Applying Section 5121 of The Consolidated Appropriations Act (CAA) of 2023 To Real World Examples Of Juvenile Justice

Highlighted Stories

Editor's Note

This week’s first highlighted story comes from St. Louis, Missouri, and examines cracks in the juvenile justice system—cracks that perpetuate a cycle of inadequate treatment for young people with mental health and substance use disorders. We spotlight this piece to remind our subscribers that many of these systemic failures were intended to be addressed by Section 5121 of the Consolidated Appropriations Act (CAA) of 2023, which went into effect on January 1, 2025.

Section 5121 mandates screening—including for mental health and substance use disorders—acknowledging that the justice system is ill-equipped to meet the complex needs of juveniles. Viewed through this lens, the article’s key point—that youth are not receiving necessary care—underscores why Section 5121 matters. Among its provisions are targeted case management, comprehensive assessment, health service referrals, and ongoing monitoring. These services are precisely the kind of supports that could begin to fill the gaps described in the article. In addition, Section 5122 of the CAA allows states to keep juveniles on Medicaid while they await disposition, facilitating smoother handoffs to community-based providers.

The second highlighted story is a study from Florida examining the mental health challenges faced by incarcerated juveniles. The study casts doubt on the reliability of existing screening tools used in juvenile facilities. Like so much in criminal justice health practices, these tools operate in silos. The researchers found that the screenings often lacked clinical interviews and direct observation—and failed to incorporate caregiver input. These shortcomings reinforce the need for more integrated, evidence-based approaches—something Section 5121 is designed to support.

As noted above, Section 5121 became law on January 1. COCHS—and surely other stakeholders—will be interested to see whether these statutory changes result in real, on-the-ground improvements.

St. Louis Missouri

Cracks in the American criminal justice system appear one at a time, often from seemingly unrelated causes. Take, for example, the arrest a couple of weeks ago of a 16-year-old after a carjacking in St. Louis. He was released to his parents and then carjacked again the same week. Law enforcement blamed the juvenile system in Missouri. Young people in need of special services for disabilities or mental health issues — who are the majority of juveniles in the system — are not getting the care they need. The next 16-year-old carjacker will end up in a juvenile facility. He won’t get the care that was promised and he’ll come out worse for wear, perhaps with increased mental health difficulties. And he’ll be arrested a couple of years later as an adult. This time he’ll end up in adult jail, but his criminal case will go nowhere. A judge will declare him incompetent to stand trial and order the Department of Mental Health to treat his illness. But the Department of Mental Health will say there are no beds available for detainees with mental health issues. The young man, now 19, will be stuck in jail, not receiving mental health treatment — and not being held accountable for the case police filed against him because it will be on interminable hold. The young man will find himself on a list of 400 or more people like him in city and county jails all across Missouri. Most of those jails pay a private, for-profit company to provide health care. The companies are notorious for choosing profits over quality care. He’ll have a mental health episode. Correctional workers will strap him in a restraint chair because they don’t know what else to do. He’ll be left there for 90 minutes, or several hours, and he’ll die. This is how a 16-year-old gets the death penalty for carjacking.

Screening Tools

Approximately 70% of incarcerated youth in the United States have a mental disorder. The challenges in this population are profound – about 30% report suicidal thoughts, 12% have attempted suicide and 25% experience solitary confinement, a condition strongly associated with increased suicide risk. Depression is also widespread, affecting 10% to 25% of youth with moderate to severe symptoms. Comprehensive mental health screenings play a vital role in identifying who requires immediate care, as well as those at risk for developing more serious issues. But there are troubling gaps in the accuracy and fairness of mental health screenings used with incarcerated youth who have been adjudicated delinquent. Without timely identification and intervention, these conditions can escalate, leading to long-term psychological harm, impaired functioning and an increased risk of suicide. There is a critical need to include additional information when screening incarcerated youth, including observation and clinical interviews with the child and caregiver informants.

Follow Ups

Editor's Comment: This week’s Follow Ups once again begin with the president’s executive order, Ending Crime and Disorder on America’s Streets. The Bipartisan Policy Center provides a useful breakdown of the order’s key provisions. Of particular interest are the limits of the executive order: the federal government cannot force state legislatures to revise civil commitment laws. And while the executive order targets existing consent decrees, many of those were entered into by local governments, which constrains the Department of Justice’s ability to override them.

Moving on, we highlight three articles examining the bankruptcy strategies of Wellpath and Corizon/YesCare/Tehum Care. Two in-depth pieces from The Guardian explore the role of private equity in correctional healthcare and the implications for quality of care. One of these articles features a quote from COCHS’ own Dan Mistak. The third article focuses on how the bankruptcy restructuring is affecting litigation in the death of an incarcerated individual in Lane County, Oregon. Wellpath is arguing that the plaintiff missed the bankruptcy opt-out deadline, and therefore the lawsuit should be dismissed.

And then there is New York State. The New York Civil Liberties Union is now calling on the courts to hold the state’s Department of Corrections in contempt for refusing to comply with the Humane Alternatives to Long-Term Solitary Confinement Act (HALT). This defiance will come as no surprise to our subscribers. Just last week, we highlighted the correctional officers’ union’s vehement opposition to HALT. Since the murder of Roberts Brooks last year, stories like these from New York seem poised to become a permanent fixture in this Follow Up section.

Ending Crime and Disorder on America’s Streets

This blog breaks down key changes to federal policy, provides context from BPC analysis of homelessness trends, identifies potential implementation challenges, and reviews recent research on the structural and economic drivers fueling the rise in homelessness. The order also follows the U.S. Supreme Court’s decision in City of Grants Pass v. Johnson, which upheld the authority of local governments to enforce ordinances banning public camping and sleeping, even when individuals lack access to shelter. That ruling laid the legal foundation for a wave of encampment bans in more than 100 cities, across both Democratic- and Republican-led states. Several provisions in the order may face legal constraints. Because civil commitment procedures are governed by state law, the federal government cannot compel legislatures to expand or amend them.

Wellpath/Corizon Bankruptcies

Despite these issues, the private prison healthcare industry has only continued to grow – it was estimated to be a $9.3bn business in 2022. Both Corizon and Wellpath continued to contract with jails, prisons, immigration and juvenile detention centers around the country until they faced so much liability – both from lawsuits and other complex business issues – that both landed in bankruptcy court over the last two years.

“Healthcare in correctional facilities is often a black box,” said Dan Mistak, acting president of Community Oriented Correctional Health Services, a non-profit that aims to improve healthcare quality for incarcerated people. “With almost no transparency, and the ability to dodge accountability through bankruptcy and corporate restructuring, these companies can deliver substandard or even deadly care and still turn a profit,” Mistak explained. Neither Wellpath nor Corizon (YesCare) responded to requests for comment.

The bankruptcy of the company that provides medical services at the Lane County Jail has prompted major changes to a lawsuit filed by the family of a woman who died after an alleged overdose at the jail. The husband of Barbara Stillwell alleges negligence by Lane County and sheriff’s office officials, as well as a “delay and denial of essential care” by Wellpath, the company that provides jail health care services. But Wellpath now claims the details of its post-bankruptcy restructuring plan should halt Stillwell’s claims. Meanwhile, Lane County, a co-defendant in the lawsuit, has filed its own claims against Wellpath. The county seeks a court order forcing the company to help shoulder the burden of the Stillwell lawsuit and at least one other lawsuit related to the jail. An agreement with the company’s creditors included the creation of a $15.5 million trust from which unsecured creditors, including those with pending lawsuits, are to be paid — if those lawsuits against Wellpath even continue. Wellpath filed a motion Aug. 8 calling for the dismissal of the Stillwell case, contending that a missed “opt-out” deadline for creditors prevents the legal claims against the company and its employees from moving forward.

New York State

The New York Civil Liberties Union says the state’s corrections system should be found in contempt for failing to comply with a court order to properly implement state law restricting the use of solitary confinement. The NYCLU’s filing with the state Supreme Court is the latest development in a yearslong battle with corrections officials over their refusal to comply with the Humane Alternatives to Long-Term Solitary Confinement Act, known as HALT. Last year the Court ruled that the New York Department of Correction and Community Supervision (DOCCS) was flouting the law’s requirement that prison officials must follow.

ICE

A federal judge on Thursday ordered that no more immigrant detainees be sent to a center in the Florida Everglades, and that much of the facility be dismantled. The ruling rebuked the state and federal governments for failing to consider potential environmental harms before building the facility, known as Alligator Alcatraz. The judge gave both branches of the government 60 days to move out existing detainees and begin to remove fencing, lighting, power generators and other materials. The order also prohibits any new construction at the site. The decision is a major legal setback for the detention center, the nation’s first state-run facility for federal immigration detainees, which has faced several lawsuits and numerous complaints about poor conditions and other problems. The state immediately filed a notice saying that it intended to appeal.

Sen. Jon Ossoff, D-Ga., has released a sweeping investigation documenting hundreds of human rights abuses in U.S. immigration detention, including dozens of cases involving pregnant women and children. Since January, Ossoff’s office has identified 510 credible reports of abuse across facilities run by the Department of Homeland Security, Bureau of Prisons, Health and Human Services, county jails, federal prisons, and even overseas U.S. military bases in Cuba and Djibouti. Among them were 41 cases of physical and sexual abuse, 14 involving pregnant women, and 18 involving children.

Consumption is flourishing in immigration detention centers across the country, yet another sign that America is grinding its way through a second Gilded Age. It’s better known now by its other name, tuberculosis, and it’s the most deadly infectious disease in the world, the World Health Organization says, responsible for killing 1.5 million people each year, even though it’s both preventable and curable. Detainees have tested positive for tuberculosis at the Anchorage Correctional Complex in Alaska and Adelanto ICE Processing Center in California, according to news reports. One immigrant died days after a diagnosis of the disease in the Eloy Detention Center in Arizona, an ICE death notice shows. Detainees may have been exposed at the Denver Contract Detention Facility in Aurora, according to a lawsuit. And in Washington state, several possible cases of tuberculosis in the Northwest ICE Processing Center in Tacoma were reported this month to state authorities.

As Orange County correctional staff face more pressure than ever under orders to house immigrants detained by federal immigrants enforcement agents at the local jail, medical staff employed by the corrections department say the county is undervaluing their work. Orange County Jail, the fourth-largest jail in Florida, houses more than 3,000 people per day on average, as of last year. Since March, the jail has also had an agreement with ICE to serve as a temporary holding center for people accused of violating federal immigration law.

It is always important to celebrate good news when we hear it. That’s why I was happy to hear that Gov. Michelle Lujan Grisham will probably call a special session of the Legislature and hear legislation that bans detention centers in New Mexico. New Mexico is home to three facilities that house people detained by Immigration and Customs Enforcement. All of these facilities are notorious for the poor conditions. CoreCivic runs two of the detention facilities in New Mexico and numerous others around the country. This billion-dollar corporation profits from the incarceration of individuals, all of whom are somebody’s family, friend and neighbor. It is in the interest of company executives and other stockholders to lock up as many people as possible; that is how the company makes a profit. Unfortunately, CoreCivic also increases its profit by cutting corners in the care it provides to its incarcerated population, resulting in inhumane living conditions.

State Roundup

California

Eight of the 11 Alameda County sheriff's deputies and medical staff originally charged in the death of Maurice Monk found languishing in his Santa Rita Jail cell for days will have their cases dismissed. Body camera video shows that deputies and Wellpath nurses had opened the door to his cell for several days before that, but never physically entered the room or asked him if he was OK, despite his nearly catatonic state. Monk's death also spurred action against Wellpath, which is currently the focus of jail reform activists who want the Alameda County Board of Supervisors to end its five-year, $250- million contract with the company in 2027 and turn to county-run medical care instead. An independent consultant hired by the county found Wellpath is not providing the national standard of care.

Minnesota

Friends and families of inmates at the Lino Lakes state prison said they're concerned about their loved ones' health, after routine testing at the facility showed high levels of lead in the water. According to the Minnesota Department of Corrections (DOC), three out of 10 water samples collected at the Lino Lakes prison on July 29 tested above the Environmental Protection Agency (EPA) action level of 15 parts per billion (ppb). The contaminated samples were found in two living units and a kitchen area.

Missouri

Nate Hayward inherits a Herculean task as he assumes control of the St. Louis City Justice Center (CJC) plagued by deaths, contraband, short staffing and ignored warnings from inside its own ranks. Judge David Mason, who retired from the bench and now advises the St. Louis Sheriff’s Office, described the situation in stark terms. “There is literally a cascade of constitutional failure in our CJC,” he said. “Inmate morale is a serious problem… inadequate health care, food quality, access to lawyers. Falling below the base level federal courts require.”

For six years, Honesty Jade Bishop was held in solitary confinement in a Missouri prison after she was sexually assaulted by her cellmate. The Department of Corrections deemed that Bishop, a transgender woman who was living with HIV, was sexually active and needed to be isolated. And from 2015 to 2021, she was in administrative segregation at the Jefferson City Correctional Center, a prison that houses men.A federal lawsuit filed on Bishop’s behalf in 2023 after her parole says her prolonged time in solitary confinement caused “depression, hopelessness, severe anxiety and feeling as if she were going insane and reaching a mental breaking point.” It also, the lawsuit says, drove her to “physically self-harm including attempts to take her own life.”

North Carolina

A North Carolina inmate with mental illness who had been held in solitary confinement died of thirst, according to an autopsy report released Thursday. Anthony Michael Kerr, 53, was found unresponsive in the back of the van March 12 after being driven roughly three hours from Alexander Correctional Institution in Taylorsville to a mental hospital at Central Prison in Raleigh. The North Carolina Department of Public Safety subsequently fired a captain and four nurses at Alexander. A nurse and a staff psychologist resigned.

Oregon

The Multnomah County jail system will soon have a new leader, a doctor who finished his residency about two months ago. Corrections Health announced that Dr. Stephen Kane, of Maryland, is tentatively expected to take the position of medical director starting Oct. 7. Kane, 32, finished a residency and master’s program in public health in late June at the Johns Hopkins Bloomberg School of Public Health, in Baltimore. He is currently applying for a medical license in Oregon.

Pennsylvania

When Allegheny County voters approved a referendum in 2021 eliminating the use of solitary confinement at the county jail, they also barred use of leg shackles by corrections officers there. As a result, jail staff cannot restrain the legs of incarcerated people being transported to the hospital for medical appointments or emergencies. That has led to 14 attempted escapes in the last 16 months, according to the president of the union representing corrections officers.

Texas

An estimated 1 in 3 people in Texas jails has a mental health disorder, according to the Meadows Mental Health Policy Institute, an organization that works to improve mental health care in Texas. Population records kept by the Texas Commission on Jail Standards show that the average total of people incarcerated in Texas jails has hovered around 71,000 since 2022.

Utah

A Utah firing squad is scheduled to execute Ralph Menzies Sept. 5 for the 1986 murder of Maurine Hunsaker. The 67-year-old has been in a Utah prison for 37 years and now has vascular dementia. His defense argues that he is mentally incompetent to be executed. According to a 2022 American Bar Association study, state prisoners aged 55 and older increased by 400% from 1993 to 2013. The report predicted that the age group will account for a third of the U.S. prison population by 2030. As the U.S. population ages, inside and outside of prisons, a rise in dementia is expected to follow.

Vermont

Sheriff’s deputies will no longer transport people who are released from the Springfield prison, according to the Vermont Department of State’s Attorneys and Sheriffs. Now, if a person is released after their arraignment while awaiting trial, they will be let out of the relatively rural prison to fend for themselves, according to Valerio. Due to a lack of capacity, sheriff’s transport deputies, who are paid by the state, have gradually stopped providing post-release rides.

Washington State

Investigators said they found at least four policy violations at the Washington Corrections Center for Women in Gig Harbor, involving improper use of pepper spray, delayed response to a suicide attempt and prolonged solitary confinement, according to an investigation by the Office of the Corrections Ombuds. The investigation looked into incidents from September 2024 to April 2025. The study documented multiple instances of what investigators called "incorrect" use of control tactics against female inmates at the facility. In one case, identified as Individual "A," officers administered pepper spray directly into an inmate's eyes after she allegedly swung at an officer.

Rikers Island

Mayor Eric Adams “violated” the law when he blocked the City Council’s ban on solitary confinement in Big Apple prisons, a Manhattan judge ruled. “Mayor Adams acted beyond the scope of his emergency powers,” wrote Manhattan Supreme Court Judge Jeffrey Pearlman in his decision. “He cannot suspend the law because he disapproves of its impact.” The ruling paves the way for a council law — passed in late 2023 — banning solitary confinement to finally take effect. Days before it was set to begin, Adams signed an emergency order blocking it.

Correctional Healthcare Vendors

Advanced Correctional Healthcare

A federal trial is underway for a wrongful death lawsuit against Calumet County (WI) Jail staff for the 2019 suicide of an 18-year-old prisoner, Demetrius Stephenson. Despite staff's knowledge that Stephenson had reported experiencing visual and auditory hallucinations and suicidal ideation, Stephenson was not provided medication he had been taking for schizophrenia prior to his time in jail, and was not provided adequate mental health care, the complaint alleges. As defendants, the lawsuit initially named Calumet County and the jail's medical contract management company, Advanced Correctional Healthcare.

MEDIKO/PrimeCare

At least 50 people who provide healthcare services at the York County Prison are expected to be laid off due to a change in providers. PrimeCare Medical said in the WARN notice that the county plans to terminate its contract for services at the prison. The York County Prison Board voted on Tuesday to approve a conditional letter of intent for health care services at the prison. The board selected Virginia-based Mediko as the new health care services provider for York County Prison.

Physician Correctional

A Florida-based subsidiary of Physician Correctional, Puerto Rico’s private prison health care provider, is being sued in St. Louis, Missouri, over the death of a jail detainee who allegedly convulsed for 20 minutes after being placed in a restraint chair without supervision. Physician Correctional USA —chaired by Puerto Rican doctor, businessman and political donor Raúl Villalobos Díaz— has provided health care services at the St. Louis City Justice Center since November 2023, after it was awarded a no-bid emergency contract.

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In Observation of Labor Day