Florida incarcerates approximately 88,000 people in its state prison system. More than 18,000 of them carry a diagnosis of mental illness that requires treatment. That is one in five people in FDOC custody living with a condition -- schizophrenia, bipolar disorder, major depression, PTSD, or another serious psychiatric illness -- that needs more than a cell and a meal schedule to manage.
The Florida Department of Corrections (FDOC) is constitutionally required to provide adequate mental health care under Estelle v. Gamble (1976) and subsequent federal case law. It operates 10 inpatient mental health units spread across its facilities, treats approximately 1,200 people at the inpatient level, and classifies all prisoners by mental health level from intake through release. An independent oversight body -- the Correctional Medical Authority (CMA) -- conducts triennial surveys of FDOC facilities and reports to both the Secretary of Corrections and the legislature.
In 2018, Disability Rights Florida reached a landmark federal settlement (Disability Rights Florida v. Jones) with FDOC that overhauled care at the 10 inpatient units -- requiring individualized treatment plans, multidisciplinary teams, evidence-based practices, minimum out-of-cell time standards, and Crisis Intervention Training for staff. That settlement remains the baseline for inpatient care standards.
Florida also passed the Tristin Murphy Act in 2025, which expands pre- and post-arrest diversion programs to keep people with serious mental illness out of the criminal justice system before incarceration begins.
If someone you care about is in Florida state prison and has a mental illness, this article explains what FDOC is required to provide, how care is structured, and what you can do when it falls short.
Mental Health Screening at Intake
Every person entering the FDOC system passes through one of its reception centers before being assigned to a permanent facility. At the reception center, all incoming prisoners receive a comprehensive mental health screening that includes:
- Mental health history and symptom evaluation.
- Sex offender screening.
- Substance abuse identification.
The results of this screening drive the initial mental health classification. People identified at intake with a serious mental illness that requires active treatment are assigned to a mental health level that determines their housing placement and what services they are entitled to receive.
If your person had a mental health history, prior psychiatric hospitalizations, or active medication needs before entering FDOC, that information should be disclosed at intake -- or provided by family to the receiving facility -- to ensure appropriate initial classification.
Mental Health Classification Levels
FDOC uses a mental health classification system that determines the level of care each prisoner receives. The levels move from most intensive to least:
Inpatient (S-3 / Crisis Stabilization and Inpatient Care): For people with serious mental illness that significantly impairs their ability to function in a general prison environment. Approximately 1,200 people are housed in the 10 FDOC inpatient mental health units at any given time. Inpatient-level care includes psychiatric medication management, individual and group therapy, multidisciplinary treatment teams, and individualized service plans (ISPs).
Residential Treatment Unit (RTU): For people who need more mental health structure and support than general population provides, but who do not require full inpatient-level care. Two of FDOC's larger facilities have dedicated RTUs with on-site mental health staff, services, and programming. RTU placement provides a step-down from inpatient or a more supported environment for people with moderate mental illness.
Outpatient (S-1 / S-2): For people with mental health needs that can be managed in general population with periodic contact and medication. Outpatient services include medication management, periodic psychiatric or counseling contacts, and crisis intervention access. The frequency of contact depends on classification level.
Crisis Stabilization: For people in acute psychiatric crisis regardless of their general classification. FDOC facilities have crisis stabilization capacity for emergencies. Access to crisis stabilization should be available at all FDOC facilities.
The 10 Inpatient Mental Health Units
FDOC operates 10 inpatient mental health units distributed across its facility system. These units are where people with serious mental illness who cannot function safely in general population are housed. They are not psychiatric hospitals -- they are corrections facilities with enhanced mental health programming -- but they are the highest level of care available within the state prison system.
The 2018 federal settlement (see below) governs the standards of care at these 10 units. Under the settlement, each person in an inpatient unit must have:
- An individualized service plan (ISP) tailored to their specific diagnosis and needs.
- A Multidisciplinary Services Team (MST) that meets at the initial stage and at regular and emergent intervals to address care needs.
- Access to evidence-based treatment practices.
- A minimum of 10 hours per week of structured out-of-cell treatment activities.
- A minimum of 10 hours per week of unstructured out-of-cell time, including at least 5 hours of outdoor exercise.
Families should confirm which specific FDOC facilities house inpatient mental health units at publish, as unit assignments can change. Contact FDOC's Office of Health Services (contact information at fdc.myflorida.com) for current inpatient unit locations.
The 2018 Disability Rights Florida Settlement
Disability Rights Florida v. Jones (U.S.D.C. M.D. Fla., Case No. 3:18-cv-00179-HES-JRK) was filed and settled in January 2018, with the settlement approved by Federal District Judge Harvey Schlesinger in February 2018. It was the product of a multiyear investigation by Disability Rights Florida -- the state's federally mandated protection and advocacy organization -- into care and treatment of FDOC prisoners with mental health issues.
The complaint alleged:
- Lack of qualified clinical staff and security staff in inpatient mental health units.
- Involuntary medication, restraints, and punishment used for behavior caused by mental illness.
- No system to identify and correct systematic deficiencies in quality of care.
What the settlement required:
- Individualized service plans (ISPs) for all inpatient-level prisoners.
- Multidisciplinary Services Teams (MSTs) meeting at initial placement and at regular and emergent intervals.
- Evidence-based treatment practices and measures.
- 10 hours per week of structured out-of-cell treatment.
- 10 hours per week of unstructured out-of-cell time including at least 5 hours outdoor exercise.
- Crisis Intervention Training (CIT) for correctional officers in inpatient units, including working knowledge of mental illness, de-escalation skills, and crisis intervention techniques.
- A Mental Health Ombudsman for the inpatient units -- described at its creation as the first of its kind in a U.S. state prison system -- serving as a specialized liaison to the Office of Health Services for mentally ill prisoners in inpatient care.
This settlement remains the governing standard for Florida's inpatient mental health units. Whether FDOC is in compliance with its terms at any given facility should be verified at publish.
The Correctional Medical Authority
The Correctional Medical Authority (CMA) is an independent administrative agency housed within the Florida Department of Health. It is not part of FDOC. The CMA:
- Advises the FDOC Secretary on professional conduct, standards of care, cost management, and projected medical needs.
- Advises the Governor and Legislature on the status of FDOC's health care delivery system.
- Conducts triennial (every three years) surveys of all 49 major FDOC facilities to verify that adequate standards of physical and mental health care are maintained.
- Is governed by a seven-member volunteer board appointed by the Governor and subject to Senate confirmation, with members required to represent a range of medical professions.
- Operates with approximately 10 staff members and a budget of roughly $1.69 million (FY 2025-26).
The CMA's triennial survey reports are public records. If you have concerns about mental health care at a specific FDOC facility, the CMA's survey of that facility -- when available -- is a starting point for understanding the independent assessment of that facility's standards.
Medication in Florida Prisons
FDOC provides psychiatric medication to prisoners who need it, including antidepressants, antipsychotics, mood stabilizers, and anti-anxiety medications. Medication access is part of both outpatient and inpatient mental health classification.
Involuntary medication -- medicating a prisoner against their will -- was specifically addressed in the 2018 settlement as a concern. The settlement required that medication practices meet clinical and legal standards. Florida state law and federal case law govern the circumstances under which involuntary medication may be ordered; it generally requires a judicial or clinical process rather than unilateral correctional decision-making.
If your person is being prescribed medication they did not consent to or do not understand, they have the right to request a review and explanation from the treating psychiatrist. Document any concerns and file a grievance.
Continuity of Care and Release
FDOC policy includes discharge planning for people in mental health treatment at release. People who have been in inpatient mental health units or on psychiatric medication are supposed to receive transition planning, including referrals to community mental health services and medication supply to bridge the gap between release and first community appointment.
Florida's Baker Act (Florida Mental Health Act) governs involuntary psychiatric examination in the community. When someone is released from prison with serious mental illness and no community support in place, Baker Act proceedings may become relevant shortly after release if they decompensate.
If your person is approaching a release date and is on psychiatric medication or has been in inpatient mental health care, ask FDOC about the discharge planning process and what community mental health referrals are being arranged. The Florida Department of Children and Families (DCF) administers community mental health services. Contact the local community mental health center in the county where your person will live.
What Families Can Do
If your person is in FDOC custody and has a mental illness:
Disclose mental health history at intake. If your person is newly entering the FDOC system and has a psychiatric history -- prior hospitalizations, current diagnoses, active medications -- provide documentation to the receiving facility as early as possible. FDOC's intake screening is the first classification point. Accurate information at intake drives appropriate placement.
Confirm the mental health classification. Contact the facility to ask what mental health level your person has been assigned (S-1, S-2, S-3, RTU, or inpatient). Ask whether they are being seen by mental health staff, at what frequency, and whether they have an active ISP (individualized service plan).
Know what inpatient-level care requires. If your person is in one of the 10 inpatient mental health units, they are entitled under the 2018 settlement to an ISP, a Multidisciplinary Services Team, evidence-based treatment, 10 hours of structured out-of-cell treatment weekly, and 10 hours of unstructured out-of-cell time weekly including 5 hours outdoors. Document any shortfalls.
Ask about medication management. If your person is on psychiatric medication, confirm with the facility that the medication is being provided consistently and at the correct dose. Interruptions in psychiatric medication are a common and serious problem in prison transitions (intake, transfers between facilities, release). If medication has been stopped without clinical explanation, file a grievance immediately.
File a grievance. FDOC's administrative grievance process is the required first step before any federal civil rights lawsuit. Help your person file formal grievances at the facility level (Step 1) and the central office level (Step 2) for: denial of mental health evaluation, failure to provide medication, failure to provide inpatient-level care when needed, and conditions in inpatient units that fall below the 2018 settlement standards.
Contact Disability Rights Florida. DRF (disabilityrightsflorida.org) is the federally mandated protection and advocacy organization for Florida and is the organization that brought the 2018 inpatient settlement. It provides legal representation and advocacy for prisoners with mental health and disability-related issues.
Contact the CMA. The Correctional Medical Authority (flcma.org) accepts complaints about health care standards at FDOC facilities and may investigate or flag issues in its triennial survey process.
Seek legal help. If your person has been denied mental health classification despite a documented diagnosis, if inpatient-level care has been withdrawn without clinical justification, or if conditions at an inpatient unit fall below the 2018 settlement's standards, consult a prisoner rights attorney with experience in FDOC's federal courts (Middle District and Northern District of Florida are the primary venues).
Frequently asked questions
How does Florida screen prisoners for mental illness?
All incoming FDOC prisoners are screened at a reception center before their permanent facility assignment. The comprehensive intake screening includes mental health history and symptom evaluation, sex offender screening, and substance abuse identification. Results drive the initial mental health classification (S-1 through S-3 / inpatient). Families can help by providing documentation of prior psychiatric history, hospitalizations, diagnoses, and active medications to the receiving facility at intake.
What mental health levels does Florida DOC use?
FDOC classifies prisoners by mental health level: inpatient (S-3 level, for serious mental illness that impairs general population function), Residential Treatment Unit (RTU, for moderate mental illness needing more support than general population), outpatient (S-1/S-2, for mental health needs manageable in general population with periodic contact and medication), and crisis stabilization (for acute psychiatric emergencies). Approximately 1,200 people are in the inpatient level at any time; over 18,000 total carry a diagnosed mental illness.
How many Florida prisoners have a mental illness?
More than 18,000 of FDOC's approximately 88,000 prisoners -- roughly one in five -- have a diagnosis of mental illness requiring treatment. Of those, approximately 1,200 are housed in one of FDOC's 10 inpatient mental health units at any given time. The remainder receive outpatient or RTU-level services in general population or specialized housing.
What are FDOC's inpatient mental health units?
FDOC operates 10 inpatient mental health units distributed across its facility system for prisoners whose serious mental illness significantly impairs their ability to function in general population. These units are not stand-alone psychiatric hospitals -- they are corrections facilities with enhanced mental health programming. Under the 2018 federal settlement, each person in an inpatient unit must have an individualized service plan, a multidisciplinary treatment team, evidence-based care, and minimum weekly out-of-cell time standards.
What is a Residential Treatment Unit in Florida prisons?
An RTU (Residential Treatment Unit) is a step between general population outpatient care and full inpatient mental health housing. Two FDOC facilities have dedicated RTUs with on-site mental health staff, programming, and services for people who need more mental health support than general population provides but do not meet the threshold for inpatient placement. RTUs serve both as a step-down from inpatient care and as a supported environment for people with moderate mental illness.
What did the 2018 FL mental health settlement require?
Disability Rights Florida v. Jones (filed and settled January 2018, M.D. Fla.) required FDOC to: create individualized service plans (ISPs) for all inpatient-level prisoners; establish multidisciplinary services teams that meet at placement and regular intervals; implement evidence-based treatment; provide 10 hours per week of structured out-of-cell treatment and 10 hours of unstructured out-of-cell time (including 5 hours outdoors) in inpatient units; conduct Crisis Intervention Training for security staff; and establish a Mental Health Ombudsman for the inpatient units.
Who oversees mental health care in Florida prisons?
Two bodies: FDOC's own Office of Health Services administers day-to-day care. The Correctional Medical Authority (CMA) -- an independent agency within the Florida Department of Health, with a seven-member volunteer board appointed by the Governor -- provides external oversight via triennial surveys of all 49 major FDOC facilities and reports to both the FDOC Secretary and the legislature. CMA survey reports are public records and can be a resource for families assessing care at a specific facility.
Can Florida prisoners be forced to take medication?
Involuntary medication was specifically flagged in the 2018 Disability Rights Florida settlement as a problem that required clinical and legal compliance. Under federal and state law, involuntary psychiatric medication generally requires a judicial or established clinical process -- not unilateral staff decision-making. If your person is receiving medication without consent or without understanding what they are being given, they have the right to request a clinical review and explanation from the treating psychiatrist and to file a grievance.
Can families access mental health records in FL prisons?
Prisoners can authorize the release of their health records, including mental health records, to family members or attorneys. FDOC's medical records process requires the prisoner's written authorization. Contact the facility's health services department for the records release form. In some circumstances, family members acting under a power of attorney or legal guardianship can access records without a separate release. Mental health records are protected under HIPAA and Florida state law, but a valid authorization from the prisoner grants access.
What can families do if mental health care is denied in FL?
Provide documentation of your person's psychiatric history at intake. Confirm their mental health classification level and whether they have an ISP and regular clinical contact. Ask about medication consistency, especially after any facility transfer. File FDOC grievances (facility level first, then central office) for care denial, medication interruption, or failure to provide inpatient-level care. Contact Disability Rights Florida (disabilityrightsflorida.org) for legal advocacy. Contact the CMA (flcma.org) with facility-level care concerns. Consult a prisoner rights attorney for conditions falling below the 2018 settlement's inpatient standards. ---