Jails and prisons

Abstract

There are many similarities between prisons and jails, especially in regard to the constitutional standard for mental health services. However, the differences are important to recognize in assuring that the unique needs of each kind of institution are met. Historically, jails have been used to hold defendants for trial, and to confine prisoners who have been sentenced for misdemeanors, typically for sentences of 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, significantly increased risk of suicide, and the increases in workload due to the much higher percentage 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 have more time with which to work, they also face significantly greater expectations for treatment that goes beyond crisis response and psychotropic medication. Distinctions between prisons and jails in terms of service delivery and the kinds of treatment challenges that exist in the long-term management of prisoners with serious mental illness are discussed.