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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.

Evaluating Early Access to Medicaid as a Reentry Strategy

Background: 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, assessed 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 and study findings on Medicaid effects may be found in Prison Inmates' Prerelease Application for Medicaid: Take-up Rates in Oregon.

Assistance With This Issue

Last reviewed: a while ago.

Consulting, Training and Research Services

Professional services for the field of corrections.

Key Resources
Web Sites

Recommended Reading

Date	Title	Type
2012	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
2009	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
2009	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.
2010	Crisis Intervention Teams: An Effective Response to Mental Illness in Corrections [Satellite/Internet Broadcast] National Institute of Corrections Academy (Aurora, CO). Our nation’s jails, prisons, and community corrections agencies are confronted daily with substantial numbers of persons with mental illness in custody and under supervision. Mental illness in corrections demands an urgency of response, services, and care. Correctional staff have attempted to manage individuals suffering mental illness with varying degrees of success. In searching for meaningful methods of response, some agencies, in partnership with stakeholder communities, have implemented Cri... Read More	1 video DVD (149 min.)
2004	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.
2002	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.)
2002	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.)
2010	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.
2002	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
2016	Losing Time: Dementia and Alzheimer's Disease Behind Bars [Webinar] By Hongo, Aileen; Hughes, Barry; Levine, Ron; Iszler, Bernie. National institute of Corrections (NIC) (Washington, DC). Dementia, including Alzheimer's disease, is difficult to detect in a population often afflicted with other mental illnesses and maladaptive social behaviors. During this interactive webinar we will explore how symptoms and behaviors can be misconstrued and identify environmental risk factors that can contribute to costly accidents and injury for inmates with dementia. We will also take an in-depth look at the Gold Coat program based at the California Men's Colony State Prison in San Luis Obi... Read More	62 minutes
2015	Confabulation in Correctional Settings: An Exploratory Review By Brown, Jerrod; Hesse, Mario L.; Rosenbloom, Michael; Harris, Blake; Weaver, Jason; Wartnik, Anthony; Concepcion, Erwin; Mertz, Chris; Weinkauf, Erg; Oberoi, Pamela; Kolakowsky-Hayner, Stephanie A.. This article addresses a little understood issue in corrections—confabulation. "Confabulation can be described as a disruption in normal memory function, whereby the individual unintentionally distorts or fabricates imaginary or non-experienced events without intent to deceive or lie … In other words, individuals who inaccurately integrate incorrect information into their memory and/or subsequently present such information as fact are demonstrating confabulation … Individuals who confabulate are... Read More	8 pages
2010	The Effects of Solitary Confinement: Commentary on One Year Longitudinal Study of the Psychological Effects of Administrative Segregation 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
2005	Improving the Response to Offenders with Mental Illness Through Mental Health and Criminal Justice Collaboration 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.
2004	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.
2001	Correctional Health Care: Women Offenders [Lesson Plans and Participant's Manual]; Prison Health Care: Women Offenders National Institute of Corrections Academy (Longmont, CO); National Institute of Corrections. Prisons Division (Washington, DC). The unique challenges of providing health care to women incarcerated in adult facilities are discussed during this 20-hour training program. Sections of this manual cover: objectives and overview; managing women offenders; litigation issues; health issues; mental health issues; creating infrastructure; substance abuse and women; co-occurring; infectious diseases; crisis intervention; and final action plans.... Read More	2 v. (v.1 - ca. 185 p., v.2 - ca. 175 p.)
2001	Commission on the Status of Mental Health of Iowa's Corrections Population Community Corrections Improvement Association (Cedar Rapids, IA); Robert Wood Johnson Foundation (Princeton, NJ); Greater Cedar Rapids Community Foundation (Cedar Rapids, IA); National Institute of Corrections (Washington, DC); Council of State Governments (Lexington, KY). State Public Policy Group, Inc. (Cedar Rapids, IA) . The effects of an increasing number of offenders with serious mental health problems are investigated. Sections of this report include: executive summary; introduction and purpose; methodology/overview of effort; hearings summary; findings; and the survey report which identifies unfulfilled mandates, non-uniform performance, a sense of urgency for problem solution, the desire for community-based correctional settings, and overwhelming support for solutions existing within Iowa's correctional sy... Read More	39 pages
1994	Concept Paper for a National Forum on Creating Jail Mental Health Systems, San Francisco, CA, November 9-10, 1994 National Institute of Corrections. Jails Division (Longmont, CO); National Institute of Justice (Washington, DC). Policy Research Associates (Delmar, NY); U.S. Dept. of Health and Human Services. Center for Mental Health Services (Washington, DC). This concept paper examines mentally ill offenders and their special needs that must be addressed when they come in contact with the criminal justice system. The various points of contact are with police, jails/lockups, prisons, probation and parole, and diversion programs. Some principles for successful mental health services and prospects for federal initiatives are discussed. Finally, there is a section describing the Center for Mental Health Services program which illustrates the hom... Read More	96 p.
1994	Proceedings of a National Forum on Creating Jail Mental Health Services for Tomorrow's Health Care Systems National Institute of Corrections (Washington, DC); U.S. Dept. of Health and Human Services. Center for Mental Health Services (Washington, DC). This report on the proceedings of the first national forum on mental health services in jails contains copies of the remarks made by the speakers and summaries of each session of the meeting. The forum resulted from a strong concern about the numbers of mentally ill persons in correctional facilities. Areas of focus included mental health services in San Francisco Sheriff's Department facilities, and special mental health and substance abuse issues for women.... Read More	75 p.
1990	Special Needs Inmates: A Survey of State Correctional Systems By Hall, Marie. National Institute of Corrections National Academy of Corrections (Boulder, CO). Illinois Dept. of Corrections (Springfield, IL). The Illinois Department of Corrections conducted a survey of all 50 states to determine the prevalence of inmates who have special medical or mental health needs. Within the 31 states responding, .08 percent to 8.2 percent of prison inmates fell into various special housing categories. These categories included chronic illness, terminally ill, advancing age, ambulation difficulties, and mental health problems.... Read More	34 p.
1990	Jail Diversion for the Mentally Ill: Breaking Through the Barriers By Steadman, Henry J.. National Institute of Corrections (Washington, DC). National Coalition for the Mentally Ill in the Criminal Justice System (Seattle, WA). A conference was held on April 2, 1990 that brought together mental health, correctional, and law enforcement professionals to address issues surrounding the mentally ill person who comes in contact with the local jail. Research and program reviews from which the conference deliberations developed are provided. Four categories identified and examined are: screening and evaluation; crisis intervention; treatment; and transfer/discharge planning. ... Read More	133 p.
1987	Basic Guide to Mental Health Services in Jails: The Workbook By Lloyd, Lillis M.. Correctional Management Consultants (Phoenix, AZ); National Institute of Corrections (Washington, DC). Areas addressed include history of mental health in jails, major types of mental disorders, personality disorders, suicide awareness/prevention, and liability and negligence. Length of training is sixteen hours. Audience includes correctional professionals such as officers, mental health staff, social workers, counselors, nurses, and intake and classification workers. The training package consists of a one-volume manual.... Read More	120 p.