Correctional facilities in the United States have increasingly become major providers of mental health care (Cherson, 2025). One in every two to three people incarcerated in U.S. prisons is estimated to live with a mental illness, far higher than the general population (Dumont et al., 2012). Despite this, these facilities are mostly designed for custody, and there is less emphasis on caring for people with health conditions, with stigma and institutional practices making it harder for individuals to receive equitable healthcare (Reagan et al., 2024).
Even if individuals are on treatment regimens, it is hard for them to remain on them when incarcerated. More than 50% of individuals who were taking medications for mental health conditions at admission did not continue receiving their medications once in prison, despite court mandates (National Alliance on Mental Illness [NAMI], 2021). Increasingly, as prisons continue to serve as de facto mental health institutions (Alves et al., 2026; Preston et al., 2022), a critical question emerges: how can effective and compassionate care be delivered in environments primarily built around security and punishment? Prison sentences should not become a sentence to untreated mental illness.
An important point to note is that correctional health is closely connected to community health. It not only affects individuals inside facilities but also families and communities after release (Macmadu & Rich, 2015). These populations also experience higher rates of substance use, traumatic brain injuries, infectious diseases, and social challenges such as unstable housing and unemployment (Centers for Disease Control and Prevention [CDC], 2024). Thus, these vulnerabilities overlap, making correctional mental health a public health concern rather than an isolated issue (Dumont et al., 2012; Macmadu & Rich, 2015).
This shift toward deinstitutionalization has contributed extensively to the movement of many individuals with severe mental illness from psychiatric hospitals into community settings.
However, inadequate community-based mental health resources can leave individuals with undertreated mental health conditions, thus leading to involvement in the criminal legal system (Macmadu & Rich, 2015; Yohanna, 2013). Consequently, prisons and jails are increasingly encountering individuals with complex mental health issues (Kolodziejczak & Sinclair, 2018).
Along with elevated rates of mental illness among incarcerated populations, another issue that arises is the intensification of psychological stressors (Haney, 2021; Morin, 2026). Factors such as isolation, separation from family, loss of autonomy, and uncertainty about the future can create an environment where existing conditions are harder to manage (Quandt & Jones, 2021).
At the same time, there are also opportunities to connect individuals with healthcare services and professionals. Services such as screening, diagnosis, treatment, and linkage to community-based care might not have been easily accessible in the community (Macmadu & Rich, 2015). These essential interventions can provide important points of contact with care. As emphasized by the CDC, correctional health must extend across the entire period of justice-system involvement from entry into a facility through reentry into the community (CDC, 2024). This is important, as it shifts perspective from simply treating mental illness during incarceration toward creating a continuity of care before, during, and after it.
Evidence-based psychological interventions also play a major role in this process. Cognitive behavioral therapy (CBT) allows individuals to identify and modify patterns of thinking and behaviour that might contribute to psychological distress (American Psychological Association, 2017). Dialectical behavior therapy (DBT) is another intervention that helps individuals emphasize essential skills such as emotional regulation, mindfulness, and distress tolerance (Cleveland Clinic, 2022). These approaches can help individuals by providing them with practical tools to manage psychological distress and develop healthier coping strategies.
Another important component of correctional mental health is trauma-informed care. Several incarcerated individuals have histories of trauma, including experiences of abuse and violence. These approaches recognize that these experiences can influence emotional responses and behaviour, and thus seek to integrate understanding of trauma into treatment and interactions with individuals in correctional settings (Palo Alto University, 2026).
Along with this, another important source of support is peer-led. This provides pivotal assistance as trained incarcerated individuals are able to support their peers, thus reducing stigma and providing encouragement with treatment. This helps reinforce a sense of community within correctional facilities (Palo Alto University, 2026).
Despite all these interventions, they do not guarantee effective care. Mental health professionals have to constantly balance their responsibilities with the institutional security requirements, along with the already existing issues of limited resources, inadequate staffing, insufficient training, and difficulties with continuity of care (Alves et al., 2026). Along with that, confidentiality also poses another ethical challenge. Since therapeutic relationships depend mainly on trust and privacy, maintaining confidentiality is hard under correctional supervision. This might push incarcerated individuals to be reluctant to disclose sensitive information when they are uncertain about who may have access to that information. This can lead to them not being able to get the treatment they need, along with affecting their circumstances in the facility (Kolodziejczak & Sinclair, 2018; Alves et al., 2026).
These challenges highlight the need for correctional mental health systems that prioritize both effective treatment and the trust necessary for individuals to seek care. Ultimately, mental health care should not end at the prison gate. By ensuring access to compassionate and continuous care during incarceration and after release, the justice system can support recovery, strengthen communities, and ensure that a prison sentence does not become a sentence to untreated mental illness.
Shriya Biswas is a PhD Student at University of Delaware. To contact the Shriya, email [email protected].
References
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