North Carolina's Department of Adult Correction (NCDAC) -- a standalone agency established January 1, 2023, separated from the Department of Public Safety -- manages about 32,000 people in 50+ state prisons. The mental health picture inside these prisons is shaped by a stark data point: 39 percent of males and 67 percent of females who entered NCDAC custody over the past five years had a need for mental health services. But only 20 social workers are responsible for providing aftercare planning for everyone on the prison system's behavioral health caseload.
That gap -- between the documented scale of mental health need and the staffing available to address it -- is the central tension in North Carolina's prison mental health story. And it has driven a significant state response: Governor Josh Stein signed Executive Order No. 33 directing stronger behavioral health and criminal justice integration, the state has invested $835 million in behavioral health system transformation (including $99 million specifically for justice-involved populations), and NCDHHS has launched FIT Wellness, Forensic Assertive Community Treatment (FACT) teams, and expanded specialized mental health supervision to all 100 North Carolina counties.
North Carolina does not have active federal court oversight of NCDAC prison mental health care specifically.
What North Carolina Prisoners Are Entitled To
Under Estelle v. Gamble (1976) and NCDAC policies:
- Mental health screening at intake.
- Behavioral health services throughout incarceration based on assessed needs.
- Social work aftercare planning beginning approximately 90 days before release.
- Connection to LME-MCO care coordination and community mental health services upon release.
Mental Health Screening at Intake
All incoming NCDAC prisoners receive behavioral health screening at intake, identifying mental health history, diagnoses, active psychiatric medications, and substance use conditions. NCDAC reports that over the past five years: 39% of entering males and 67% of entering females had a need for mental health services; 76% had a substance use condition requiring a DAC SUD treatment program placement; 30% of the SUD population had a co-occurring mental health condition.
These numbers reflect NCDAC's own intake assessment data -- they are a baseline measure of what the prison system encounters at reception, not external advocacy estimates.
If your person has a psychiatric history, provide documentation at intake -- prior hospitalizations, diagnoses, and active medications -- to support accurate behavioral health classification.
NCDAC Behavioral Health Services
NCDAC's Division of Behavioral Health provides mental health services across its 50+ state prisons. Services include:
- Mental health and substance use assessments.
- Individual and group mental health counseling.
- Psychiatric medication management.
- Substance use disorder treatment programs.
- Crisis intervention and suicide prevention.
- Social work aftercare planning for release.
NCDAC behavioral health administrator Ashlee Barnes coordinates the clinical service delivery framework. Social work director Mary Grillo (appointed March 2024) oversees the aftercare planning function.
The 20 Social Workers Problem
As of May 2026, only 20 social workers at NCDAC are responsible for providing aftercare planning for every person on the behavioral health caseload across the entire 32,000-person prison system. This planning typically starts approximately 90 days before release and involves:
- Conducting needs assessments for housing, transportation, and other community supports.
- Working with North Carolina's four LME-MCOs (local mental health management entities) to link individuals to behavioral health care services in their communities.
The "20 social workers for 32,000 prisoners" reality is not an advocacy estimate -- it came directly from NCDAC's director of social work services speaking at a joint legislative reentry council meeting. It is the operational constraint that shapes every other element of NCDAC's mental health and reentry planning.
The FIT Wellness Program
FIT Wellness (Formerly Incarcerated Transition Wellness) is a program of the North Carolina Formerly Incarcerated Transition Program at the UNC School of Medicine. NCDHHS invested $5.5 million in FIT Wellness as part of its reentry services expansion.
FIT Wellness delivers, to people in the state prison system who have Serious Mental Illness:
- Psychiatric care services.
- Physical health care services.
- Connections to community supports including housing, transportation, and phones.
The goal: ensure that people with serious mental illness leaving NCDAC have clinical care and essential community supports in place before they walk out the door. FIT Wellness fills part of the gap created by the 20-social-worker shortage by providing specialized clinical reentry support for the SMI population.
NCDAC Director of Social Work Mary Grillo stated: "It would be great if we had a FIT Wellness in every county in North Carolina. I think it's really important to have that continuity of care."
The FACT Teams
In November 2025, NCDHHS launched Forensic Assertive Community Treatment (FACT) teams across North Carolina. FACT teams provide:
- Personalized clinical and social support.
- Targeted at justice-involved individuals with serious mental health needs who also present a medium to high risk of repeated criminal behavior.
- Services designed to effectively connect people to treatment and supports -- including mental health treatment, housing, employment, and other community services.
NCDHHS's Division of Mental Health Director Kelly Crosbie described FACT teams as "providing alternatives to incarceration when it's appropriate, and then supporting people upon their release from incarceration with things like treatment, but also housing and employment."
FACT teams represent a post-release community intervention -- they are not a prison program. They serve people leaving prison or jail who have serious mental illness and are assessed as being at medium-high risk of returning to the justice system without structured support.
The High-Priority Reentry Program
NCDAC's High-Priority Reentry Program targets a small group of the riskiest, highest-need releases from the prison system. In 2025, DAC made 149 referrals to this program.
NCDAC refers eligible individuals to local LME-MCO care coordination teams, which include peer support specialists and connect people to the community mental health services they need in the county where they will live.
The LME-MCO Network
North Carolina's mental health system for Medicaid beneficiaries is managed through four Local Management Entity-Managed Care Organizations (LME-MCOs). LME-MCOs manage and arrange for behavioral health, intellectual/developmental disability, and traumatic brain injury services for Medicaid beneficiaries in their regions.
For people leaving NCDAC with mental health needs, LME-MCOs are the primary community-side connection. NCDAC's social workers work with LME-MCOs to link each releasing prisoner to appropriate behavioral health care in their home county. If the person is Medicaid-eligible, the LME-MCO becomes the care coordinator for community mental health services.
Note: North Carolina's LME-MCO system is undergoing significant transition. North Carolina launched NC Medicaid Managed Care for behavioral health in December 2022, and the LME-MCOs are evolving in their role. Verify current LME-MCO structure and names at publish.
The Specialized Mental Health Supervision Expansion
On June 9, 2026, NC Health News reported that NCDAC has expanded specialized mental health supervision to all 100 North Carolina counties. This means:
- Specialized mental health probation/parole officers are now available statewide for people with serious mental illness under community supervision.
- These officers carry smaller caseloads -- up to 40 people with SMI rather than the 60+ cases managed by a standard officer.
- Smaller caseloads allow more intensive case management and expertise in handling complex SMI cases.
- "We don't want to criminalize mental health," said NCDAC Community Supervision director Lee.
This expansion represents a significant change for people with serious mental illness on parole or post-release supervision -- they may now be assigned to a specialized officer who has lower caseloads and specific expertise in mental health case management.
Governor Executive Order No. 33
Governor Josh Stein signed Executive Order No. 33, "Protecting North Carolinians Through Stronger Behavioral Health and Criminal Justice Systems." The Order directed behavioral health and criminal justice integration, citing:
- 76% of people entering DAC in FY 2024-25 had a substance use condition requiring SUD treatment placement.
- 30% of that population had a co-occurring mental health condition.
- 39% of males and 67% of females entering DAC over the past five years had mental health service needs.
- 38% of youth assessed in the juvenile justice system had mental health needs.
The Order directed stronger integration of behavioral health and criminal justice systems -- connecting the data to a state-level policy response.
North Carolina State Psychiatric Hospitals
North Carolina's state psychiatric hospitals, operated by NCDHHS, serve both civil commitment populations and forensic patients. Key facilities include:
- Central Regional Hospital (Butner): Major state psychiatric hospital serving central NC.
- Broughton Hospital (Morganton): State psychiatric hospital serving western NC.
- Cherry Hospital (Goldsboro): State psychiatric hospital serving eastern NC.
As of 2024-2025, the capacity restoration (IST) system was under significant strain: more than 2,600 criminal defendants had their capacity evaluated in 2024 (a 33% increase over five years), and about 60% (1,500+) were found incapable of proceeding. A growing share of state psychiatric hospital beds was being consumed by justice-involved capacity restoration patients, reducing availability for other populations.
Jail-based capacity restoration programs have been developed to reduce this pressure -- competency restoration treatment delivered in county jails rather than requiring hospital admission.
What Families Can Do
If your person is in NCDAC custody and has a mental illness:
Provide psychiatric history at intake. Supply documentation of prior hospitalizations, diagnoses, and active medications. NCDAC's intake behavioral health assessment determines what services your person needs.
Know the 20-social-worker constraint. With only 20 social workers managing aftercare planning for the entire behavioral health caseload, proactive family engagement is essential. Don't wait for the social worker to reach your person -- ask the facility when aftercare planning will begin for your person, whether they are on the behavioral health caseload, and what LME-MCO connection is being made.
Know the FIT Wellness program. If your person has Serious Mental Illness and is in an NCDAC facility, ask whether FIT Wellness (UNC School of Medicine, NCDHHS-funded) is available or has been contacted for reentry planning support. FIT Wellness provides psychiatric care, physical health, and community support connections.
Know the High-Priority Reentry Program. If your person has serious mental illness and significant risk factors, ask whether they have been or will be referred to the High-Priority Reentry Program and what LME-MCO care coordination team will be assigned.
Know FACT teams post-release. FACT teams launched November 2025 and provide community-based clinical and social support for people with serious mental illness at medium-high risk of justice reinvolvement after release. Ask whether FACT team services have been requested for your person.
Know the specialized supervision expansion. As of June 2026, specialized mental health probation/parole officers are available in all 100 NC counties. If your person will be on post-release supervision or parole and has serious mental illness, ask whether they will be assigned to a specialized mental health officer.
Ask about LME-MCO connections. Ask what LME-MCO has been identified for the county where your person will be released, whether a Medicaid enrollment or reinstatement has been initiated, and whether a specific behavioral health provider has been identified.
File a grievance. NCDAC has an administrative grievance process. File formal grievances for: failure to conduct behavioral health screening, denial of mental health services, medication interruption, and failure to initiate social work aftercare planning.
Contact Disability Rights NC. DRNC (disabilityrightsnc.org) is the federally mandated Protection and Advocacy organization for North Carolina and monitors conditions for people with mental illness and disabilities in NCDAC facilities.
Seek legal help. If your person's mental health needs are not being met, medication has been interrupted, or behavioral health services are being denied, consult a prisoner rights attorney with experience in North Carolina's federal courts (Eastern, Middle, and Western Districts of North Carolina).
Frequently asked questions
How does NC screen prisoners for mental illness?
NCDAC screens all incoming prisoners at intake with a behavioral health assessment identifying mental health history, diagnoses, active psychiatric medications, and substance use conditions. Over the past five years, NCDAC's own intake data shows: 39% of entering males and 67% of entering females had mental health service needs; 76% had substance use conditions; 30% of the SUD population had co-occurring mental health. Provide psychiatric documentation at intake.
What mental health services does NCDAC provide in prisons?
NCDAC's Division of Behavioral Health provides: mental health and SUD assessments, individual and group mental health counseling, psychiatric medication management, SUD treatment programs, crisis intervention, suicide prevention, and social work aftercare planning for release. Only 20 social workers manage aftercare planning for the entire behavioral health caseload across ~32,000 prisoners -- planning typically begins approximately 90 days before release.
What is the FIT Wellness program for NC prisoners?
FIT Wellness (Formerly Incarcerated Transition Wellness, UNC School of Medicine, NCDHHS-funded at $5.5 million) delivers psychiatric care, physical health care, and community support connections (housing, transportation, phones) specifically for people in NCDAC state prisons who have Serious Mental Illness. It is designed to ensure SMI individuals leaving prison have clinical and support structures in place before release. DAC social work director described FIT Wellness as a model she wishes were available in every NC county.
What are North Carolina's FACT teams?
Forensic Assertive Community Treatment (FACT) teams launched November 2025 across North Carolina (NCDHHS). FACT teams provide personalized clinical and social support for justice-involved individuals with serious mental health needs who present a medium to high risk of repeated criminal behavior. They deliver mental health treatment, housing, employment, and other community supports post-release. FACT teams are a community intervention, not a prison program -- they serve people after release from prison or jail.
What is NC's High-Priority Reentry Program?
NCDAC's High-Priority Reentry Program targets the riskiest, highest-need releases from the prison system. In 2025, NCDAC made 149 referrals to the program. Eligible individuals are referred to LME-MCO care coordination teams, which include peer support specialists and connect people to community behavioral health services in their home county. It provides structured linkage for individuals whose needs and risk factors make the transition from prison to community especially challenging.
How does NC coordinate mental health care at release?
NCDAC's 20 social workers begin aftercare planning approximately 90 days before release for people on the behavioral health caseload, conducting needs assessments for housing, transportation, and other supports, and working with the four LME-MCOs to link individuals to community behavioral health services. FIT Wellness provides specialized psychiatric and physical health support for SMI individuals. The High-Priority Reentry Program provides targeted LME-MCO care coordination for the highest-need releases. FACT teams provide community-based support post-release.
What are LME-MCOs and how do they support NC prisoners?
LME-MCOs (Local Management Entity-Managed Care Organizations) are North Carolina's four regional managed care organizations for behavioral health, intellectual/developmental disability, and traumatic brain injury services under Medicaid. For people leaving NCDAC, LME-MCOs arrange and coordinate community behavioral health care in the county of release. NCDAC's social workers work with LME-MCOs to link releasing prisoners to appropriate community services. Verify current LME-MCO structure and names at publish as North Carolina's managed care system is undergoing evolution.
What is NC's specialized MH supervision expansion?
As of June 2026, NCDAC has expanded specialized mental health probation/parole officers to all 100 North Carolina counties. These officers carry smaller caseloads -- up to 40 people with serious mental illness rather than the 60+ managed by standard officers -- allowing more intensive case management and specialized expertise. People with serious mental illness on post-release supervision or parole in North Carolina may now be assigned to a specialized mental health officer in their county.
What can families do if mental health care is denied in NC?
Provide psychiatric documentation at intake. Know the 20-social-worker constraint and proactively engage with the facility about behavioral health caseload status and aftercare planning. Ask about FIT Wellness for SMI individuals approaching release. Ask about High-Priority Reentry Program referral. Ask what LME-MCO has been identified and whether Medicaid enrollment is underway. Know that FACT teams provide post-release support for SMI individuals. Know that specialized MH supervision officers are available in all 100 counties. File NCDAC grievances. Contact Disability Rights NC (disabilityrightsnc.org) for legal advocacy.
Who oversees mental health care in North Carolina prisons?
NCDAC's Division of Behavioral Health manages prison mental health services internally. NCDHHS's Division of Mental Health, Developmental Disabilities, and Substance Use Services (led by Kelly Crosbie) oversees the FIT Wellness, FACT teams, and LME-MCO network. No federal court actively exercises oversight of NCDAC. Disability Rights NC (DRNC, disabilityrightsnc.org) is the federally mandated P&A organization. Governor Executive Order No. 33 established executive-level policy direction for behavioral health and criminal justice integration. ---