Montana's Department of Corrections (Montana DOC) operates a mental health care system at state prisons -- primarily Montana State Prison (MSP) in Deer Lodge -- governed by a formal Mental Health Level (MHL) classification system established under Policy DOC 4.5.61. All facilities use a Qualified Mental Health Professional (QMHP) to determine mental health status at intake and reassess at least annually.
In 2022, following a 2015 federal lawsuit by Disability Rights Montana, Montana DOC settled a case challenging conditions for seriously mentally ill prisoners at Montana State Prison. The settlement established specific protections: access to natural light and potable water in cells, restrictions on solitary confinement for SMI prisoners, and access to mental health experts. DOC agreed to request eight additional mental health staff positions from the legislature.
Montana also holds a distinction unique in the series: it is the third state in the nation to receive federal approval to provide Medicaid-covered care coordination services and medications to adults in state prisons with a behavioral health need -- a waiver of the federal "inmate exclusion" that normally prevents Medicaid from covering services for incarcerated people.
Approximately 20% of Montana's state prison population has a serious mental illness. 40% of individuals processed through DOC were convicted of offenses related to substance use.
What Montana Prisoners Are Entitled To
Under Estelle v. Gamble (1976), the 2022 Disability Rights Montana settlement, and Montana DOC policies:
- Mental health screening and MHL classification at intake by a QMHP.
- Annual reassessment of MHL classification, at minimum.
- Access to mental health programs (outpatient interventions, individual and group) regardless of housing assignment.
- Access to Mental Health Residential Units for the seriously mentally ill when warranted.
- Natural light and potable water in their cells (settlement provision for MSP).
- Restrictions on solitary confinement for SMI-classified prisoners (settlement provision).
- Access to mental health experts.
- Medicaid-covered care coordination and medications for eligible prisoners with behavioral health needs (waiver program).
Mental Health Screening and MHL Classification
Policy DOC 4.5.61 (Mental Health and Severe Mental Illness Classification, effective November 4, 2021) governs intake mental health screening and classification at all Montana DOC secure care facilities. Key provisions:
- A QMHP determines the Mental Health Level (MHL) and SMI status during intake.
- The QMHP uses a Severe Mental Illness Determination form for the initial evaluation.
- MHL classification reflects the offender's current mental status and service needs -- not solely their history of treatment.
- Reassessment occurs regularly, but no later than annually per NCCHC standards.
- The MHL Classification System provides information for program planning, administrative purposes, and resource allocation.
Policy DOC 4.5.61 applies to all secure care facilities -- both Department-owned and contracted facilities, as specified in contracts.
If your person has a psychiatric history, provide documentation at intake to support accurate initial MHL classification. A classification based on current status means that evidence of current symptoms and functional impairment matters, not just a historical diagnosis.
Mental Health Programs and Residential Units
Policy DOC 4.5.53 (Mental Health Programs and Residential Units, effective April 2021) establishes that Montana DOC will ensure mental health programs meet the serious mental health needs of offenders. The policy defines two types of services:
Mental Health Programs: Organized outpatient interventions -- time-limited or ongoing -- that include individual or group interventions for offenders regardless of their housing assignment. These programs provide structured therapeutic services to prisoners at various mental health levels within general population or other housing settings.
Mental Health Residential Units: Specialized housing units providing varying levels of care to meet the needs of the seriously mentally ill. Residential units offer more intensive support than outpatient programs and serve prisoners who cannot function in general population settings due to their mental illness.
The 2022 Disability Rights Montana Settlement
In March 2022, Montana DOC settled a federal lawsuit filed by Disability Rights Montana in 2015. The lawsuit alleged that conditions at Montana State Prison for prisoners with severe mental illness violated constitutional protections against cruel and unusual punishment. Prior to the settlement, the complaint alleged that prisoners with mental illness were routinely subjected to extensive solitary confinement.
Settlement terms include:
- Access to natural light and potable water in cells for SMI prisoners.
- Restrictions on the use of solitary confinement for seriously mentally ill prisoners.
- Access to mental health experts.
- Appropriate care, treatment, and housing for SMI prisoners.
- DOC to request funding for eight additional full-time mental health staff positions for the 2023 legislative session: three licensed therapists, three mental health technicians, and two activities coordinators.
- All staff who primarily work with the disabled prison population to undergo 30 hours of initial mental health training.
The DOC communications director stated that the department had initiated many of these improvements independently and the settlement affirms work already underway. As part of the settlement, DOC was absolved of any liability.
Montana's Medicaid Inmate Waiver
Montana is one of the first states in the nation to receive federal approval to provide Medicaid-covered services to adults in state prisons with behavioral health needs. The waiver covers:
- Care coordination services.
- Medications.
This is significant because the federal "inmate exclusion" normally prevents Medicaid from paying for services for incarcerated people. Montana's approval as the third state to receive this waiver means that eligible prisoners with behavioral health needs can receive coordinated care and medication coverage under Medicaid while still in prison -- easing the transition gap at release.
The waiver is administered through Montana's Department of Public Health and Human Services (DPHHS) and its Health Initiative for Reentry (HEART Initiative), in coordination with the Justice-Involved Reentry Initiative.
Prescription Medication at Release
Policy DOC 4.5.29 (Prescription Medication for Offenders with Mental Illness) establishes a limited pharmacy benefit program through a collaboration between Montana DOC and DPHHS. The program provides:
- A limited pharmacy benefit to eligible offenders with mental illness being released from correctional institutions, the state hospital, or other secure custody placements.
- Prescription medication bridge at the point of release, addressing one of the most acute vulnerability windows for people with serious mental illness leaving incarceration.
This program directly addresses the documented elevated mortality risk for DOC-released individuals: a 2020 study found that people released from Montana DOC had an 11.2 times higher risk of death than the general population, driven by a 27 times higher overdose rate.
Montana State Hospital and Forensic Services
Montana State Hospital (Warm Springs, Deer Lodge County) is the state's primary inpatient psychiatric hospital. It serves both civil commitment patients and forensic patients from the criminal justice system. Montana State Hospital is administered by DPHHS.
For Montana DOC prisoners who require inpatient hospital-level psychiatric care, Montana State Hospital is the primary referral destination. Like many states in this series, Montana faces a persistent shortage of available psychiatric hospital beds relative to need -- county jail populations include people waiting months for state hospital admission.
The New Forensic Mental Health Hospital in Laurel
In 2025, the Montana Legislature funded a new forensic mental health hospital in Laurel, in eastern Montana. The facility is in the early stages of development as of mid-2026. It is part of a broader $300 million mental health investment made by the 2023 Legislature.
The new hospital is designed to address the state's documented shortage of forensic psychiatric capacity -- reducing the pressure on county jails housing people waiting for state hospital beds and providing a dedicated forensic mental health treatment setting in the eastern part of the state.
The Jail Pipeline and State Hospital Waitlist
Like Mississippi, Missouri, and Minnesota, Montana faces a significant IST and civil commitment waitlist problem at the county jail level. A 2025 KFF Health News / Montana Free Press investigation documented that people in mental health crises in rural Montana -- including Lake County -- were being held in walk-in-closet-sized jail cells for months waiting for a state hospital bed. 13% of Missoula's jail population at one point consisted of people legally committed to the Montana State Hospital waiting for an available spot.
This affects families whose persons are in county jails rather than Montana DOC prisons. If your person is in a county jail awaiting a state hospital bed, contact Disability Rights Montana.
What Families Can Do
If your person is in Montana DOC custody and has a mental illness:
Provide psychiatric history at intake. Supply documentation of prior hospitalizations, diagnoses, and active medications. Policy DOC 4.5.61 requires QMHP assessment at intake; documentation supports accurate MHL and SMI classification.
Know the MHL Classification. Ask what Mental Health Level your person has been assigned and whether they have been classified as having a Serious Mental Illness (SMI). MHL drives the services your person receives.
Know the settlement protections. If your person is at Montana State Prison and has SMI, the 2022 Disability Rights Montana settlement guarantees: access to natural light and potable water in cells, restrictions on solitary confinement, and access to mental health experts.
Know the Mental Health Residential Units. If your person's condition requires more intensive support than outpatient programming, ask whether placement in a Mental Health Residential Unit has been considered.
Know the Medicaid waiver. Montana's approved Medicaid inmate waiver means eligible prisoners with behavioral health needs may be entitled to Medicaid-covered care coordination and medications while in prison. Ask whether your person has been enrolled in the Medicaid program through the Justice-Involved Reentry Initiative.
Know the prescription medication bridge. Policy DOC 4.5.29 establishes a prescription medication program for eligible prisoners with mental illness being released from DOC. If your person is approaching release, ask whether this program has been initiated.
File a grievance. Montana DOC has an administrative grievance process. File formal grievances for: failure to conduct MHL classification, inappropriate classification, denial of SMI protections, violation of settlement terms (natural light, water, solitary restriction), denial of Mental Health Residential Unit placement, medication interruption, and failure to initiate the release prescription medication program.
Contact Disability Rights Montana. DRM (drmontana.org) is the federally mandated Protection and Advocacy organization for Montana, filed the 2015 lawsuit that led to the 2022 settlement, and monitors conditions for people with mental illness and disabilities in Montana DOC.
Seek legal help. Given the 2022 settlement and its ongoing compliance obligations, if SMI prisoners at Montana State Prison are not receiving natural light, potable water, appropriate care, or are being subjected to solitary confinement contrary to the settlement terms, consult a prisoner rights attorney with experience in Montana's federal courts (District of Montana).
Frequently asked questions
How does Montana screen prisoners for mental illness?
Policy DOC 4.5.61 requires a QMHP (Qualified Mental Health Professional) to determine the Mental Health Level (MHL) and SMI status during intake at all Montana DOC secure care facilities. A Severe Mental Illness Determination form is used for the initial evaluation. Classification reflects current mental status and service needs, not solely historical treatment history. Annual reassessment is required at minimum. Provide psychiatric documentation at intake -- prior hospitalizations, diagnoses, and active medications.
What is Montana DOC's mental health level classification?
Policy DOC 4.5.61 establishes the Mental Health Level (MHL) Classification System. A QMHP assigns an MHL at intake that reflects the prisoner's current mental status and service needs. The MHL is used for program planning, administrative purposes, and resource allocation. When SMI is identified, a formal Severe Mental Illness classification is assigned using a standardized determination form. Reassessment occurs regularly, at minimum annually per NCCHC standards.
What mental health services do Montana prisons provide?
Montana DOC provides, under Policy DOC 4.5.53: Mental Health Programs (organized outpatient interventions -- individual and group -- available to all offenders regardless of housing assignment) and Mental Health Residential Units (specialized housing providing varying levels of care for seriously mentally ill prisoners who cannot function in general population). Additionally, DOC operates in partnership with DPHHS on the Medicaid inmate waiver and the release prescription medication bridge program.
What is the Disability Rights Montana settlement about?
In March 2022, Montana DOC settled a 2015 federal lawsuit by Disability Rights Montana (DRM) challenging conditions at Montana State Prison for SMI prisoners. The lawsuit alleged that SMI prisoners were routinely subjected to extensive solitary confinement in violation of the Eighth Amendment. Settlement terms include: access to natural light and potable water in cells, restrictions on solitary confinement for SMI prisoners, access to mental health experts, appropriate care and housing, DOC requesting 8 additional mental health staff positions, and 30 hours of mental health training for staff primarily working with disabled prisoners.
What is Montana's Medicaid inmate waiver for mental health?
Montana received federal approval as the third state in the nation to waive the federal "inmate exclusion" and provide Medicaid-covered care coordination services and medications to adults in state prisons with a behavioral health need. This waiver is administered through DPHHS and its Justice-Involved Reentry Initiative. Eligible prisoners with behavioral health needs can receive coordinated care and medication coverage under Medicaid while still in prison, easing the transition gap at release and reducing the elevated mortality risk documented for DOC-released individuals.
What is the prescription medication program at DOC release?
Policy DOC 4.5.29 establishes a Prescription Medication for Offenders with Mental Illness Project -- a collaboration between Montana DOC and DPHHS providing a limited pharmacy benefit program to eligible prisoners with mental illness being released from correctional institutions, the state hospital, or other secure custody placements. The program provides prescription medications at the point of release to bridge the gap to community mental health services. This addresses the documented 11.2 times higher risk of death for DOC-released individuals (driven by a 27 times higher overdose rate) by ensuring released prisoners have medications during the vulnerable transition period.
What is the new forensic mental health hospital in Montana?
The 2025 Montana Legislature funded a new forensic mental health hospital in Laurel (eastern Montana) as part of a broader $300 million mental health investment made by the 2023 Legislature. The facility is in early development as of mid-2026. It is designed to address Montana's shortage of forensic psychiatric capacity, reduce pressure on county jails housing people waiting for state hospital beds, and provide a dedicated forensic mental health treatment setting in eastern Montana. Verify construction timeline at publish.
How does Montana handle mental health care at release?
Montana's release mental health framework includes: the DOC/DPHHS Prescription Medication for Offenders with Mental Illness Project (Policy DOC 4.5.29), providing a limited pharmacy benefit at release; the Medicaid inmate waiver (care coordination and medications for eligible prisoners while still incarcerated to ease the transition); and connection to DPHHS's community mental health resources. Ask the facility what community mental health providers have been identified, whether Medicaid enrollment is underway, and whether the release prescription medication program has been initiated.
What can families do if mental health care is denied in MT?
Provide psychiatric documentation at intake to support accurate MHL and SMI classification. Know the MHL classification your person has been assigned. Know the 2022 settlement protections at MSP: natural light, potable water, solitary restrictions, mental health expert access. Know the Mental Health Residential Units option. Ask about Medicaid waiver enrollment for behavioral health care coordination. Ask about the release prescription medication bridge. File Montana DOC grievances for classification failures, settlement violations, medication interruptions, and service denials. Contact Disability Rights Montana (drmontana.org) for legal advocacy.
Who oversees mental health care in Montana prisons?
Montana DOC's Clinical Services Division administers mental health services system-wide under policies DOC 4.5.61, 4.5.53, and related directives. DPHHS partners with DOC on the Medicaid inmate waiver and release prescription medication programs. The 2022 DRM settlement has ongoing compliance obligations, monitored by Disability Rights Montana (DRM, drmontana.org), which is also the federally mandated P&A organization. Montana State Hospital (Warm Springs, DPHHS) provides inpatient psychiatric care for prisoners requiring hospital-level treatment. ---
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