More than half of people in U.S. custody report a mental illness. [1] With a majority mentally ill population, correctional facilities have become de facto mental health institutions. But jails and prisons were built for security, not treatment. Facilities are not equipped to care for a difficult-to-treat, often noncompliant population — yet they’re being tasked with doing so without the funding needed to add services. Few want to adequately fund these “de facto” psychiatric facilities.
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Limitations of community health
Community mental health is often presented as a “free” solution, but community providers rarely specialize in corrections. They may be unlicensed, untrained or remote-only and never enter the facility. When acute incidents occur, hospitals typically hold people for about 72 hours, then return them to custody. Even when admitted to an emergency department or state hospital, one symptomatic outburst can lead to criminal charges and a return to the jail. With too few psychiatric beds, patients languish in custody without appropriate behavioral health services, not because services don’t exist, but because funding is not approved. [2]
Across the country, jails function as the largest mental health institutions in their regions:
- In Washington, “quite unintentionally, the jail has become King County’s largest institution for the mentally ill.” [3]
- In Texas, “the Travis County Jail has admitted so many prisoners with mental disabilities that its psychiatric population rivals that of Austin State Hospital.” [4]
- In New York, the estimated population of 10,000 mentally ill inmates in state prisons “now surpasses [that of] the state’s psychiatric hospitals.” [5]
- In California, roughly 3,300 of 21,000 detainees in the Los Angeles County Jail “require mental health services on a daily basis,” making it “the largest mental institution in the country.” [6]
Remodeling to improve behavioral health operations
Facility leaders have long urged boards and local officials to fund in-custody behavioral health: addiction specialists, individual and group counseling, discharge planning, suicide watch release and rounding. Suicide is the leading cause of death in jail, yet many sheriffs struggle to secure even a few hours of counseling per week for an entire facility.
Remodeling with behavioral health in mind would enable a continuum of safe, therapeutic care — from outpatient and transitional housing to inpatient-level care. Core design elements include:
- More spaces for group and individual classification appropriate for peer support and rapid intervention
- Inaccessible lighting fixtures and sprinkler heads
- Ligature-resistant sinks and toilets
- No tie-off points that enable hanging or asphyxiation
- Nonbreakable, flush-mounted mirrors
- Padded cells rather than concrete
- Plexiglass for clear lines of sight
- Privacy doors that allow staff to see heads and feet for safety
- Solid platform beds
Supervision is critical; patients should ideally be under continuous observation.
Funding choices facing communities
States and counties must allocate funds to remodel correctional psychiatric facilities in their capitals and regions. If taxpayers reject that approach, communities must still fund correctional addiction services, counseling, discharge planning, mental health and psychiatric care, psychological services and substance use disorder treatment within facilities. Public welfare and safety depend on it.
The bottom line
With addiction, mental health and suicide crises surging, the question is whether we will fund behavioral health programs in jails or invest in intentional reconstruction for therapeutic care. History will judge how we addressed this public safety crisis. Until then, correctional facilities will continue to operate as modern-day state hospitals, doing the best they can with shrinking budgets.
Tactical takeaway
Remodeling for behavioral health — paired with funded, in-custody services — gives corrections the design, supervision and care continuum needed to reduce deaths, liability and staff strain.
References
- Bronson J, Berzofsky M. (2017). Indicators of mental health problems reported by prisoners and jail inmates, 2011–12. U.S. Department of Justice.
- Geringer-Sameth E. (2022). Despite state budget funding, little progress bringing psychiatric beds back into service. Gotham Gazette.
- Keene L. (1993). A helping hand keeps mentally ill out of jail. Seattle Times, pp. A1, A7.
- Gamino D. (1993). Jail rivals state hospital in mentally ill population. Austin American-Statesman.
- Foderaro LW. (1994). For mentally ill inmates, punishment is treatment. New York Times, p. A1.
- Grinfeld MJ. (1993). Report focuses on jailed mentally ill. Psychiatric Times, pp. 1–3.
About the author
Spark Training is a nationally recognized center of excellence that sets the standard for training and compliance through high-quality programs and quality improvement. Spark Training was recently named Healthcare Training Company of the Year in the 2025 Innovation & Excellence Awards hosted by Corporate LiveWire Global.
