Oregon's Department of Corrections (ODOC) has undergone a documented decade-long transformation in how it treats seriously mentally ill prisoners -- a story shaped by a 2015 investigative report by Disability Rights Oregon (DRO), a 2016 agreement between DRO and ODOC, years of monitored improvement, and a nationally recognized model of care known as "the Oregon Way."
Oregon's mental health special housing system is defined in Oregon Administrative Rule OAR 291-048-0210 and includes three named types of specialized housing: the Mental Health Infirmary (MHI), Intermediate Care Housing (ICH), and the Behavioral Health Unit (BHU). The BHU, located at the Oregon State Penitentiary (OSP) -- Oregon's only maximum-security prison -- serves the roughly 2% of seriously mentally ill prisoners who have also demonstrated violent and assaultive behavior.
In July 2024, Oregon received federal approval to offer Medicaid services to eligible prisoners 90 days before release -- one of the first five states to receive this approval in the second wave of the program. And in December 2024, ODOC commissioned Falcon Correctional and Community Services to conduct a comprehensive system-wide healthcare assessment, with findings released July 25, 2025.
Oregon does not have active federal court oversight of ODOC prison mental health care.
What Oregon Prisoners Are Entitled To
Under Estelle v. Gamble (1976), OAR 291-048 (Mental Health Services), and the ODOC-DRO agreement framework:
- Mental health screening at intake.
- Mental health special housing placement (MHI, ICH, or BHU) when the prisoner's serious mental illness prevents safe adjustment to general population.
- Treatment in a mental health clinic outside the residential living environment.
- Crisis intervention and stabilization through the Mental Health Infirmary.
- Intensive treatment in the Behavioral Health Unit for those with both SMI and dangerous behavior.
- 90-day pre-release Medicaid services for eligible prisoners.
Mental Health Screening at Intake
ODOC conducts mental health screening for all incoming prisoners as part of the health intake process. The Behavioral Health Services (BHS) administrator's staff provides mental health program services at each facility. Mental health specialists -- any person who reports to the BHS administrator with responsibility for mental health program services -- conduct assessments and determine the appropriate level of care.
If your person has a psychiatric history, provide documentation at intake -- prior hospitalizations, diagnoses, and active medications -- to support accurate classification.
Mental Health Special Housing: Three Named Types
Oregon Administrative Rule OAR 291-048-0210 defines Mental Health Special Housing as a housing assignment separate and apart from the general population, including facilities, rooms, or cells for inmates who are unable to adjust satisfactorily to the general inmate population because of a serious mental illness. Mental health special housing includes three types:
Mental Health Infirmary (MHI): A crisis response unit that provides psychiatric care and a therapeutic environment for inmates requiring intensive assessment, care, and stabilization. The MHI is the acute crisis level of care -- the destination for prisoners who need immediate psychiatric stabilization.
Intermediate Care Housing (ICH): A step-level between the crisis stabilization of the MHI and the intensive treatment of the BHU, or between the BHU and general population. ICH provides a structured therapeutic housing environment for prisoners with serious mental illness who need more support than general population provides but are not in acute crisis or requiring BHU-level intensive treatment.
Behavioral Health Unit (BHU): The most intensive mental health housing in ODOC's system. The BHU is located at Oregon State Penitentiary (OSP), Oregon's only maximum-security prison. The BHU serves people who represent approximately the top 2% of dangerousness in the ODOC system -- those with serious mental illness who have also demonstrated violent and assaultive behavior. The BHU provides the highest-intensity behavioral health treatment within a maximum-security environment.
The Behavioral Health Unit at Oregon State Penitentiary
The BHU at OSP is the flagship of Oregon's prison mental health transformation. It serves the most difficult-to-treat population in Oregon's corrections system: people with serious mental illness who are also violent and assaultive.
Key features of the BHU model (the "Oregon Way"):
- Expanded types of treatment offered.
- Increased collaboration between behavioral health staff and security staff.
- Training and support for all professional staff working within the treatment program.
- A mental health clinic established outside the adults in custody's living environment -- a physical separation designed to make the clinical environment distinct from the security environment.
The IACFP (International Association of Correctional and Forensic Psychology) documented the BHU's transformation in a 2021 article, noting that "the leadership and collaboration evident among all these individuals have been critical to the transformation that has taken place in Oregon over the last ten years."
The DRO-ODOC Partnership and the 2016 Agreement
Disability Rights Oregon (DRO) is not just Oregon's federally mandated Protection and Advocacy organization -- it is an active monitoring and advocacy partner that has driven the most significant documented improvements in Oregon's prison mental health system.
The sequence of events:
2015: DRO published an investigative report documenting that dozens of men living in the OSP mental health unit were spending 23 hours a day in cells, with inadequate treatment -- conditions that constitute solitary confinement regardless of what the department calls it.
2016: DRO and ODOC reached an agreement establishing goals for improving mental health treatment for seriously mentally ill prisoners at OSP.
2020: DRO published a monitoring report confirming that ODOC had improved conditions for inmates with serious mental health conditions at OSP. DRO's executive director Jake Cornett stated: "After four years of advocacy, inmates with serious mental illness are being treated more humanely and we've made real progress toward providing the behavioral healthcare they need."
2020 continuing concern: While lauding progress, DRO urged ODOC to reform the ongoing overuse of solitary confinement. DRO noted that "ODOC no longer uses the term 'solitary confinement,' but the practice continues under several other names."
The DRO-ODOC relationship represents one of the most productive P&A-corrections partnerships in this series -- a watchdog that documented a crisis, negotiated an agreement, monitored improvement, confirmed progress, and continues to press for further reform.
The 2025 Falcon Healthcare Assessment
In December 2024, ODOC commissioned Falcon Correctional and Community Services, Inc. (Falcon) to conduct a system-wide healthcare assessment. Falcon's comprehensive report was released July 25, 2025, with an executive summary establishing a baseline for Continuous Quality Improvement (CQI).
The assessment was framed in the legal context of Estelle v. Gamble (1976) and Bowring v. Godwin (1977, extending Estelle to psychiatric care) -- acknowledging that ODOC must provide healthcare commensurate with community standards for both medical and behavioral health needs.
The assessment identified "priority areas in need of immediate attention" and made recommendations for improvement. The full report is publicly available from ODOC. Families whose person has medical or mental health care concerns should know this assessment exists and reference its findings when advocating for improved care.
The July 2024 Medicaid Pre-Release Waiver
In July 2024, the U.S. Department of Health and Human Services approved Oregon's request to offer Medicaid services to eligible prisoners 90 days before release. Oregon joined Illinois, Kentucky, Utah, and Vermont as the second wave of states to receive this approval (following California, Massachusetts, Montana, and Washington in the first wave).
Under Oregon's approved program:
- Eligible inmates who meet Medicaid's low-income limits qualify for Medicaid services beginning 90 days before their release.
- Services include addiction treatment and certain other services.
- The program provides a seamless healthcare transition as people rebuild their lives in the community.
- Being screened for mental health issues while still behind bars is expected to help people access counseling and treatment more quickly after release.
For prisoners approaching release with mental health or substance use needs, ask whether they have been assessed for Medicaid eligibility under this 90-day pre-release program and whether enrollment has been initiated.
Oregon Health Authority (OHA) Partnership
The Oregon Health Authority (OHA) administers Medicaid in Oregon (through Oregon Health Plan, OHP) and is the primary community-side partner for people being released from ODOC with mental health needs. OHA coordinates with Coordinated Care Organizations (CCOs) -- Oregon's managed care organizations for Medicaid -- to provide mental health and other healthcare services.
Upon release, people with Medicaid coverage connect with their assigned CCO for mental health, addiction, and other healthcare services. The 90-day pre-release Medicaid enrollment helps ensure this connection is in place before someone walks out.
Ongoing Concerns: Solitary Confinement by Other Names
DRO's 2020 monitoring report confirmed progress at OSP but raised a persistent concern: ODOC has eliminated the term "solitary confinement" but continues practices that amount to solitary confinement under other names. DRO continues to monitor and advocate for reform of these practices.
For families: if your person is being held in any form of severe cell restriction -- segregation, enhanced security housing, any restrictive housing -- document the hours per day spent outside the cell, the quality and frequency of mental health contact, and the clinical justification. If your person has serious mental illness and is in any form of solitary-equivalent housing, contact DRO.
Women in Oregon Prisons
A 2023 Gender Informed Practices Assessment (GIPA) of Coffee Creek Correctional Facility (CCCF), the primary women's prison in Oregon, found that "there were consistent reports that medical and mental health care is inadequate, delayed or denied, poor in quality, and not calibrated to the needs of women (e.g., reproductive health)." This finding from a state-commissioned assessment documents ongoing concerns specific to women in ODOC custody.
What Families Can Do
If your person is in ODOC custody and has a mental illness:
Provide psychiatric history at intake. Supply documentation of prior hospitalizations, diagnoses, and active medications to support accurate behavioral health classification.
Know the three mental health special housing types. Ask whether your person has been assessed for Mental Health Special Housing (MHI, ICH, or BHU). If they have serious mental illness and cannot adjust safely to general population, they may be entitled to mental health special housing under OAR 291-048-0210.
Know the BHU. If your person has serious mental illness and has also been violent or assaultive in a prison setting, ask whether BHU placement at OSP has been considered.
Know the DRO-ODOC history. DRO's 2015 investigation and 2016 agreement established the framework for current mental health care at OSP. The documented progress and the documented ongoing concerns about solitary-by-other-names are both relevant to families today.
Know the solitary concern. DRO has documented that ODOC continues practices amounting to solitary confinement under other names. If your person with serious mental illness is in any restrictive housing arrangement limiting out-of-cell time, document the specifics and contact DRO.
Know the 2025 Falcon assessment. The July 2025 Falcon healthcare assessment established a CQI baseline. Families with concerns about medical or mental health care quality can reference this assessment's findings when filing grievances or raising concerns.
Ask about the 90-day Medicaid pre-release program. If your person is within 90 days of release and has mental health or addiction needs, ask whether the Medicaid 90-day pre-release enrollment has been initiated.
File a grievance. ODOC has an administrative grievance process. File formal grievances for: failure to conduct mental health screening, denial of mental health special housing when warranted, inadequate mental health treatment, solitary-equivalent housing for SMI prisoners, medication interruption, and failure to initiate pre-release Medicaid enrollment.
Contact Disability Rights Oregon. DRO (droregon.org) is the federally mandated Protection and Advocacy organization for Oregon. DRO has been the most active external force in improving Oregon's prison mental health system. Contact DRO for advocacy, monitoring, and legal help.
Seek legal help. If your person has serious mental illness and is being held in solitary-equivalent housing, if mental health special housing has been denied, or if care has materially declined since the DRO-ODOC agreement, consult a prisoner rights attorney with experience in Oregon's federal courts (District of Oregon).
Frequently asked questions
How does Oregon screen prisoners for mental illness?
ODOC's Behavioral Health Services (BHS) staff conducts mental health screening for all incoming prisoners as part of the health intake process. Mental health specialists -- BHS staff responsible for mental health program delivery at each facility -- assess prisoners and determine appropriate care levels. Prisoners who cannot adjust safely to general population due to serious mental illness are assessed for Mental Health Special Housing (MHI, ICH, or BHU) under OAR 291-048-0210. Provide psychiatric documentation at intake -- prior hospitalizations, diagnoses, and active medications.
What is the BHU at Oregon State Penitentiary?
The Behavioral Health Unit (BHU) at Oregon State Penitentiary (OSP) is the most intensive mental health housing in ODOC's system, serving approximately the top 2% of most dangerous seriously mentally ill prisoners -- those who have also demonstrated violent and assaultive behavior. The BHU features expanded treatment types, collaboration between behavioral health and security staff, staff training and support, and a mental health clinic outside the living environment. The BHU transformation is the centerpiece of what IACFP has called "the Oregon Way."
What is the Mental Health Infirmary in Oregon prisons?
The Mental Health Infirmary (MHI) is a crisis response unit providing psychiatric care and a therapeutic environment for prisoners requiring intensive assessment, care, and stabilization. It is defined in OAR 291-048-0210 as one of three types of Mental Health Special Housing. The MHI is the acute crisis level -- for prisoners who need immediate psychiatric stabilization rather than ongoing intensive treatment. Prisoners may be transferred from the MHI to ICH or general population as their condition stabilizes.
What is the Oregon Way in prison mental health?
"The Oregon Way" is a nationally recognized model of prison mental health transformation developed over the last decade at ODOC. It features: expanded types of behavioral health treatment; increased collaboration between behavioral health and security staff; training and support for all professional staff; and a mental health clinic established outside the residential living environment. The BHU at OSP is its centerpiece. The "Oregon Way" emerged from the DRO-ODOC partnership following DRO's 2015 investigative report, and its evolution has been documented by IACFP (International Association of Correctional and Forensic Psychology).
What is the DRO-ODOC agreement on mental health care?
In 2015, DRO published an investigation documenting that dozens of men in the OSP mental health unit spent 23 hours a day in cells with inadequate treatment -- conditions amounting to solitary confinement. In 2016, DRO and ODOC reached an agreement establishing goals for improving mental health treatment at OSP. DRO monitored progress and in 2020 confirmed that conditions had improved, stating "inmates with serious mental illness are being treated more humanely." DRO continues to advocate for reform of what it describes as solitary-by-other-names practices that persist.
What did the 2025 Falcon healthcare assessment find?
Falcon Correctional and Community Services conducted a system-wide healthcare assessment commissioned by ODOC in December 2024, with findings released July 25, 2025. The assessment established a baseline for Continuous Quality Improvement (CQI) and identified priority areas in need of immediate attention. The comprehensive report is publicly available from ODOC. The assessment framed ODOC's obligations in terms of Estelle v. Gamble and Bowring v. Godwin, noting that prisons must provide care commensurate with community standards for both medical and behavioral health needs.
What is Oregon's Medicaid pre-release waiver program?
In July 2024, the U.S. Department of Health and Human Services approved Oregon to offer Medicaid services to eligible prisoners 90 days before release -- part of the second wave of state approvals (joined by IL, KY, UT, VT; following CA, MA, MT, WA). Eligible inmates who meet Medicaid's low-income limits qualify for addiction and certain other services starting 90 days before their release date. The program provides a seamless healthcare transition and enables earlier connection to mental health treatment after release.
How does Oregon handle mental health care at release?
Oregon's 90-day pre-release Medicaid program (approved July 2024) connects eligible prisoners to Medicaid coverage before release. The Oregon Health Authority (OHA) administers Medicaid through Coordinated Care Organizations (CCOs) that provide community mental health, addiction, and other healthcare services post-release. ODOC's reentry services connect prisoners with community resources. For people with serious mental illness approaching release, ask about pre-release Medicaid enrollment, what CCO has been assigned, and whether a first mental health appointment has been arranged.
What can families do if mental health care is denied in OR?
Provide psychiatric documentation at intake. Know the three mental health special housing types (MHI, ICH, BHU) under OAR 291-048-0210 and ask whether your person has been assessed for placement. Know the ongoing DRO-documented solitary concern -- if your person with SMI is in restrictive housing, document out-of-cell hours and mental health contacts. Know the 2025 Falcon assessment and reference its CQI framework when raising care quality concerns. Ask about 90-day pre-release Medicaid enrollment. File ODOC grievances for placement denials, medication interruptions, and inadequate treatment. Contact DRO (droregon.org) for monitoring and legal advocacy.
Who oversees mental health care in Oregon prisons?
ODOC's Behavioral Health Services (BHS) division manages mental health care system-wide. OAR 291-048 governs mental health services. No federal court actively exercises oversight of ODOC. Disability Rights Oregon (DRO, droregon.org) is the federally mandated P&A organization -- and has been the primary external force driving improvement in Oregon's prison mental health system through investigation, agreement, monitoring, and advocacy. The Oregon Health Authority (OHA) coordinates community-side Medicaid and behavioral health services for people being released. ---