Pew Study: Mental Health Screening Tools in Jail; Correction's Unwanted Role As Mental Health Provider

Highlighted Stories

Editor's Note

This week’s first highlighted story comes from a new Pew study examining the widespread use of behavioral health screening tools in jails. While the study confirms that most jails conduct these screenings, it also raises a provocative question: If so many individuals are identified with behavioral health issues, why are so few diverted from incarceration? That question, however, may reflect a misunderstanding of the role jails play—and were never intended to play—in our behavioral health system.

To understand how jails operate is to understand their limitations. Jails do not choose who is brought to their doors; they must accept nearly everyone law enforcement delivers—except in cases of acute medical emergencies (see COCHS' Intake Process flowchart). Diversion is not the jail’s responsibility; it is the responsibility of the community’s behavioral health system. The screening tools used in jails are not intended to reroute individuals into treatment programs, but rather to help manage risk and safety within the facility.

That responsibility—diversion and treatment—was meant to fall on community-based behavioral health systems, the very systems promised but never fully funded following the Kennedy administration’s push for deinstitutionalization in the early 1960s. As last week’s Editor’s Note discussed, the failure to fulfill that promise has left jails functioning as mental health providers of last resort. As noted in our April 8, 2025 Editor’s Note, the sheriff of Russell County, Georgia, cited the ineffectiveness of outpatient behavioral health care as a key driver of the jail’s revolving door. A second highlighted article from Montana further underscores this point, describing how local jails in that state absorb the fallout from an under-resourced state hospital system.

Turning to California—which is often a leader on such issues—the next two articles illustrate how fragmented county-level responses to behavioral health needs can be. In Sacramento County, the sheriff has announced that deputies will no longer respond to mental health crises. Meanwhile, Napa County is preparing to open a new 332-bed jail at a cost of $400,000 per bed. Though this facility includes medical and mental health units, the scale and expense underscore how costly it becomes when community behavioral health care is displaced onto correctional systems.

As COCHS has long maintained, bringing Medicaid into correctional settings—via 1115 waivers or the Consolidated Appropriations Act of 2023—is key to integrating community healthcare as the appropriate venue for behavioral health. Until that alignment occurs, jails will continue to screen, but diversion will largely remain beyond their legal remit.

Screening Tools

A survey of administrators at U.S. jails shows that only about one-third of facilities use information from behavioral health screening and assessment tools to divert people from jail. Most facilities do conduct screenings and assessments, but few use them for diversion purposes. That represents a significant missed opportunity to connect people to the care they may need. The results: 88% reported screening everyone for mental health needs and 80% conducted assessments based on information gained through screenings or prior records. Additionally, 86% of responding jails screened everyone entering their doors for substance use issues and roughly 65% performed assessments based on those screening results and just 33% used screenings and assessments to divert people with mental health concerns and only 33% used those tools to divert people with substance use issues.

Mental Health Crisis In Corrections

When someone accused of a crime in this small northwestern Montana town needs mental health care, chances are they’ll be locked in a basement jail cell the size of a walk-in closet. Last year, a man sentenced for stealing a rifle stayed in that cell 129 days. He was waiting for a spot to open at Montana’s only state-run psychiatric hospital after a mental health evaluator deemed he needed care, according to court records. More than half of Wyoming’s 23 sheriffs told lawmakers there that they were housing people in crisis awaiting mental health care for months. Nevada has struggled despite a $500 daily fine for each jailed patient whose treatment is delayed. Disability Rights Oregon has said delays in that state continue after two people died in jail while on the state’s psychiatric waitlist.

In early January, Sacramento County Sheriff Jim Cooper met with county behavioral health and emergency medical response partners and dropped a bomb. His department would no longer respond to mental health crisis calls unless a crime had occurred, was in progress, or someone other than the person in crisis was deemed to be in imminent danger. “Law enforcement officers are not trained mental health professionals,” Cooper announced in a news conference a month later. “We wear the badge; we carry the gun. We deal with crime – not mental health crises.” Yet these issues have challenged policymakers for more than half a century: Because mental illness isn’t a crime, when should law enforcement be involved, if at all?

Napa County’s long-awaited new jail is set to open in June, replacing the outdated downtown Hall of Justice facility from 1976. The 109,000-square-foot jail, located off Highway 221, offers expanded space, modern infrastructure, and resources to support inmate health and reduce recidivism. The $133 million project — including $97 million in construction — has been over a decade in development. With 332 beds, the cost is about $400,000 per bed, higher than average but comparable to similar facilities with medical and mental health units. Santa Barbara’s 2022 Northern Branch Jail, for example, cost $120 million for 376 beds.

Follow Ups

Editor's Comment: This week’s Follow Ups begin with the long-running Wellpath bankruptcy, which now appears to be nearing resolution. A Texas bankruptcy judge has approved the company’s reorganization plan, despite continued objections from junior creditors. As noted in recent Editor’s Notes and stories, critics argue that bankruptcy has become a business strategy for proprietary correctional healthcare companies—used to avoid accountability for deficient care and unpaid obligations. Case in point from the second story: the University of Maryland Medical Center is seeking payment from the state’s Department of Corrections after allegedly serving as a subcontractor to Corizon/YesCare without reimbursement. Similarly, in the final bankruptcy-related article, the Michigan Health & Hospital Association is urging a $35 million supplemental state appropriation to cover unpaid debts owed by Wellpath to its member hospitals.

Next Follow Up, we return to Dauphin County, Pennsylvania. As subscribers may recall, former County Commissioner and Prison Board Chair Jeff Haste received over $350,000 from PrimeCare Medical while in office. PrimeCare is currently the jail’s healthcare provider. The county is now reviewing bids from Centurion, NaphCare, Wellpath, Allegheny Health Network—and PrimeCare itself. Notably, after the county announced the competitive bidding process, PrimeCare indicated it would terminate its contract early—a move that recalls Turn Key Health Clinics’ exit from Oklahoma County last year amid scrutiny over inmate deaths. Turn Key, for its part, cited inadequate security as the reason.

Speaking of Oklahoma, the article frou OU Daily suggests that the quality of healthcare in the state’s prisons and jails has finally drawn the attention of lawmakers. The governor recently signed Senate Bill 595, which sets new standards for detention centers. This article focuses on how the legislation may affect Cleveland County, where Turn Key—echoing its earlier exit from Oklahoma County—abruptly ended its contract, citing poor security. However, the company had also faced criticism for four inmate deaths at the facility (see Weekly Update of October 15, 2024).

Finally, we return to the aftermath of the New York wildcat strike. A set of five articles examines staffing shortages, internal violence, and legislative proposals. The Hill highlights the national correctional officer staffing crisis, citing New York’s strike as a cautionary example. State Senator Samra G. Brouk has introduced legislation offering sentence reductions for incarcerated individuals who participate in mental health or substance use treatment. Other reports investigate possible links between the beating death of Robert Brooks and contraband, while a Marshall Project article suggests that prison infirmaries may be hotspots for assaults by correctional officers.

Together, these stories reveal a correctional system under sustained pressure—with accountability, safety, and care seeming to be in a precarious state.

Bankruptcies: Wellpath & Tehum Care/Corizon/YesCare

A Texas bankruptcy judge said Wednesday he will confirm prison healthcare company Wellpath's Chapter 11 plan over objections after the debtor achieved a global settlement and agreed to additional changes, saying he was convinced the plan offered the best outcome. Near the end of a multi-hour hearing, U.S. Bankruptcy Judge Alfredo R. Perez said he will confirm the debtor's reorganization plan as soon as he gets a draft order reflecting the final amendments. The plan had faced opposition from multiple parties, including over its third party release provisions, but Judge Perez said he believed the plan was a good faith effort that offered a better result than a liquidation and confirming it would be safer for patients.

Fighting to claw back huge losses from $4.6 million in unpaid debts owed by a for-profit prison health care company, the University of Maryland Medical System says the state corrections department should be made to foot the bill. In a lawsuit filed Tuesday, UMMS argued that it is entitled to protections in Maryland procurement law as a “subcontractor” for YesCare, a private-equity owned health care company that provided care in state-run correctional facilities before it was terminated by the state last year. But when YesCare assumed the health care contract for state-run prisons and jails in 2023, things quickly went downhill. YesCare was spun off from a company formerly known as Corizon Health, which abruptly restructured itself in a controversial “Texas two-step” bankruptcy. The bankruptcy left scores of current and formerly incarcerated people, as well as medical providers, holding the bag with debts owed by YesCare, drawing the condemnation of advocacy groups and progressive U.S. senators. Now, one of those providers, the University of Maryland Medical System, is asking a judge to hold the state corrections department liable for the money it‘s owed by YesCare.

The MHA provided testimony April 30 to the House Appropriations Committee about healthcare services provided to prisoners by Michigan hospitals that have not been reimbursed by Wellpath, a third-party private vendor. The House Appropriations Committee heard from several key stakeholders, including the MHA, on issues related to Wellpath and their failure to reimburse hospitals and EMS providers for delivering healthcare services to prisoners. Further, it was shared that hospitals provided more than $35 million in healthcare services to prisoners from January 2022 through May 2024 that have not been reimbursed from Wellpath, and that the vendor has since filed for bankruptcy.

Dauphin County, Pennsylvania

Dauphin County (Harrisburg, PA) will interview five vendors the week of May 5—Wellpath, Centurion, NaphCare, PrimeCare, and Allegheny Health Network—before voting on a new correctional healthcare provider June 4. The process was prompted by scrutiny of PrimeCare Medical, the long-time contractor, after reports revealed former commissioner Jeff Haste received over $525,000 from PrimeCare and its founder while still in office, including a $225,000 payment used as a home down payment. Haste also earned $60,000 annually as a consultant for the company while chairing the county prison board, raising serious concerns about oversight and transparency. A week after the search for new provider was announced, PrimeCare submitted a letter to the county formally notifying them that PrimeCare was moving to terminate its contract early.

Oklahoma

Amid rising public concern about jail conditions and accountability, Cleveland County officials and state lawmakers weigh in on a new law that will establish comprehensive standards for the operation of detention and lockup facilities across Oklahoma. Gov. Kevin Stitt approved and signed Senate Bill 595 Monday. Known as the Oklahoma Jail Standards Act, the bill authored by Sen. Darrell Weaver (R-Moore) requires all facilities to adopt policies covering key operational aspects, including 24-hour supervision of prisoners by direct observation or electronic video surveillance and ensuring adequate diet and proper sanitary conditions. SB 595 comes at a critical time for Oklahoma's detention system. Recent inspections revealed that 51 of the state’s 65 county jails, including the Cleveland County Detention Center, were not in compliance with health standards. Since 2022, the Cleveland County Detention Center has repeatedly failed unannounced annual inspections. Major complaints cited in inspection reports include unsanitary living conditions, delayed provision of hygiene products and inadequate inmate safety checks.

Wildcat Strike (New York)

Understaffing harms everyone who lives and works in prisons. Due in part to rising prison populations, understaffing has reached unsustainable levels, and there appears to be no end in sight. Recently, corrections officers in New York engaged in a wildcat strike because of the severe impacts that understaffing is having on employees’ health and wellbeing. The numbers are shocking. Our data shows that the number of corrections officers working in state prisons has fallen by 20 percent since 2017. At least 13 states have lost more than a quarter of their corrections officers since 2017. At the same time, state prison populations are rising, and of the 13 states facing the highest loss in officers, ten have imprisonment rates higher than the national average.

Senator Samra G. Bourk writes: We must support New Yorkers with mental health crises by connecting them to programming and treatment, acknowledging their positive transformation, and enabling them to rejoin their communities once they’re ready. Not to mention incarceration is expensive, leaving less money for research-backed solutions: access to housing, mental health and substance use treatment, education, and employment. As the brutal deaths of Robert Brooks and Messiah Nantwi make clear, incarceration can be traumatizing and deadly. People often come out worse than they went in, making all New Yorkers less safe. Our policies must deliver safety and accountability, giving incarcerated people tools to positively change their lives and stop further harm.

A leaked email has surfaced linking possible unknown substance exposures at New York state prisons to suspected retaliation following the death of inmate Robert Brooks, according to former correctional officers. The message, dated Jan. 23, reportedly outlined methods for moving drugs through facilities, just one day after 20 staff at Upstate Correctional Facility were hospitalized. Ex-COs Nathan Locke and Ross Driscoll described strong odors, symptoms requiring Narcan, and a surge in incidents after the Marcy Correctional Facility beating.

While beating deaths and murder charges like the Robert Brooks Brooks and Messiah Nantwi killings are incredibly rare, alleged physical abuse in New York prison infirmaries is not. The Marshall Project has identified 46 allegations that corrections officers assaulted prisoners in medical wings of New York prisons since 2010, according to a review of court settlements, disciplinary records and pending lawsuits. Three prisoners died, including Brooks and Nantwi, while many others were left with severe injuries such as collapsed lungs and broken bones. And in the past six years, three women have alleged in lawsuits that male officers raped them in an infirmary.

Opioid Epidemic

Despite his own history of overcoming heroin addiction, Health and Human Services Secretary Robert F. Kennedy Jr. is backing plans to end a federal Narcan distribution program credited with helping drive a steep drop in U.S. overdose deaths. A $56 million annual grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA) has funded the distribution of Narcan to first responders across the country, training over 66,000 individuals and distributing more than 282,500 kits in 2024 alone. Recent CDC data shows a nearly 24% drop in overdose deaths for the 12 months ending September 2024, the sharpest one-year decline in decades—an achievement partly attributed to widespread naloxone access.

Juveniles

Though rates of drug overdose deaths decreased by 4.0% between 2022 and 2023, they had been steadily increasing for the 20 years beforehand. In 2024, the Centers for Disease Control and Prevention (CDC) reported a 31% increase from 2019 to 2020 among all age groups analyzed.1 In this same report, the highest number of overdose deaths occurred among adults aged 35-44, with the greatest rate increase (49%) observed among people aged 15-24 years.

At Los Padrinos Juvenile Hall were interrupted on a Friday in early April when three teenagers suffered what county officials later confirmed were drug overdoses. One collapsed in front of his classmates and two others passed out in their rooms, according to multiple sources who requested anonymity to discuss the ongoing investigation. The L.A. County Probation Department, which oversees Los Padrinos, said three youths were hospitalized on April 10 because of overdoses from an unspecified drug. The day before, the sources familiar with the investigation said, probation officers found a large quantity of Xanax inside the Downey facility, where most of the approximately 270 detainees are 18 or younger. Four years after the state’s Department of Justice entered into a settlement to improve conditions in L.A. County’s juvenile halls, frustrations are hitting a boiling point. The Probation Department has shown no signs of progress, prompting calls for Atty. Gen. Rob Bonta to intervene.

Youths with mental and behavioral health disorders form a disproportionately large percentage of those in contact with the United States juvenile justice system. Roughly 50%-75% of youths who have had contact with the juvenile justice system have a mental-health disorder. In 2019, a northeastern state required probation departments to implement an evidence-based behavioral health (BH) screen. e-Connect is a digital clinical decisional support system designed to identify suicide thoughts and behaviors and related BH risk and triage youths based on BH need, then facilitate linkage to care.

ICE

A new report from the California Department of Justice finds that immigration detention facilities across the state continue to fall short in providing basic mental health care, with gaps in suicide prevention and treatment, recordkeeping, and use of force incidents against mentally ill detainees. The report’s release today comes alongside an aggressive expansion of immigration enforcement and broader changes to immigration policy under President Donald Trump’s second administration. The timing of the report’s release signals California officials plan to continue oversight as federal officials move to expand immigration detention capacity in the state.

State Roundup

Alaska

A federal lawsuit filed on behalf of people imprisoned in Alaska alleges the state Department of Corrections provides inadequate medical, mental health and dental care, calling it a systemic issue that goes back years. At any one time, about 4,400 people are in Department of Corrections custody, including people who are being detained before trials, according to the lawsuit. It says the state “routinely” denies medical services to incarcerated people based on their pre-trial status and says people often end up for years in corrections facilities while awaiting trial due to court system delays in handling criminal cases.

California

Thousands of inmates wrongly tested positive for opiate use inside California state prisons last year because of a laboratory mistake, and civil rights attorneys now worry many of them could be denied parole and a chance at freedom because of it. About 6,000 drug tests are believed to have generated false positive results in 2024, according to attorneys at UnCommon Law, a nonprofit advocacy group that represents inmates seeking parole. The organization confirmed the false test results through a series of public records requests, which showed positive test results suddenly spiked across California prisons between April and July last year.

Los Angeles County’s overall jail population has increased nearly 4% since late last year, in part because of more arrests related to a voter-approved proposition that allowed police to once again arrest people accused of certain low-level drug and theft crimes. It’s a relatively small increase — roughly 500 incarcerated people — but it could indicate what is to come now that Proposition 36 is California law.

Florida

The Florida House has approved a measure that would divert those being held in legal custody experiencing mental illness to mental health facilities instead of remaining in prison or jail. “Our jails have become our mental health providers in many counties,” Daley said. “This is a huge step in the right direction for mental health and the criminal justice system.”

Hawai'i

The city’s emergency medical workers will no longer care for sick or injured inmates in state correctional facilities, and instead will require the prisoners be brought outside for treatment, according to the director of Honolulu Emergency Services. In a letter dated Thursday, Emergency Services Director Jim Ireland said the change came in response to recent incidents at the Oʻahu Community Correctional Center and Hālawa Correctional Facility “where EMS crews did not have adequate prison staff in attendance for their safety.”

The state prison system and the Honolulu Emergency Services Department have resolved a dispute over security at Oʻahu correctional facilities after the emergency services director warned last week medical crews would no longer enter jails or prisons to treat patients. EMS rescinded the letter after corrections officials guaranteed that an officer will be assigned to accompany EMS crews from the time they arrive at correctional facilities until they leave, Enright said.

Maine

The Kennebec County budget, a small portion of property tax bills that funds essential services, has increased again this year after a significant jump last year. The key challenge is how to maintain services while fairly compensating county employees. Of the $25.5 million total budget, 81% ($20.7 million) supports law enforcement and corrections. That amount is distributed across several departments. The District Attorney’s Office comprises 6% ($1.7 million) of the budget, with 12 prosecutors and 15 staff handling 4,800 cases last year. The Sheriff’s Office, with 44 sworn officers and four administrative staff, makes up 20% ($5 million) of the budget and responded to 19,699 calls.

Maryland

On April 1, 2025, the Center for Mental Health and Addiction Policy (CMAP) at Johns Hopkins Bloomberg School of Public Health hosted a pivotal event titled “Suicide Prevention in U.S. Jails". Topics focused on the current state of suicide prevention protocols, highlighting both challenges and innovative solutions. Particular attention was given to efforts within Maryland and broader national initiatives, focusing on the design and implementation of effective suicide prevention strategies within correctional settings.

Mississippi

Sinatra Jordan stepped out the glass doors of the Raymond Detention Center and headed toward his father’s waiting car. It had been 940 days, and he wasn’t going to linger. Jordan’s ordeal was the result of an opaque and overburdened criminal justice system where judges, prosecutors, investigators and court-appointed defense lawyers are struggling to keep pace with a tide of cases, perpetuating delays that force defendants to wait years for their day in court — and postpone justice for victims.

Wisconsin

Prosecutors have reduced a felony misconduct charge against a former Wisconsin prison warden implicated in two inmate deaths to a misdemeanor as part of a plea deal. Randall Hepp was charged with felony misconduct in office in June 2024 in the deaths of Cameron Williams and Donald Maier at the Waupun Correctional Institution. Eight members of Hepp's staff were charged in June with abuse or misconduct in the deaths. According to court documents, Williams told an inmate advocate three days before he died that he needed to go to a hospital but no action was taken. He had fallen in the shower two days earlier and had to crawl into his cell. A day before that he collapsed on the way back to his cell but neither fall was documented. No one checked on him the night he died.

The mother of an inmate who died of dehydration and malnutrition at Wisconsin's oldest maximum security prison last year has filed a federal lawsuit, marking the fourth action brought by relatives of inmates who have died at the troubled institution since 2023. The lawsuit seeks unspecified damages and names state Department of Corrections Secretary Jared Hoy, former Waupun Warden Randall Hepp and multiple Waupun staffers as defendants. Donald Maier, 62, was found dead in his cell in February 2024 at Waupun. The Dodge County medical examiner determined he died of dehydration and failure to thrive due to malnutrition. (see last weeks Editors Note)

The Jonathan Delagrave Youth Development and Care Center will open for youth inmate occupancy May 1. The new facility includes 48 beds and is expected to serve about 400 youth annually through both secure detention and correctional placement, according to the county. The center was designed to feel “welcoming and therapeutic,” according to the county, including features such as natural lighting; soft finishes; warm color palettes; private youth bedrooms with beds, desks, tablets and chalkboards; courtyards; a family-style cafeteria; private visitation rooms; a recording studio; a micro-nursery for plants; and a teaching garden.

Correctional Communications

Global Tel Link (GTL) agreed to a class action lawsuit settlement to resolve claims it charged incarcerated individuals and their families excessive fees for communications services. The Global Tel Link class action settlement benefits those who were incarcerated in a West Virginia jail or prison between May 15, 2022, and April 30, 2023, and were charged excess amounts by ViaPath for video calls and other messaging services or who contacted an individual incarcerated in a West Virginia jail or prison between May 15, 2022, and April 30, 2023, and were charged excess amounts for video calls and/or other messaging services.