Care While Incarcerated
Most correctional facilities do not have the capacity to provide effective mental health services that meet the needs of those incarcerated,1K. L. Cropsey et al., “The Unmet Medical Needs of Correctional Populations in the United States,” J Natl Med Assoc 104, no. 11–12 (December 2012): 487–92. and do not offer evidence-based substance use treatments.2L. Brinkley-Rubinstein et al., “Addressing Excess Risk of Overdose among Recently Incarcerated People in the USA: Harm Reduction Interventions in Correctional Settings,” Int J Prison Health 13, no. 1 (March 13, 2017): 25–31, https://doi.org/10.1108/ijph-08-2016-0039. Indeed, many mental health conditions are exacerbated as individuals face adverse conditions and inadequate treatment, leading to high levels of distress. While many jails and prisons are county and state run, federal policy can help create incentives that ensure people get access to the care they need.
Providing Incentives for Quality Care
Correctional health has not been included in many of the mental health care reform efforts. Without these incentives, quality and access varies, and the emphasis is on ensuring compliance with minimum standards. Relatedly, the correctional health system does not often coordinate with community providers, causing potentially dangerous gaps in care or changes in treatment.
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- The federal government should include requirements in federal justice system funding for aligning correctional health funding with quality and access standards for general health care, including penalties for failing to screen for mental health conditions and providing evidence-based services.
- The federal government should also promote quality classifications of facilities so that high-need inmates can be placed in facilities that have the capacity to meet their needs.3Freudenberg and Heller, “A Review of Opportunities to Improve the Health of People Involved in the Criminal Justice System in the United States”; Kim, Becker-Cohen, and Serakos, “The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System.”
- The federal government should expand interoperability and electronic health record incentives and requirements to correctional health settings, including allowing the use of Medicaid funds for information technology investments to promote integration between correctional and community providers.4Ben Butler and Judy Murphy, “The Impact Of Policies Promoting Health Information Technology On Health Care Delivery In Jails And Local Communities,” Health Affairs 33, no. 3 (March 11, 2014): 487–92. In 2016, guidance authorized 90% match for connecting eligible providers to correctional health providers.5Vikki Wachino “Availability of HITECH Administrative Matching Funds to Help Professionals and Hospitals Eligible for Medicaid EHR Incentive Payments Connect to Other Medicaid Providers,” CMS, February 29, 2019. https://www.medicaid.gov/federal-policy-guidance/downloads/smd16003.pdf
Supporting Staff and Inmates
Both correctional staff and incarcerated individuals should be provided with skills to create an environment of positive mental health and recovery. In the same way that law enforcement officers are increasingly being supplied with greater mental health training, correctional officers should receive similar supports. Skill-building is a key part of treatment and recovery for mental health, increasing likelihood of success upon release.
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- The federal government should offer initial funding to train correctional officers in evidence-based mental health supports, and increasingly make having staff with competencies in this area a requirement for receiving federal justice funding.
- The federal government should fund learning networks for implementing recovery supports in jails and prisons and allow incarcerated individuals to have access to federal education loans and grants to support access to formal educational opportunities as well.
Tailored Policies for Unique Needs
To be effective, mental health solutions need to address individuals' range of identities based on race, ethnicity, language, gender, or gender identity, sexual orientation, disability, veteran's status, or life circumstances. We recommend meaningful policies to combat a harmful legacy of one-size-fits-all solutions.Explore our recommended policies for focus populations