Breaking Barriers: The Mental Health Reform Movement Doesn’t Stop at Prison Walls


The wave of reform washing over the behavioral healthcare market has been well documented.  Three legislative landmarks, the Patient Protection and Affordable Care Act, the Mental Health Parity and Addiction Equity Act, and the Medicare Improvements for Patient and Providers Act, have dramatically improved the accessibility and affordability of mental health services.  Furthermore, these new laws have facilitated public dialogue on mental health, which has acted as a catalyst for public education and the de-stigmatization of mental illnesses.

The need for mental healthcare is even greater in incarcerated populations.  Approximately 16% of the 2.4 million Americans incarcerated suffer from a serious mental disorder; this is compared to 5% of all adult Americans.  The numbers have been increasing too – in Oklahoma for example, the percentage of inmates diagnosed with mental illness has nearly doubled to 36% in only 5 years.  Correctional facilities have become de facto mental institutions.  Some attribute these trends to the waning supply of mental healthcare in the community – only 45% of U.S. counties have practicing psychiatrists, psychologists, or social workers and the number of psychiatric hospitals and psychiatrics units has declined by more than half since 1995.

Correctional facilities are not set up to handle this influx of mentally ill inmates, but change may be on the way.

A tragedy, several lawsuits and court mandates regarding correctional facility practices and mental health offerings may serve as an impetus for reform.  On March 19th, 2013, Tom Clements, the Executive Director of Colorado prisons was murdered by an inmate that had been released directly from solitary confinement into the community.  In the wake of this tragedy, Clements’ successor, Rick Raemisch, has championed reform in the state prisons.  He is advocating for an increased number of mental health staff at state facilities and reduced use of solitary confinement.  Raemisch even stayed a night in solitary confinement for his own education and wrote a widely syndicated editorial about his experience.

Under pressure from a series of lawsuits filed in recent years, the state of New York instituted a set of changes to its use of solitary confinement and other forms of alternative punishment.  These changes have increased the need for correctional mental healthcare in the state as hundreds of inmates have transitioned from solitary confinement to Residential Mental Health Units.  Similarly, in Illinois, correctional mental health and counseling services have expanded at the behest of a court mandate.

This burgeoning demand, coupled with tight state budgets and minimal public resources, may increase the need for mental health services provided by private correctional healthcare companies.

Transactions are already happening in the space as two of the largest correctional healthcare companies, Correct Care Solutions (CCS) and Correctional Healthcare Companies (CHC) recently took steps to complete a merger. This same platform also recently acquired Geo Care, a specialist in providing correctional mental healthcare services and operating state psychiatric hospitals.

We are closely monitoring this space, but would like to know what you think.

Justin Fengler
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