Jails and prisons

Abstract There are many similarities between prisons and jails, especially regarding the constitutional standard for mental health services. However, the differences are important to recognize in ensuring that the unique needs of each kind of institution are met. Historically, jails have been used to hold defendants for trial and to confine individuals who have been sentenced for misdemeanors, typically for less than one year. In contrast, prisons are managed by state or federal governments and used for longer term confinement of convicted felons who generally serve sentences of one year or longer. Predominant among these differences is the very high degree of turnover in jail populations, resulting in dramatic increases in acuity of mental illness and substance misuse, risk of suicide, and workload for mental health professionals due to the higher volume of initial assessments. In contrast, prison mental health services are more often faced with the realities of serious and persistent mental illnesses and the hopelessness that can come after years of incarceration and in the face of very long sentences. While prison mental health clinicians may have more time with which to work, they also face significantly greater expectations for treatment beyond crisis response and psychotropic medication. This chapter discusses the distinctions between prisons and jails in terms of service delivery, risks, and treatment challenges.