Tennessee's Department of Correction (TDOC) delivers mental health care through two closely coordinated divisions: Health Services, which performs screening, medical care, and Case Management release planning; and Behavioral Health Services, which establishes policy standards for mental health and substance use treatment delivery. Together, these divisions provide a continuum of behavioral health care from intake through release.
TDOC's Behavioral Health Services has two stated goals: to reduce the debilitating effects of serious mental illness and maximize each inmate's ability to participate in programs while maintaining a safe prison environment; and to help prepare inmates with mental illness or substance use treatment needs to successfully transition from incarceration back to the community.
TDOC partners with the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) on peer support training, mental health court programs, and community reentry connections. Tennessee's Mental Health Treatment Act of 2022 created and expanded mental health courts, which divert justice-involved individuals with mental illness into community treatment rather than incarceration.
Tennessee does not have active federal court oversight specifically of TDOC prison mental health care.
What Tennessee Prisoners Are Entitled To
Under Estelle v. Gamble (1976) and TDOC policies:
- Mental health assessment by mental health staff upon initial intake.
- A continuum of behavioral health services throughout incarceration.
- Access to sick call for triage of any health or mental health complaint.
- Psychological assessment, case management, medication management, and crisis intervention.
- Individual and group therapy.
- Substance use treatment services.
- Case Management release planning including community mental health connections.
Mental Health Screening at Intake
Upon initial intake into TDOC, mental health staff assess all inmates. TDOC's Health Services performs extensive medical and dental screenings on all offenders immediately upon arrival at intake/diagnostic facilities, and these screenings include behavioral health components.
The mental health intake assessment drives initial classification and determines what behavioral health services the person will receive.
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.
TDOC Behavioral Health Services
Behavioral Health Services establishes the policy standards for mental health and substance use treatment across TDOC. The division monitors and ensures quality care throughout the system.
Services provided through TDOC Behavioral Health Services include:
Psychological assessment: Clinical evaluation of mental health needs, diagnoses, and functional impairment.
Case management: Ongoing coordination of mental health services, treatment planning, and continuity of care throughout incarceration and into the transition to community.
Medication management: Psychiatric medication prescription, administration, and monitoring.
Crisis intervention: Emergency mental health response for prisoners in acute psychiatric distress.
Individual therapy: One-on-one counseling with licensed mental health professionals.
Group therapy: Evidence-based therapeutic groups addressing mental health and behavioral issues.
Substance use treatment: Integrated SUD programming for prisoners with substance use disorders, including co-occurring disorders.
Sex offender treatment programs: Specialized programming for this population.
TDOC Health Services: The Multidisciplinary Framework
TDOC's Health Services division provides the framework within which Behavioral Health Services operates. Health Services delivers a multidisciplinary approach offering:
- Sick call: Triage of any health or mental health complaint.
- Emergency care.
- Chronic care clinics: Ongoing management of long-term health conditions including chronic psychiatric conditions.
- Medication management.
- Diagnostic tests and procedures.
- Infirmaries.
- Inpatient hospitalization.
- Case Management release planning.
- SUD treatment.
- Specialty services.
Health Services works closely with Behavioral Health Services to ensure unified delivery of mental health care. The coordination between Health Services and Behavioral Health Services is documented in TDOC policy -- these are not separate silos but integrated service lines.
The TDMHSAS Partnership
TDOC and the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) maintain an active partnership. In fiscal year 2024, TDMHSAS Recovery Services partnered with TDOC to deliver six 40-hour peer support training sessions to 57 qualified TDOC inmates. This peer support training builds the capacity of incarcerated individuals to support their peers with mental illness and substance use disorders -- both inside the prison and as trained peer specialists after release.
TDMHSAS also coordinates with TDOC on mental health court referrals and community reentry mental health services through its network of contracted community mental health providers.
The Tennessee Mental Health Treatment Act of 2022
Tennessee's General Assembly enacted the Mental Health Treatment Act of 2022 to reduce the incarceration of justice-involved individuals living with mental illness. The Act:
- Created new mental health court programs statewide.
- Supported the continuation and expansion of existing mental health courts.
- Directs justice-involved individuals with mental illness into judicially supervised, community-based treatment programs and services.
- Promotes public safety through evidence-based treatment diversion rather than incarceration.
TDMHSAS's FY 2024 Joint Annual Report noted continued expansion of mental health courts under the Act's authority and appropriated funding. Mental health courts provide a pathway out of the traditional criminal prosecution pipeline for people whose criminal involvement is tied to untreated mental illness.
Tennessee State Psychiatric Hospitals
TDMHSAS operates Tennessee's state psychiatric hospitals. These hospitals serve civil commitment populations and forensic patients from the criminal justice system:
Middle Tennessee Mental Health Institute (Nashville, Davidson County): Large psychiatric hospital serving middle Tennessee.
Memphis Mental Health Institute (Memphis, Shelby County): Serving western Tennessee.
Western Mental Health Institute (Bolivar, Hardeman County): Serving southwestern Tennessee.
Moccasin Bend Mental Health Institute (Chattanooga, Hamilton County): Serving southeastern Tennessee.
Eastern Tennessee State Mental Health Regional Hospital (Lakeshore): Northeastern Tennessee.
For TDOC prisoners who require inpatient hospital-level psychiatric care beyond what TDOC facilities can provide, TDMHSAS state hospitals are the referral destination for competency evaluation, restoration, NGRI treatment, and inpatient psychiatric care.
Case Management Release Planning
TDOC's Health Services division includes Case Management release planning as a core service. For inmates with mental illness and/or substance use disorders approaching release, Case Management coordinates:
- Connection to community mental health providers in the release area.
- Coordination with TDMHSAS's contracted community mental health centers (CMHCs) statewide.
- Medication continuity -- ensuring psychiatric medications are available at release.
- Linkage to Medicaid or TennCare enrollment.
TennCare (Tennessee's Medicaid program) is the primary coverage vehicle for community mental health services after release. Enrolling in TennCare before release -- or ensuring automatic reinstatement upon release -- is a priority for people with mental illness leaving TDOC.
What Families Can Do
If your person is in TDOC custody and has a mental illness:
Provide psychiatric history at intake. Supply documentation of prior hospitalizations, diagnoses, and active medications. TDOC's mental health staff assessment at intake drives initial classification and service assignment.
Know Behavioral Health Services is the clinical authority. If your person is receiving inadequate mental health care, document the specific gap -- what was requested, what was denied, and when. TDOC Behavioral Health Services establishes policy standards and is responsible for ensuring quality care.
Know the sick call right. Any health or mental health complaint can be submitted through sick call. If your person is experiencing mental health symptoms and has not submitted a sick call request, encourage them to do so.
Know the Case Management release planning right. If your person is approaching release and has a mental illness, ask whether Case Management has been initiated, what community mental health provider has been identified, whether TennCare enrollment is underway, and whether medication continuity is arranged.
Know the TDMHSAS hospital pathway. If your person requires inpatient hospital-level psychiatric care, ask whether TDMHSAS referral has been made. The five state psychiatric hospitals serve TDOC prisoners who need this level of care.
Know mental health courts. If your person is in the pretrial phase or involved in ongoing criminal proceedings and has a mental illness, ask their attorney about mental health court eligibility under the 2022 Mental Health Treatment Act.
File a grievance. TDOC has an administrative grievance process. File formal grievances for: failure to conduct mental health assessment at intake, denial of Behavioral Health Services, medication interruption, failure to initiate Case Management release planning, and failure to refer to TDMHSAS hospitals when warranted.
Contact Disability Rights Tennessee. DRT (disabilityrightstn.org) is the federally mandated Protection and Advocacy organization for Tennessee and monitors conditions for people with mental illness and disabilities in TDOC facilities.
Seek legal help. If your person has serious mental illness and is not receiving adequate mental health care, if Behavioral Health Services has been denied, or if medication has been interrupted without clinical justification, consult a prisoner rights attorney with experience in Tennessee's federal courts (Eastern, Middle, and Western Districts of Tennessee).
Frequently asked questions
How does Tennessee screen prisoners for mental illness?
Upon initial intake into TDOC at intake/diagnostic facilities, mental health staff assess all inmates. Health Services performs extensive medical, dental, and behavioral health screenings immediately upon arrival. The mental health assessment drives initial classification and Behavioral Health Services assignment. Provide psychiatric documentation at intake -- prior hospitalizations, diagnoses, and active medications.
What is TDOC's Behavioral Health Services division?
TDOC Behavioral Health Services establishes policy standards for mental health and substance use treatment across the prison system, and monitors and ensures quality care. Its two goals are: (1) reduce the debilitating effects of serious mental illness and maximize program participation while maintaining safety; and (2) prepare inmates with mental illness or SUD to successfully transition back to the community. The division operates in close coordination with TDOC Health Services and in partnership with TDMHSAS.
What mental health services does Tennessee TDOC provide?
A continuum of behavioral health services including: psychological assessment, case management, medication management, crisis intervention, individual therapy, group therapy, substance use treatment services, and sex offender treatment programs. Integrated with Health Services: sick call for mental health complaints, chronic care clinics for ongoing psychiatric conditions, emergency care, inpatient hospitalization, and Case Management release planning.
How does TDOC work with TDMHSAS on mental health?
TDOC and TDMHSAS (Tennessee Department of Mental Health and Substance Abuse Services) maintain an active partnership. In FY 2024, TDMHSAS Recovery Services delivered six 40-hour peer support training sessions to 57 qualified TDOC inmates. TDMHSAS also coordinates on mental health court referrals, community reentry mental health connections, and provides the state psychiatric hospital system (Middle Tennessee MHI, Memphis MHI, Western MHI, Moccasin Bend MHI, and Eastern Tennessee State MH Regional Hospital) for TDOC prisoners needing inpatient psychiatric care.
What is Tennessee's mental health court program?
The Mental Health Treatment Act of 2022 reduced the incarceration of justice-involved individuals with mental illness by creating new mental health courts and supporting existing ones statewide. Mental health courts provide judicially supervised, community-based treatment for people whose criminal involvement is tied to untreated mental illness. TDMHSAS coordinates the mental health court program, and TDOC Case Management works with mental health courts on diversion and reentry cases.
What mental health care does Tennessee provide at release?
TDOC Health Services Case Management coordinates release planning for inmates with mental illness or SUD. This includes: connecting to community mental health providers in the release area; linking to TennCare (Tennessee Medicaid) enrollment; arranging medication continuity; and coordinating with TDMHSAS's contracted CMHCs statewide. If your person is approaching release, ask whether Case Management has been initiated and what specific providers, TennCare enrollment, and medication continuity plans are in place.
What are Tennessee's state psychiatric hospitals?
TDMHSAS operates five state psychiatric hospitals: Middle Tennessee Mental Health Institute (Nashville); Memphis Mental Health Institute (Memphis); Western Mental Health Institute (Bolivar); Moccasin Bend Mental Health Institute (Chattanooga); and Eastern Tennessee State Mental Health Regional Hospital (Lakeshore). These hospitals serve civil commitment, forensic (IST, NGRI), and inpatient psychiatric care populations. For TDOC prisoners requiring hospital-level psychiatric care, TDMHSAS hospitals are the referral destination.
Who provides mental health care in Tennessee prisons?
TDOC Behavioral Health Services establishes policy and delivers mental health care through TDOC's own clinical staff (mental health professionals employed by or contracted to TDOC). Health Services coordinates the broader healthcare framework. Psychiatrists providing medication management may be employed by TDOC or contracted through a healthcare vendor -- verify the current contractor model at publish. TDMHSAS provides inpatient psychiatric hospital care and community reentry partnerships.
What can families do if mental health care is denied in TN?
Provide psychiatric documentation at intake. Know TDOC Behavioral Health Services is the clinical authority -- document specific service denials. Know the sick call right for mental health complaints. Ask about Case Management release planning approaching release, including TennCare enrollment and medication continuity. Know the TDMHSAS hospital pathway for inpatient needs. Know mental health courts for pretrial situations. File TDOC grievances for assessment failures, Behavioral Health Services denials, medication interruptions, and Case Management failures. Contact Disability Rights Tennessee (disabilityrightstn.org) for legal advocacy.
Who oversees mental health care in Tennessee prisons?
TDOC Behavioral Health Services establishes policy and monitors mental health care quality system-wide. TDOC Health Services coordinates the broader healthcare delivery framework. TDMHSAS oversees state psychiatric hospitals and community mental health services. No federal court actively exercises oversight of TDOC. Disability Rights Tennessee (DRT, disabilityrightstn.org) is the federally mandated P&A organization monitoring conditions for people with mental illness and disabilities in TDOC. ---