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With an estimated 44% of individuals in local jails having a history of mental illness, America’s jails have become de facto mental health institutions. We have identified five core challenges in addressing mental health needs in correctional settings: inconsistent or biased treatment, the sensory and psychological harm caused by in-cell restraint practices (especially for individuals with autism or PTSD), limited access to therapy due to understaffing in both clinical and custody roles, insufficient training for correctional staff on mental health risks and suicide prevention, and fragmented care for those with co-occurring substance use disorders. These issues contribute to worsening symptoms, increased liability, and higher rates of behavioral crises and recidivism. To confront these challenges, we propose implementing integrated, standards-driven solutions that prioritize continuity of care, evidence-based therapeutic interventions, and collaborative engagement among security, medical, and behavioral health teams. Interventions include timely and equitable mental health screenings, expanded MAT/MOUD programs for individuals with substance use disorders, de-escalation strategies to reduce the use of traumatizing in-cell restraint practices, and comprehensive staff training on suicide prevention, trauma-informed care, and environmental sensitivity. By embedding mental health services into the core of jail healthcare delivery, we aim to stabilize individuals during incarceration and lay the foundation for successful reentry into the community

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