New Hampshire is a small state with three primary adult correctional facilities and a prison mental health system that includes two specialized units at the State Prison for Men in Concord: the Secure Psychiatric Unit (SPU), the most intensive inpatient psychiatric facility in the state behavioral health system, and the Residential Treatment Unit (RTU), a step-down therapeutic unit for male prisoners with behavioral health conditions struggling in general population.
New Hampshire is also in the process of completing its first dedicated forensic psychiatric hospital -- a 24-bed facility connected to New Hampshire Hospital in Concord, expected to open in late 2026. Currently, when patients at New Hampshire Hospital become a danger to themselves or others despite multiple interventions, they are transferred to the SPU on the grounds of the State Prison for Men.
On January 1, 2025, NHDOC and NH Department of Health and Human Services (DHHS) launched the Community Re-Entry program -- believed to make New Hampshire the second state in the country to implement this type of Medicaid coverage for incarcerated people. The program provides Medicaid-covered health care and peer services to eligible adults with severe and persistent mental illness and substance use disorders for 45 days prior to their release.
New Hampshire does not have active federal court oversight of its prison mental health system.
What New Hampshire Prisoners Are Entitled To
Under Estelle v. Gamble (1976) and NHDOC policies:
- Mental health screening at intake.
- Individual behavioral health programs appropriate to assessed needs.
- Access to the Residential Treatment Unit (RTU) when a behavioral health condition is causing difficulty in general population.
- Access to the Secure Psychiatric Unit (SPU) for acute inpatient psychiatric needs.
- Approximately 30 hours per week of structured therapeutic interventions in the RTU.
- An individualized treatment plan developed with the treatment team.
- Medicaid-covered health care and peer services through the Community Re-Entry program in the 45 days prior to release (for eligible individuals with SPMI or SUD).
Mental Health Screening at Intake
NHDOC conducts behavioral health screening for all incoming prisoners as part of the intake process. The screening identifies mental health history, active diagnoses, and current psychiatric medications, and drives assignment to appropriate treatment programs and housing.
If your person has a psychiatric history, provide documentation at intake -- prior hospitalizations, diagnoses, and active medications -- to support accurate initial assessment and medication continuity.
The Secure Psychiatric Unit (SPU)
The Secure Psychiatric Unit (SPU) is physically located on the grounds of the New Hampshire State Prison for Men in Concord, but it is a separate and distinct unit overseen by the Director of Medical and Forensics -- not by the prison's warden. It is not subject to the prison's standard operations and administration.
The SPU is the most intensive and secure inpatient treatment facility in the entire New Hampshire state behavioral health service delivery system -- not just the corrections system. It serves acute psychiatric needs requiring inpatient care.
Who the SPU serves (under state statutes):
- Residents from state correctional facilities (NHDOC state prisons).
- Residents from county correctional facilities (county jails).
- Patients committed through the NH judicial system due to mental illness and dangerousness (civil commitment).
- People found not guilty by reason of insanity (NGRI).
- Individuals committed under the state's sexually violent predator law.
- Individuals who are developmentally disabled and require intervention for extreme dangerousness.
Mailing address for SPU: Patient Name, Patient #, Secure Psychiatric Unit, PO Box 2828, Concord, NH 03302.
The SPU serves multiple populations beyond NHDOC state prisoners. It is the state's most secure psychiatric setting and serves people who cannot be safely managed in New Hampshire Hospital or other less secure settings.
The Residential Treatment Unit (RTU)
The Residential Treatment Unit (RTU) is a step-down therapeutic housing unit at the New Hampshire State Prison for Men, designed for male prisoners who have a behavioral health condition and are struggling in a general prison setting.
Key RTU features:
- Approximately 30 hours per week of structured therapeutic, recreational, and diversional interventions.
- Individualized treatment plans developed by an interdisciplinary team in conjunction with the inmate.
- Evidence-based treatments and best practices.
- Available by inmate request (not only by staff referral) -- prisoners may self-refer to the RTU.
- Staff can also refer prisoners to the RTU.
- Often serves as a step-down from the SPU, providing a less intensive transition before returning to a standard prison housing unit.
The RTU specifically serves male prisoners. Behavioral health programming for women at the NH Correctional Facility for Women in Concord should be confirmed directly with that facility.
The New Forensic Psychiatric Hospital
New Hampshire is constructing its first dedicated forensic psychiatric hospital. Key facts:
Location: Adjacent to and connected with New Hampshire Hospital (inpatient psychiatric facility) at Clinton Street in Concord.
Capacity: 24 beds.
Timeline: Targeted for operational start in late 2026. (PC Construction listed a 2025 completion; verify current status at publish.)
Population served: Three groups -- defendants in the criminal justice system with severe mental illness; those found unfit to stand trial (IST) due to mental health challenges; and individuals civilly committed to treatment, all requiring heightened security protocols.
Current system: Prior to the new hospital's opening, patients at New Hampshire Hospital who become dangerous despite interventions are transferred to the SPU at the State Prison for Men. The new forensic hospital is designed to replace this practice, providing a setting that is therapeutic and secure without being a prison.
Context: New Hampshire Hospital's CEO explained that when patients are admitted to NH Hospital and become a significant danger despite multiple interventions, they require more secure conditions than a standard inpatient psychiatric hospital can safely provide. The new forensic hospital addresses this need without placing psychiatric patients in a prison environment.
NHDOC Mental Health Programs
NHDOC provides individualized programs including behavioral health, sexual offender treatment, and treatment programs for substance use disorders at all three state correctional facilities:
- New Hampshire State Prison for Men (NHSPM), Concord: Men's primary prison; SPU, RTU, and behavioral health programming.
- New Hampshire Correctional Facility for Women (NHCFW), Concord: Women's facility; behavioral health programming.
- Northern New Hampshire Correctional Facility, Berlin: Men's facility in the northern part of the state; behavioral health programming.
The New Hampshire Corrections Special School District operates educational programming at all three facilities.
The Community Re-Entry Program
Launched January 1, 2025, the Community Re-Entry program is a joint NHDOC-DHHS initiative under New Hampshire's Section 1115(a) Medicaid Demonstration Waiver ("Substance Use Disorder, Serious Mental Illness and Serious Emotional Disturbance, Treatment Recovery and Access"). New Hampshire is believed to be the second state to implement this type of program.
What the program provides:
- Medicaid coverage to eligible adult incarcerated individuals diagnosed with a mental illness, specifically targeting those with severe and persistent mental illness and/or substance use disorders.
- A targeted set of health care and peer services.
- Coverage begins 45 days prior to the individual's scheduled release date.
- Peer services to support the transition.
Goals: Support health needs during the critical transition period; reduce recidivism linked to unmet health care needs; support long-term stability, wellness, and recovery; reduce overdose deaths.
The program launched in state correctional facilities on January 1, 2025, with plans to expand to county correctional departments.
For prisoners approaching release who have SPMI or SUD: ask NHDOC whether you are enrolled in the Community Re-Entry program and what services are being arranged through it.
DHHS Partnership
New Hampshire DHHS is the state's health and human services agency, overseeing the community behavioral health system. DHHS partners with NHDOC on:
- The Community Re-Entry program.
- The broader Section 1115(a) waiver framework.
- Connecting prisoners with community mental health resources at release.
- New Hampshire Hospital, the state's primary inpatient psychiatric hospital.
DHHS's Bureau of Mental Health Services coordinates community mental health through designated community mental health centers across New Hampshire's regions.
What Families Can Do
If your person is in NHDOC custody and has a mental illness:
Provide psychiatric history at intake. Supply documentation of prior hospitalizations, diagnoses, and active medications. This information drives initial classification and treatment program assignment.
Know the RTU. If your person is struggling with a behavioral health condition in general population, they can request admission to the RTU or be referred by staff. Ask whether RTU evaluation or admission has been discussed. The RTU offers approximately 30 hours per week of structured therapeutic programming.
Know the SPU. The SPU provides the most intensive inpatient psychiatric care in New Hampshire's state system. If your person has acute psychiatric needs requiring inpatient care, ask whether SPU admission has been considered. The SPU is a separate and distinct unit, not subject to standard prison operations.
Know the new forensic hospital timeline. The 24-bed forensic psychiatric hospital adjacent to New Hampshire Hospital in Concord is expected to open in late 2026. For people who have acute mental health needs requiring secure psychiatric care, this facility may become available during their sentence. Verify current status at publish.
Know the Community Re-Entry program. If your person is within 45 days of release and has SPMI or SUD, ask whether they are enrolled in the Community Re-Entry program and what Medicaid-covered services and peer support are being provided for the transition.
Ask about DHHS community mental health connections. Ask what community mental health center has been identified in the area where your person will be released, whether Medicaid has been enrolled or reinstated, and whether medication continuity has been arranged.
File a grievance. NHDOC has an administrative grievance process. File formal grievances for: failure to conduct behavioral health screening, denial of RTU referral or evaluation, denial of SPU admission when acute inpatient care is warranted, medication interruption, and failure to enroll in the Community Re-Entry program approaching release.
Contact Disability Rights New Hampshire. DRN-NH (drnnh.org) is the federally mandated Protection and Advocacy organization for New Hampshire and monitors conditions for people with mental illness and disabilities in NHDOC facilities.
Seek legal help. If your person has serious mental illness and is not receiving appropriate behavioral health programming, if SPU or RTU admission has been denied when clinically warranted, or if Community Re-Entry enrollment has not occurred, consult a prisoner rights attorney with experience in New Hampshire's federal courts (District of New Hampshire).
Frequently asked questions
How does New Hampshire screen prisoners for mental illness?
NHDOC conducts behavioral health screening for all incoming prisoners, identifying mental health history, active diagnoses, and current psychiatric medications. Screening drives placement in appropriate treatment programs and, when needed, referral to the Residential Treatment Unit (RTU) or Secure Psychiatric Unit (SPU). Provide psychiatric documentation at intake -- prior hospitalizations, diagnoses, and active medications.
What is the Secure Psychiatric Unit at NH State Prison?
The Secure Psychiatric Unit (SPU) is located on the grounds of the New Hampshire State Prison for Men in Concord but is a separate and distinct unit overseen by the Director of Medical and Forensics. It is the most intensive and secure inpatient psychiatric treatment facility in the entire New Hampshire state behavioral health system. The SPU serves people with acute psychiatric needs from state prisons, county jails, civil commitments, NGRI, sexually violent predators, and dangerously developmentally disabled individuals. Mailing address: Secure Psychiatric Unit, PO Box 2828, Concord, NH 03302.
What is the Residential Treatment Unit at NH State Prison?
The RTU is a step-down therapeutic housing unit for male prisoners with behavioral health conditions who are struggling in general population. Prisoners can self-refer or be referred by staff. It offers approximately 30 hours per week of structured therapeutic, recreational, and diversional interventions. The treatment team works with the inmate to develop an individualized treatment plan using evidence-based practices. The RTU often serves as a step-down from the SPU before return to standard prison housing.
Who is served by the NH Secure Psychiatric Unit?
The SPU serves, under state statutes: residents from NHDOC state prisons; residents from county correctional facilities; patients committed through the NH judicial system due to mental illness and dangerousness; people found not guilty by reason of insanity (NGRI); individuals committed under the sexually violent predator law; and individuals who are developmentally disabled requiring intervention for extreme dangerousness.
What is New Hampshire's new forensic psychiatric hospital?
New Hampshire is constructing a 24-bed forensic psychiatric hospital adjacent to New Hampshire Hospital on Clinton Street in Concord -- the state's first dedicated facility for forensic psychiatric patients. It serves three populations: defendants with severe mental illness, those found unfit to stand trial (IST), and civil commitments requiring heightened security. Operational start is targeted for late 2026. It is designed to replace the current practice of transferring difficult patients from NH Hospital to the SPU at the State Prison for Men.
What is NH's Community Re-Entry Medicaid waiver program?
Launched January 1, 2025, the Community Re-Entry program is a joint NHDOC-DHHS initiative under New Hampshire's 1115(a) Medicaid waiver. It provides eligible incarcerated adults with severe and persistent mental illness and/or SUD a targeted set of Medicaid-covered health care and peer services beginning 45 days prior to release. New Hampshire is believed to be the second state in the country to implement this type of program. It aims to reduce recidivism, support successful transitions, and reduce overdose deaths.
What mental health programs does NHDOC provide generally?
NHDOC provides individualized behavioral health programs at all three correctional facilities (NH State Prison for Men, NH Correctional Facility for Women, Northern NH Correctional Facility). Programs include behavioral health treatment, sexual offender treatment, and substance use disorder treatment. At the State Prison for Men specifically, the RTU (approximately 30 hours/week of structured programming) and the SPU (inpatient psychiatric care) represent the most specialized levels of care. NHDOC partners with DHHS on the Community Re-Entry program for eligible individuals approaching release.
How does NH coordinate mental health care at release?
The Community Re-Entry program (launched January 1, 2025) provides Medicaid-covered services and peer support starting 45 days before release for eligible prisoners with SPMI or SUD. DHHS's Bureau of Mental Health Services coordinates community mental health through regional community mental health centers. For prisoners approaching release, ask whether Community Re-Entry enrollment has occurred, what community mental health center has been identified for the release area, whether Medicaid has been enrolled or reinstated, and whether medication continuity is arranged.
What can families do if mental health care is denied in NH?
Provide psychiatric documentation at intake. Know the RTU (self-referral available; ~30 hours/week structured programming). Know the SPU for acute inpatient needs. Know the forensic hospital opening late 2026. Ask about Community Re-Entry enrollment if release is within 45 days. File NHDOC grievances for screening failures, RTU/SPU referral denials, medication interruptions, and Community Re-Entry enrollment failures. Contact Disability Rights New Hampshire (drnnh.org) for legal advocacy.
Who oversees mental health care in New Hampshire prisons?
NHDOC's Director of Medical and Forensics oversees the SPU and mental health services within the prison system. DHHS's Bureau of Mental Health Services coordinates community mental health and the 1115(a) waiver framework. No federal court actively exercises oversight of NHDOC mental health. Disability Rights New Hampshire (DRN-NH, drnnh.org) is the federally mandated P&A organization monitoring conditions for people with mental illness and disabilities in NHDOC. ---