegration difficulties upon release, and they typically have poorer outcomes with respect to employment, re-offending, and re-incarceration. Maintaining treatment for these health problems may help improve post-release outcomes. Many inmates presently receive health care while incarcerated, but a lack of health insurance and other barriers contribute to declines in health treatment and functioning once released. Access to care through insurance coverage helps not only the individual, but it may also lower societal health care and criminal justice system expenditures by reducing costly emergency room visits, enabling individuals to work, and decreasing repeat criminal activity.

Project Purpose
This study, supported by the National Institute of Corrections and conducted by the Urban Institute, will assess whether currently available Medicaid coverage—for example, in states that cover childless adults under age 65—helps newly released inmates access health care and, thereby, contributes to improved employment and recidivism outcomes. Data collection activities are planned for 2012–2013, and study findings on Medicaid effects will be available in 2014.

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Recommended Reading

Date Title Type
Document 026605
Adults with Behavioral Health Needs Under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery
By Osher, Fred; D'Amora, David A.; Plotkin, Martha; Jarrett, Nicole; Eggleston, Alexa. U.S. Bureau of Justice Assistance (Washington, DC). Council of State Governments. Justice Center (New York, NY); Criminal Justice/Mental Health Consensus Project (New York, NY); National Institute of Corrections (Washington, DC).
“This white paper presents a shared framework for reducing recidivism and behavioral health problems among individuals under correctional control or supervision—that is, for individuals in correctional facilities or who are on probation or parole. The paper is written for policymakers, administrators, and practitioners committed to making the most effective use of scarce resources to improve outcomes for individuals with behavioral health problems who are involved in the corrections system. It i... Read More
82 pages
Document 023851
The Mentally Ill in Jail: Whose Problem Is It Anyway? [Satellite/Internet Broadcast]
National Institute of Corrections. Academy Division (Aurora, CO).
This 3-hour program, originally broadcast July 15, 2009, provides an overview of opportunities that can help your organization prepare to work with persons suffering from mental illness in jails. Mental health issues in the criminal justice system are a community wide problem, and corrections stakeholders, including government officials and corrections personnel, all have a role in identifying creative programs and solutions that tackle the problem at its core. This broadcast investigates the sc... Read More
3 computer disks; DVD-ROM (159 min.) + 1 computer disk; CD-ROM
Document 023634
Improving Outcomes for People with Mental Illnesses Under Community Corrections Supervision: A Guide to Research-Informed Policy and Practice
By Prins, Seth Jacob; Draper, Laura. John D. and Catherine T. MacArthur Foundation (Chicago, IL); National Institute of Corrections (Washington, DC). Council of State Governments. Justice Center (New York, NY).
“This guide is organized around policymakers’ common questions about people with mental illnesses under community corrections supervision and the type and effectiveness of strategies designed to respond to this population” (p.3). Sections include: executive summary; introduction; the extent and nature of the problem; strategies to improve outcomes for people with mental illnesses under community corrections supervision; future research questions and implications for policy and practice; and conc... Read More
44 p.
Document 018604
Effective Prison Mental Health Services: Guidelines to Expand and Improve Treatment
By Hills, Holly; Siegfried, Christine; Ickowitz, Alan. National Institute of Corrections (Washington, DC). National Mental Health Association (Alexandria, VA); National Institute of Corrections (Washington, DC).
"[H]istorical , legal, and ethical issues relevant to dealing with mental illness in the field of corrections" are discussed (p. iii). Chapters include: introduction; screening and assessment; mental health and substance abuse treatment; use of seclusion, segregation, and restraints; suicide prevention; treating women offenders; psychopharmacological intervention for psychiatric disorders; transitional services; treatment of special populations (e.g., persons with mental retardation or developme... Read More
91 p.
Document 017693
Jail Inmates with Mental Illness: A Community Problem [Videoconference Held April 17, 2002]
National Institute of Corrections Academy (Longmont, CO).
This videoconference addresses issues faced by jails that must deal with increasing numbers of inmates with serious mental illnesses. Topics discussed include:
  • Essential jail-based service components for mentally ill inmates;
  • Creative approaches to meet the service needs of the mentally ill;
  • Identification of potential resources that can be used in the management of this special population;
  • Mental health courts;
  • And how to maintain continuity of care.
... Read More
1 DVD (180 min.)
Document 017901
Meeting the Challenge in Correctional Mental Health Care: The Prison Experience
  • [Videoconference Held June 19, 2002]
  • National Institute of Corrections Academy (Longmont, CO).
    This videoconference provides Information regarding cooperation between correctional agencies and mental health authorities to ensure continuity of care and adequate treatment for offenders with mental illness or mental health problems. Participants will learn about:
    • The scope of the problem concerning mental illness in prison;
    • Innovative program strategies and best practices;
    • The value of early planning for community re-entry;
    • And approaches for determining program effi... Read More
    1 DVD (180 min.)
    Document 024308
    National Study of Jail Suicide: 20 Years Later
    By Hayes, Lindsay M.. National Institute of Corrections. Jails Division (Washington, DC). National Center on Institutions and Alternatives (NCIA) (Mansfield, MA); National Institute of Corrections. Jails Division (Washington, DC).
    This report “does more than simply present a calculation of suicide rates. It presents the most comprehensive updated information on the extent and distribution of inmate suicides throughout the country, including data on the changing face of suicide victims. Most important, the study challenges both jail and health-care officials and their respective staffs to remain diligent in identifying and managing suicidal inmates” (p.vii). Five chapters follow an executive summary: introduction; national... Read More
    68 p.
    Document 017907
    Understanding Managed Behavioral Health Care in Community Corrections
  • [Videoconference Held July 17, 2002]
  • National Institute of Corrections Academy (Longmont, CO).
    This program addresses behavior health care services for offenders under community supervision. Topics include: mental illness and its impact on individuals in community corrections; special issues with behavioral managed care in criminal justice; the history and components of managed behavioral healthcare and what has not worked; what constitutes good managed behavioral healthcare; legal issues and liabilities related to behavioral health care and community corrections; collaborative strate... Read More
    1 DVD (180 min.)

    Related Resources

    Date Title Type
    Document 027293
    Minimum Standards for Mental Health Services in Correctional Settings
    By Livingston, Jamie.
    Even though this presentation was given to a Canadian audience, it has a lot of great information for correctional agencies in the United States. Issues related to providing services to mentally ill offenders are covered. Topics discussed include: the problem; the cause; ways to meet the needs of this population in correctional settings while also reducing recidivism; the 2010 report “Mental Health and Drug and Alcohol Addiction in the Federal Correctional System”; seven core elements for a ment... Read More
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    Bureau of Prisons: Timelier Reviews, Plan for Evaluations, and Updated Policies Could Improve Inmate Mental Health Services Oversight
    U.S. Government Accountability Office (Washington, DC).
    The U.S. Bureau of Prisons (BOP) “is responsible for the care and custody--including mental health care--of more than 219,600 federal inmates. BOP identifies and treats inmates' mental health disorders, and has procedures in place to assess the provision of mental health services in its 119 facilities, and 15 private prisons operating under contract. GAO was requested to provide information on BOP's costs and oversight of inmate mental health services. This report addresses: (1) BOP's costs to p... Read More
    76 pages
    Document 026381
    Mental Health Issues in County Corrections vs State Prisons
    By Hatcher, Joe W.; Pichette, Shauna. corrections.com (Scituate, MA).
    The author explains why “the mental health environment in county corrections [local detention facilities or jails] is, in important respects, more difficult for inmates and for staff than it was at the state institution [she] left” (p. 1). Most of jail inmates’ difficulty dealing with mental health issues seems to be based on their increased levels of stress and the inability of addressing it by themselves or with the help of professional staff.... Read More
    3 pages
    Document 026376
    Webinar Archive: Women Engaged in the Criminal Justice System
    By Ramirez, Rachelle; Gehring, Krista S.. Council of State Government. Justice Center (New York, NY); Council of State Government. Criminal Justice Mental Health Consensus Project (New York, NY).
    This webinar “discussed the current research and best practices related to the successful management and treatment of women in the criminal justice system … with a particular focus on behavioral health. The webinar also included a discussion about gender-specific criminogenic risk and need assessment tools, as well as the importance of responsivity for females." This website provides access to a recording of the webinar and the accompanying slides.... Read More
    Document 026323
    A Primer for Mental Health Practitioners Working With Youth Involved in the Juvenile Justice System
    By Kinscherff, Robert. U.S. Dept. of Health and Human Services. Center for Mental Health Services. Federal Child, Adolescent and Family Branch (Washington, DC). Technical Assistance Partnership for Child and Family Mental Health (TA Partnership) (Washington, DC); National Center for Mental Health and Juvenile Justice (NCMHJJ) (Delmar, NY).
    “This paper provides an overview for mental health practitioners who provide professional services to youth who are involved with the juvenile justice system …. While primarily intended for mental health professionals working within system of care communities or interested in developing a system of care collaboration in their area, this paper is relevant for any mental health practitioner providing professional services to youth involved or at risk of involvement in the juvenile justice system. ... Read More
    28 pages
    Document 026392
    Juvenile Justice Resource Series
    U.S. Dept. of Health and Human Services. Substance Abuse and Mental Health Services Administration (SAMSHA) (Rockville, MD). Technical Assistance Partnership for Child and Family Mental Health (TA Partnership) (Washington, DC); National Center for Mental Health and Juvenile Justice (NCMHJJ) (Delmar, NY).
    “This resource series was developed to help communities address the mental health and related needs of young people involved or at risk of involvement with the juvenile justice system … Each brief examines a unique aspect of serving this population within system of care communities”. Papers in the series include: “A Primer for Mental Health Practitioners Working With Youth Involved in the Juvenile Justice System by Robert Kinscherff (2012); “New Directions for Behavioral Health Funding and Impli... Read More
    Document 025988
    15 Common Cognitive Distortions
    By Grohol, John M.. psychcentral.com (Newburyport, MA).
    Common cognitive distortions that are found in the general and offender populations are described. “Cognitive distortions are simply ways that our mind convinces us of something that isn’t really true. These inaccurate thoughts are usually used to reinforce negative thinking or emotions — telling ourselves things that sound rational and accurate, but really only serve to keep us feeling bad about ourselves” (p. 1). Addressing these perceptions can help in changing offender behaviors so they can ... Read More
    3 pages
    Document 025569
    Frequently Asked Questions: Health, Mental Health, & Substance Use Disorders
    U.S. Bureau of Justice Assistance (Washington, DC). National Reentry Resource Center. Committee on Health, Mental Health, and Substance Use Disorders (New York, NY).
    Questions related to recently released inmates’ health services, mental health care, mental illness, and co-occurring disorders are answered. Some of the topics covered include: health risks faced by these offenders; difference between screening and assessment; continuity of care; and federal benefits available to justice-involved individuals.... Read More
    15 pages
    Document 025722
    Task Force for Criminal Justice Collaboration on Mental Health Issues: Final Report: Recommendations for Changing the Paradigm for Persons With Mental Illness in the Criminal Justice System
    Judicial Council of California. Administrative Office of the Courts (San Francisco, CA); Council of State Governments (Lexington, KY); California Department of Mental Health. Mental Health Services Act (MHSA)/Proposition 63 (Sacramento, CA). Judicial Council of California. Administrative Office of the Courts. Center for Families, Children and the Courts. Task Force for Criminal Justice Collaboration on Mental Health Issues (San Francisco, CA).
    “The task force was charged to explore ways to improve practices and procedures in cases involving adult and juvenile offenders with mental illness, to ensure the fair and expeditious administration of justice, and to promote improved access to treatment for defendants with mental illness in the criminal justice system” (p. 1). This report has seven sections that follow “Guiding Principles” and “Report and Recommendation Development”: prevention, early intervention, and diversion programs; court... Read More
    96 pages
    Document 024923
    Jail Diversion & Trauma Recovery--Priority to Veterans
    National GAINS Center (Delmar, NY).
    This report explains how the “Jail Diversion and Trauma Recovery Initiative has reshaped how communities and states address the behavioral health service needs of justice-involved veterans in numerous ways” (p. 1). Some of these ways include extending traditional criminal justice/behavioral health partnerships, addressing the pervasive effects of trauma, coordinating services between the Veteran Health Administration and community providers, and developing a strong presence of peers on advisory ... Read More
    5 pages
    Document 025885
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    By Smith, Peter Scharff. National Institute of Corrections (Washington, DC).
    The author comments on research done by the Colorado Department of Corrections and the University of Colorado’s Department of Psychology concerning the effects of solitary confinement. Sections of this article include: the Colorado study; why available research was not used the authors of the Colorado study; available European studies on the effects of solitary confinement; social contact and contamination across groups; whether the study participants were harmed by solitary confinement prior to... Read More
    11 pages
    Document 021374
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    National Institute of Corrections (Washington, DC).
    Proceedings from hearings regarding mentally ill offenders are provided. Contents of this publication include: executive summary; outline of proceedings; opening remarks and introduction; hearing panel -- setting the context -- the increasing number of people with mental illness under corrections supervision -- origins of the problem and key strategies for addressing it; hearing panel -- case studies of state and local mental health and corrections collaboration; summary of day's proceedings; D... Read More
    183 p.

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