Mental Health Provisions in Idaho Prisons

Idaho's Department of Correction (IDOC) operates Correctional Mental Health Care Services (CMHS) across all its prisons, with NCCHC accreditation at every facility, a no-cost treatment policy for all prisoners, and a stated continuum of care from intake through release. For most IDOC prisoners with mental illness, these services represent the available support.

But Idaho's mental health story has a second track that has drawn national attention: the state has been housing civilly committed patients -- people who have not been charged with or convicted of any crime -- in the Idaho Maximum Security Institution (IMSI), in conditions that approximate solitary confinement, for decades. A ProPublica investigation published in December 2023 documented that Idaho had been warned at least 14 times since 1954 that it needed a separate secure mental health facility and had ignored those warnings every time. In 2024, the state finally acted: Governor Little signed legislation allocating $25 million to build a 26-bed secure mental health facility, to be operated jointly by IDOC (security) and the Idaho Department of Health and Welfare (DHW, mental health care).

What Idaho Prisoners Are Entitled To

Under Estelle v. Gamble (1976), Idaho Code § 19-2524, and IDOC's CMHS framework:

- Mental health screening at intake, with referral to DHW for further examination if serious mental illness is indicated.

- Access to CMHS services appropriate to their mental health classification, including outpatient services and secure living units for the seriously mentally ill.

- All mental health care provided free of charge.

- Mental health care practices based on current clinical research, delivered by qualified, licensed mental health professionals.

- NCCHC-accredited care at every IDOC facility.

Mental Health Screening at Intake

All incoming IDOC prisoners are screened for mental health needs at intake. Under Idaho Code § 19-2524, if the mental health screening indicates that a serious mental illness may be present, IDOC shall refer the prisoner to the Idaho Department of Health and Welfare for further examination.

If a person is sentenced to IDOC custody, any substance use disorder assessment, mental health examination, or plan of treatment from the presentence process is sent to IDOC along with the presentence report -- providing IDOC with clinical history from the court process.

If your person has a psychiatric history, provide documentation at intake. The Idaho Code § 19-2524 referral provision means that documented serious mental illness at intake triggers a DHW evaluation.

Correctional Mental Health Care Services (CMHS)

IDOC's Correctional Mental Health Care Services (CMHS) is the internal mental health system operating across all Idaho prisons. IDOC describes CMHS as:

- Providing identification and services to all residents with mental health needs.

- A continuum of care from initial incarceration to release back into the community.

- Ranging from lower level support to secure living units specifically designed to treat the seriously mentally ill.

- Delivered by qualified mental health professionals with current licensing through the Idaho Bureau of Occupational Licenses.

- Available to all residents -- all IDOC residents have the right to mental health care, and the right to refuse it.

- Free of charge for all residents.

- Comparable to services offered in the community (IDOC's stated standard).

All IDOC prisons are accredited by the National Commission on Correctional Health Care (NCCHC). As of 2018 data, approximately 29% of the IDOC prison population qualified with a serious and persistent mental illness.

The Secure Living Unit

At the highest level of CMHS care, IDOC operates secure living units specifically designed to treat and meet the needs of the seriously mentally ill. These are the most intensive mental health housing available within IDOC's prison system, providing structured therapeutic environments for prisoners whose mental illness prevents them from functioning in general population.

The Idaho Maximum Security Institution (IMSI), located south of Boise, is the primary location of intensive mental health housing in Idaho. IMSI has 30 dedicated beds for prisoners with acute mental illness, including a designated C Block acute behavioral health unit with nine cells for men considered "dangerously mentally ill."

The Idaho Maximum Security Institution and Civil Commitments

IMSI is Idaho's maximum-security prison, housing death row, the execution chamber, high-security general population, and Idaho's acute mental health unit. It is one of the few prisons in the country to house both convicted prisoners and people who have never been charged with or convicted of a crime.

Idaho statute authorizes the civil commitment of people with serious mental illness to IDOC's custody when no other appropriate secure facility exists. These patients -- civilly committed by courts after being found to be a danger to themselves or others -- are housed at IMSI's C Block in conditions that a December 2023 ProPublica investigation described as solitary confinement.

Key documented facts about Idaho's civil commitment in prison practice:

- Patients are held in isolation in a maximum-security prison despite having not been charged with or convicted of a crime.

- Average stays: 110 to 160 days in recent years.

- Idaho has been warned about this practice at least 14 times since 1954 -- by federal courts, the American Psychiatric Association, the American College of Correctional Physicians, and the United Nations -- and has continued it.

- IDOC Director Josh Tewalt acknowledged to the legislature in 2024 that he had toured the psychiatric unit and seen four patients who were civil commits, "that had never been convicted of a crime, that are being housed at the Idaho Maximum Security Institution."

- Tewalt told lawmakers: "It's a practice that has a significant amount of risk for us as a state. Not having a secure environment that is not a prison is problematic."

The 2024 Secure Mental Health Facility Law

In 2024, Governor Brad Little signed legislation allocating $25 million to construct a secure mental health facility to replace the practice of housing civilly committed patients at IMSI. The facility:

- Will have 26 beds: 16 dedicated to patients who display violent behaviors and whose mental illness is so severe they are placed in involuntary treatment by court order; 10 for other patients.

- Will be operated jointly: IDOC provides security; the Idaho Department of Health and Welfare (DHW) provides mental health care.

- Specifically targets patients who have not been convicted of a crime and should not be housed in a prison setting.

The passage of this law followed the December 2023 ProPublica investigation. The Governor's press secretary described the building as "a critical part of our state's behavioral health infrastructure." As of available 2024 reporting, the facility was in the early planning and development phase. Verify the current construction status at publish.

The DHW Partnership

Idaho's Department of Health and Welfare (DHW) is IDOC's primary partner for mental health services:

- Under Idaho Code § 19-2524, IDOC refers prisoners with potential serious mental illness to DHW for further examination.

- DHW provides mental health treatment services to civilly committed patients housed at IMSI.

- Under the 2024 legislation, DHW will be the treatment operator of the new secure mental health facility.

- DHW also operates community mental health centers across Idaho, which are the intended referral destinations for prisoners being released with mental health needs.

Pre-Release and Reentry

CMHS is designed as a continuum of care from initial incarceration to release back into the community. IDOC works to connect prisoners with mental health needs to community mental health services upon release. DHW's network of regional behavioral health centers serves as the community-side landing point for people released from IDOC with ongoing mental health needs.

IDOC also launched a Pre-prosecution Diversion Grant Program ($2.5 million) in 2022, funded through the Governor's Leading Idaho plan, offering grants to state and local agencies to help people accused of nonviolent crimes avoid prosecution by addressing mental health and substance-use disorders. This upstream investment is intended to reduce the number of people with untreated mental illness who end up in IDOC prisons.

What Families Can Do

If your person is in IDOC custody and has a mental illness:

Provide psychiatric history at intake. Supply documentation of prior hospitalizations, diagnoses, and active medications. Idaho Code § 19-2524 requires IDOC to refer prisoners with potential serious mental illness to DHW for further examination -- this referral is triggered by intake screening findings.

Know the no-cost policy. All mental health care in IDOC is free of charge. If your person has been denied mental health services because of any payment requirement, file a grievance.

Know the CMHS structure. Ask what level of CMHS care your person is receiving: outpatient support in general population, or placement in a secure living unit for the seriously mentally ill. If your person has a serious mental illness and is in general population without referral to a secure living unit, ask why and document the response.

Know the IMSI civil commitment situation. If your person is civilly committed (not convicted) and housed at IMSI, know that the 2024 law is intended to eventually move civilly committed patients to the new secure mental health facility. In the meantime, document conditions and contact Disability Rights Idaho.

Ask about DHW referral. If your person has serious mental illness, confirm with the facility that a DHW examination referral has been made as required by Idaho Code § 19-2524.

Ask about release planning. CMHS is designed as a continuum through release. Ask what community mental health providers have been identified in the area where your person will live, whether DHW community services have been contacted, and whether medication continuity has been arranged.

File a grievance. IDOC has an administrative grievance process. File formal grievances for: failure to refer to DHW when serious mental illness is present, denial of CMHS services, conditions at IMSI that fall below constitutional standards, and medication interruption.

Contact Disability Rights Idaho. Disability Rights Idaho (disabilityrightsidaho.org) is the federally mandated Protection and Advocacy organization for Idaho and monitors conditions for people with mental illness and disabilities in IDOC facilities.

Seek legal help. If your person has serious mental illness and is not receiving appropriate CMHS services, is civilly committed and housed in prison conditions, or has been denied DHW referral, consult a prisoner rights attorney with experience in Idaho's federal courts (District of Idaho).