Colorado's approach to prison mental health care has been shaped by two decisions -- one from the top of the department and one from the legislature -- that together represent the most explicit policy pivot in this series. In 2013, CDOC Executive Director Rick Raemisch said publicly: "I've accepted the fact that I run the biggest mental health institution in the state of Colorado." In 2014, the Colorado General Assembly passed Senate Bill 14-064 -- the first law in the nation explicitly prohibiting placement of prisoners with serious mental illness in long-term isolation, absent exigent circumstances.
Those two decisions -- an administrator's candor and a legislature's action -- define Colorado's framework for prison mental health: treatment over isolation, structured programming over segregation, and a transition planning system that begins up to 180 days before release.
Colorado does not have active federal court oversight of its prison mental health system at the level of Alabama, Arizona, or California. What it has instead is the Residential Treatment Program (RTP) -- a multi-level, intensive therapeutic housing program for prisoners with the most significant mental health needs, operating as the alternative to administrative segregation for seriously mentally ill prisoners.
What Colorado Prisoners Are Entitled To
Under Estelle v. Gamble (1976) and subsequent federal case law, CDOC is constitutionally required to provide adequate mental health care. Under Colorado statute (SB 14-064, codified in Colorado Revised Statutes):
- Before anyone is placed in long-term segregation (extended restrictive housing, ERH), their mental health status must be assessed.
- Clinical experts and correctional professionals jointly determine whether the person has a serious mental illness.
- If serious mental illness is identified, the response must be treatment -- specifically RTP placement -- not isolation.
- Exceptions exist only for exigent circumstances, which must be documented.
This is a statutory floor, not a policy preference. Placement of a prisoner with serious mental illness in extended restrictive housing without following this process is a violation of state law.
Mental Health Screening at Intake
All incoming CDOC prisoners are screened at intake for mental health needs. The screening identifies prisoners with mental illness diagnoses, prior psychiatric history, active medications, and acute needs. Mental health classification at intake determines the level of care and whether RTP assessment is indicated.
The RTP assessment process uses various tools including the Brief Psychiatric Rating Scale (BPRS), mental status examinations, and psychological testing to measure overall functioning and monitor treatment response. If your person has a psychiatric history, provide documentation at intake.
The Residential Treatment Program
The Residential Treatment Program (RTP) is CDOC's primary mental health treatment program for prisoners with the most significant mental health needs. It was initiated in early 2013 under CDOC Director Tom Clements as a way to provide intensive mental health care as an alternative to administrative segregation.
The RTP operates at the Colorado Correctional Facility (CCF) in Canon City as its primary location. The program:
- Delivers best practice and evidence-based treatment services.
- Uses a multi-level structure (diagnostics unit plus five levels with associated privileges).
- Provides structured out-of-cell therapeutic time.
- Monitors treatment progress through assessments including the BPRS, mental status examinations, and psychological testing.
- Operates as a team-based approach, with clinical experts and correctional professionals making placement and treatment decisions jointly.
Under SB 14-064, prisoners with serious mental illness who would otherwise be placed in extended restrictive housing must be diverted to the RTP instead.
The RTP Level Structure
The RTP uses a diagnostics unit for initial assessment, followed by five program levels with associated privileges. Level progression is based on treatment response and behavioral stability. Specific privileges and requirements at each level are defined in CDOC's Administrative Regulation governing the RTP.
People enter the RTP through the diagnostics unit, where their functioning is assessed and an appropriate level is assigned. As treatment progresses and functioning improves, the person moves through the levels toward lower security and eventual return to general population or community release.
Senate Bill 14-064 (2014): The Solitary Ban
Senate Bill 14-064 (2014) made Colorado the first state in the nation to explicitly prohibit long-term solitary confinement for prisoners with serious mental illness by statute. Key provisions:
- CDOC is prohibited from placing prisoners diagnosed with a serious mental health disorder in administrative segregation or restrictive housing.
- Before any prisoner is placed in long-term segregation, mental health status must be assessed by clinical staff in consultation with correctional staff.
- If serious mental illness is identified, placement in the RTP is the required response rather than extended restrictive housing.
- Exceptions for exigent circumstances must be documented.
The law was the product of a partnership between CDOC, the Colorado General Assembly, and local advocates, including work with the Vera Institute of Justice and ACLU of Colorado. It was described by Vera's Safe Alternatives to Segregation Initiative as a national model for legislative-correctional partnership.
Enforcement note: A Colorado Office of the State Auditor report documented violations of SB 14-064 in 2014 and 2015, including three prisoners with serious mental illness placed in long-term solitary because of errors in how mental illness was coded in the computer system. CDOC agreed with the auditor's recommendations and committed to fixes. Compliance verification at current facilities should be confirmed at publish.
Behavioral Health Transition Planning
Colorado has one of the most developed pre-release mental health transition planning systems in this series. CDOC's Behavioral Health Transition Plans program:
- Begins tracking upcoming releases for prisoners with moderate to severe mental health, medical, or intellectual/developmental disability needs up to 180 days before release.
- Recommends specialized community resources in proximity to the release area.
- Identifies care needs for chronic mental health conditions.
- Connects prisoners with Medicaid care coordination, durable medical equipment, and specialized services as needed.
- Coordinates with facility case managers to identify the prisoner's choice of treatment agency, community providers, and Regional Accountability Entities (RAEs) for Medicaid-eligible individuals.
- Upon release, meets with the individual to identify health-related goals, develop an action plan for barriers, and support access to community care.
CDOC maintains four Parole Mental Health Clinicians and one supervisor who serve the parole division specifically, providing continuity for people with higher-risk/higher-need mental health profiles who transition to parole.
Colorado's Medicaid Prerelease Mental Health Waiver
Colorado has taken steps to address the Medicaid gap at release -- the period when a person leaves prison without active Medicaid coverage and before they can access community mental health services. Key developments:
Colorado's 1115 Substance Use Disorder and Behavioral Health Reform Medicaid Waiver received CMS approval in April 2024 and August 2024 for amendments that:
- Authorize prerelease services for individuals transitioning from correctional facilities.
- Provide reimbursement for acute inpatient and residential stays in Institutions for Mental Disease (IMDs) for individuals with serious mental illness leaving incarceration.
- Extend 12 months of continuous Medicaid coverage for individuals leaving incarceration.
Note: In July 2025, CMS notified states it would no longer approve new or renewed 1115 waivers for continuous Medicaid eligibility. The status of Colorado's 12-month continuous coverage for people leaving incarceration should be confirmed at publish, as federal policy changes may affect implementation.
What Families Can Do
If your person is in CDOC custody and has a mental illness:
Provide psychiatric history at intake. Supply documentation of diagnoses, prior hospitalizations, current medications, and treating providers. Intake mental health screening determines initial classification and whether RTP assessment is warranted.
Know SB 14-064. If your person has a serious mental illness diagnosis and is being considered for or placed in extended restrictive housing, SB 14-064 requires a mental health assessment before that placement and RTP referral if SMI is confirmed. A placement in long-term segregation without this assessment process may be a violation of Colorado law. Document it and file a grievance.
Know the RTP structure. If your person is in the RTP, ask which level they are currently at, what criteria determine advancement to the next level, and what the timeline for level progression looks like. Ask whether they are receiving the minimum out-of-cell therapeutic time required at their level.
Ask about pre-release transition planning. If your person is within 180 days of release and has moderate to severe mental health needs, ask the facility what Behavioral Health Transition Plan has been initiated. Ask what community mental health providers have been identified, whether Medicaid enrollment has been started, and what the care coordination plan is.
File a grievance. CDOC has an administrative grievance process. File formal grievances for: failure to conduct the required mental health assessment before restrictive housing placement, failure to refer to RTP when SMI is identified, failure to provide RTP programming at the appropriate level, medication interruption, and failure to initiate pre-release transition planning within the 180-day window.
Contact Disability Rights Colorado. DRC (disabilityrightsco.org) is the federally mandated protection and advocacy organization for Colorado and monitors conditions for people with disabilities and mental illness in CDOC facilities.
Contact the ACLU of Colorado. The ACLU of Colorado (aclu-co.org) has monitored CDOC mental health conditions and SMI isolation compliance and may be able to provide referrals.
Seek legal help. If your person has a serious mental illness and has been placed in long-term segregation without the SB 14-064 assessment process, or if RTP programming has been denied or conditions fall below program standards, consult a prisoner rights attorney with experience in Colorado's federal courts (District of Colorado).
Frequently asked questions
How does Colorado screen prisoners for mental illness?
All incoming CDOC prisoners are screened at intake for mental health needs, using assessments including the Brief Psychiatric Rating Scale (BPRS), mental status examinations, and psychological testing. The screening identifies mental illness diagnoses, prior psychiatric history, active medications, and acute needs. It also triggers the required pre-segregation mental health assessment process under SB 14-064 if the person is later considered for extended restrictive housing. Provide documentation of psychiatric history at intake.
What is the CDOC Residential Treatment Program?
The RTP (Residential Treatment Program) is CDOC's primary mental health treatment program for prisoners with the most significant mental health needs. Initiated in 2013, it operates primarily at the Colorado Correctional Facility (CCF) in Canon City. The RTP delivers evidence-based treatment through a multi-level structure, uses a team-based clinical and correctional approach, and functions as the statutory alternative to extended restrictive housing for prisoners with serious mental illness under SB 14-064. It includes a diagnostics unit for initial assessment plus five program levels with associated privileges.
What are the RTP levels in Colorado prisons?
The RTP uses a diagnostics unit for initial assessment, followed by five program levels (Level 1 through Level 5) with associated privileges that increase as the person progresses through treatment. Level placement is based on mental health assessment results and behavioral stability. Level advancement is based on treatment response and functioning improvement. People move through the levels with the goal of returning to general population or transitioning to the community. Specific privilege and requirement details at each level are governed by CDOC's RTP Administrative Regulation.
Does Colorado ban solitary for mentally ill prisoners?
Yes, by statute. Senate Bill 14-064 (2014) -- the first such law in the nation -- prohibits CDOC from placing prisoners with a serious mental health disorder diagnosis in administrative segregation or extended restrictive housing. Before any prisoner is placed in long-term segregation, mental health status must be assessed jointly by clinical and correctional staff. If serious mental illness is identified, RTP placement is required. Exceptions for exigent circumstances must be documented. Violations were documented in 2014-2015 by the state auditor; current compliance should be verified.
What is Senate Bill 14-064 in Colorado?
SB 14-064 (signed 2014) is the Colorado law that prohibits placement of seriously mentally ill prisoners in long-term solitary confinement or restrictive housing, absent exigent circumstances. It requires: a mental health assessment before any long-term segregation placement; joint determination by clinical experts and correctional professionals; RTP placement if serious mental illness is confirmed; and documentation of any exigent circumstance exception. It was described as the first legislation of its kind in the nation at the time of passage and emerged from a partnership between CDOC, the legislature, and advocacy organizations.
How does Colorado plan mental health care before release?
CDOC's Behavioral Health Transition Plans program begins tracking releases up to 180 days before the release date for prisoners with moderate to severe mental health needs. It identifies community providers in the release area, coordinates Medicaid enrollment, connects the person to Regional Accountability Entities (RAEs), and meets with the individual upon release to develop an action plan. CDOC also has four Parole Mental Health Clinicians who provide continuity for higher-risk/need individuals on parole. The program coordinates with facility case managers, parole staff, and community providers.
What is Colorado Medicaid prerelease mental health waiver?
Colorado's 1115 SUD and Behavioral Health Reform Medicaid Waiver received CMS approval in 2024 for amendments providing: prerelease services for people transitioning from correctional facilities; Medicaid reimbursement for acute inpatient and residential stays in Institutions for Mental Disease (IMDs) for people with SMI leaving incarceration; and 12 months of continuous Medicaid coverage after release. Note: In July 2025, CMS announced it would no longer approve 1115 waivers for continuous Medicaid eligibility -- verify the status of Colorado's 12-month coverage provision at publish, as federal policy changes may affect implementation.
Who provides mental health care in Colorado prisons?
CDOC's Office of Clinical and Correctional Services manages mental health services system-wide. Mental health care is delivered by CDOC clinical staff (not a private vendor, unlike several other states in this series). The RTP at CCF is the primary intensive mental health treatment program. Parole Mental Health Clinicians (four clinicians and one supervisor) serve the parole division for continuity of care post-release. Community providers and Medicaid RAEs are integrated into the pre-release transition planning system.
What can families do if mental health care is denied in CO?
Provide psychiatric history at intake. If your person has SMI and is placed in or considered for long-term segregation, demand the SB 14-064 assessment process has been followed -- document it and file a grievance if not. If they are in the RTP, know their current level and what advancement criteria apply. If within 180 days of release, ask what Behavioral Health Transition Plan has been initiated and what community providers have been identified. File CDOC grievances for assessment failures, RTP placement denials, programming shortfalls, and transition planning failures. Contact Disability Rights Colorado (disabilityrightsco.org) or ACLU of Colorado (aclu-co.org).
Who oversees mental health care in Colorado prisons?
CDOC's Office of Clinical and Correctional Services oversees mental health care internally. Externally: Disability Rights Colorado (DRC, disabilityrightsco.org) is the federally mandated protection and advocacy organization monitoring conditions for people with disabilities and mental illness in CDOC. The ACLU of Colorado (aclu-co.org) has actively monitored CDOC compliance with SB 14-064 and RTP standards. The Colorado Office of the State Auditor has conducted reviews of CDOC mental health programming, including documented compliance reviews of SB 14-064 implementation. ---