West Virginia's Division of Corrections and Rehabilitation (DCR) incarcerates approximately 11,000 people in jails and prisons -- and roughly half of them struggle with mental illness and/or substance use disorder. West Virginia also has one of the highest death rates in the country for incarcerated people, primarily driven by suicides and overdoses.
West Virginia also holds a grim distinction in female incarceration: the state incarcerates women at a rate of 273 per 100,000 population -- the highest female incarceration rate of any U.S. state and, by some measures, any jurisdiction in the world.
Clinical mental health care in West Virginia prisons is delivered by PSIMED, a private contractor. Dr. Merideth Smith is PSIMED's Director of Clinical Services and serves as a primary liaison to the DCR system. The mental hygiene transfer process -- for prisoners who need hospital-level psychiatric care -- requires circuit court or mental hygiene commissioner approval under West Virginia Code § 15A-4-19, a process criticized for inconsistency across West Virginia's different counties and jurisdictions.
When hospital-level care is needed, William R. Sharpe Jr. Hospital in Weston is West Virginia's primary state psychiatric hospital, serving both civil commitment and forensic patients.
West Virginia does not have active federal court oversight specifically of DCR prison mental health care.
What West Virginia Prisoners Are Entitled To
Under Estelle v. Gamble (1976), WV Code § 15A-4-19, and DCR policies including Policy Directive 410.19:
- Mental health screening and evaluation at intake.
- Mental health care through PSIMED clinical staff.
- Transfer to a mental health facility (including Sharpe Hospital) when clinical criteria are met and court approval is obtained.
- Access to MAT (Medication-Assisted Treatment) for opioid and alcohol use disorders.
- Access to the G.O.A.L.S. Substance Abuse Treatment Units for co-occurring SUD.
Mental Health Screening at Intake
DCR conducts health screening for all incoming prisoners at intake, including mental health assessment. The screening identifies mental health history, current diagnoses, and active psychiatric medications.
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.
PSIMED: The Clinical Care Contractor
Mental health care in West Virginia prisons is delivered by PSIMED, a private contractor providing clinical mental health services to DCR. Key PSIMED personnel:
Dr. Merideth Smith: Director of Clinical Services for PSIMED. Dr. Smith has presented to the West Virginia Legislature's Joint Committee on Finance and Administration on MAT and behavioral interventions in prisons.
Dr. David Clayman: Clayman & Associates, Chair of the Dangerousness Assessment Advisory Board in West Virginia.
PSIMED provides clinical mental health staff -- including psychologists, social workers, and psychiatric professionals -- at DCR facilities across the state.
For families: all clinical mental health care decisions are made by PSIMED employees. Document all care requests and responses in writing. Grievances go through DCR's administrative process.
The Mental Hygiene Transfer Process
When a West Virginia prisoner needs hospital-level psychiatric care that cannot be provided within DCR facilities, West Virginia Code § 15A-4-19 governs the transfer process:
A circuit court or mental hygiene commissioner must review the evidence and make findings on four questions: (1) Is the individual mentally ill, intellectually disabled, or addicted? (2) Because of that condition, is the individual likely to cause serious harm to themselves or others? (3) Could the individual not obtain the requisite treatment at the correctional facility or another appropriate correctional facility? (4) Could the designated facility provide the treatment with appropriate security?
If all four findings are affirmative, the circuit court may order transfer to the appropriate facility.
DCR Policy Directive 410.19 ("Mental Hygiene Commitment Application Procedures") governs the internal DCR process for preparing and submitting these applications.
The fragmented nature of this process -- with different circuit courts and mental hygiene commissioners across West Virginia's counties handling these applications -- has been criticized for producing inconsistent outcomes depending on jurisdiction. A 2024 WVU Bridge Initiative analysis proposed either a regional or centralized model to improve consistency. House Bill 4405 in the 2024 West Virginia legislative session proposed a regional decision-making model.
William R. Sharpe Jr. Hospital
William R. Sharpe Jr. Hospital in Weston, Lewis County is West Virginia's primary state psychiatric hospital and the primary referral destination for DCR prisoners transferred for inpatient psychiatric care.
Key facts:
- 150-bed acute care psychiatric facility.
- Joint Commission accredited.
- Serves patients committed through civil commitment and forensic patients ordered through the judicial system.
- Works closely with Community Behavioral Health Centers and community organizations to ensure smooth transitions after discharge.
- WVU partnership: West Virginia University's Department of Behavioral Medicine and Psychiatry provides psychologists, clinical social workers, physician assistants, and psychiatrists to the hospital.
- MICA program: specifically for patients who are dually diagnosed with mental illness and chemical addiction (Mentally Ill/Chemically Addicted), implementing an integrated treatment approach.
- Serves people found Not Guilty by Reason of Mental Illness (NGRI) and people found incompetent to stand trial (IST) requiring competency restoration.
Sharpe Hospital is described as a premier center for mental health education and research in West Virginia, given its WVU partnership.
The Documented Crisis: Death Rates and Fragmented Care
West Virginia's incarcerated population faces documented acute risks:
High death rate: WV incarcerated people have one of the highest death rates in the country among prison populations, primarily driven by suicides and overdoses. This crisis is directly connected to the roughly 50% prevalence of mental illness and SUD in the prison population and the documented challenges in providing consistent care.
Overcrowding and understaffing: DCR facilities have been documented as overcrowded and understaffed -- a chronic condition that limits the capacity for adequate mental health care delivery.
Inconsistent mental hygiene process: The county-by-county variation in how mental health transfer applications are handled means that a prisoner in one county may receive timely access to hospital care while a prisoner with identical needs in another county faces delays or denials.
MAT in West Virginia Prisons
In May 2024, PSIMED Director of Clinical Services Dr. Merideth Smith presented to the West Virginia Legislature on Medication-Assisted Treatment (MAT) and behavioral interventions in prisons, documenting the medical and mental health outcomes of inmates with opioid use disorders and co-occurring mental health conditions.
West Virginia has been a national epicenter of the opioid epidemic, and the prevalence of opioid use disorder among WV prisoners is significant. MAT -- including methadone, buprenorphine, and naltrexone -- is evidence-based treatment for opioid use disorder that reduces overdose deaths, improves mental health outcomes, and reduces recidivism.
Ask whether MAT is available at the specific DCR facility where your person is housed and whether your person has been offered or enrolled in MAT if they have opioid or alcohol use disorder.
G.O.A.L.S. Substance Abuse Treatment Units
DCR operates G.O.A.L.S. (Gaining Opportunities and Achieving Life Skills) Substance Abuse Treatment Units at designated facilities. The G.O.A.L.S. program provides structured substance use disorder treatment in a residential unit setting, addressing the SUD that underlies much of the mental health crisis in WV prisons.
Community Behavioral Health Centers (CBHCs)
West Virginia's Community Behavioral Health Centers (CBHCs) provide the primary community mental health services across the state's counties. CBHCs are the primary reentry mental health connection for people leaving DCR.
Upon release from DCR, prisoners with mental health needs are expected to connect with the CBHC serving the county where they will live. Ask what CBHC has been identified for the release county, whether a first appointment has been arranged, and whether Medicaid enrollment is underway.
What Families Can Do
If your person is in WV DCR custody and has a mental illness:
Provide psychiatric history at intake. Supply documentation of prior hospitalizations, diagnoses, and active medications to support accurate initial assessment and medication continuity.
Know PSIMED is the clinical contractor. Document all care requests and responses in writing. PSIMED employees make clinical decisions; DCR's administrative grievance process handles complaints.
Know the mental hygiene transfer process. If your person needs hospital-level psychiatric care, DCR must submit a mental hygiene commitment application to the circuit court or mental hygiene commissioner in the relevant county. DCR Policy Directive 410.19 governs this process. Ask whether an application has been submitted if your person's condition warrants hospital care.
Know Sharpe Hospital is the primary referral. William R. Sharpe Jr. Hospital (Weston, Lewis County) is the state's primary psychiatric hospital for DCR transfers. Ask whether a referral or transfer has been initiated if your person requires inpatient psychiatric care.
Know the fragmented transfer process risk. Given county-by-county variation in how mental hygiene applications are processed, document all requests for transfer and follow up if the process is delayed.
Ask about MAT. If your person has opioid or alcohol use disorder, ask whether MAT (methadone, buprenorphine, or naltrexone) is available at their facility and whether enrollment has been discussed.
Ask about G.O.A.L.S. If your person has a substance use disorder with co-occurring mental illness, ask whether placement in a G.O.A.L.S. Substance Abuse Treatment Unit has been considered.
Ask about CBHC reentry connections. Ask what Community Behavioral Health Center has been identified for the release county, whether a first appointment has been arranged, and whether Medicaid enrollment is underway.
File a grievance. DCR has an administrative grievance process. File formal grievances for: failure to conduct mental health screening, denial of mental health care by PSIMED, failure to submit a mental hygiene transfer application when warranted, medication interruption, and failure to initiate CBHC reentry connections.
Contact Disability Rights of West Virginia. DRoWV (drofwv.org) is the federally mandated Protection and Advocacy organization for West Virginia and monitors conditions for people with mental illness and disabilities in DCR facilities.
Seek legal help. Given the high death rate, documented overcrowding and understaffing, fragmented mental hygiene transfer process, and roughly 50% prevalence of mental illness and SUD, there are significant documented risks for prisoners with serious mental illness in WV DCR. Consult a prisoner rights attorney with experience in West Virginia's federal courts (Northern and Southern Districts of West Virginia) if your person's mental health needs are not being met.
Frequently asked questions
How does West Virginia screen prisoners for mental illness?
DCR conducts health and mental health screening for all incoming prisoners at intake. The screening identifies mental health history, current diagnoses, and active psychiatric medications. PSIMED clinical staff conduct mental health evaluations as part of the intake process. Provide psychiatric documentation at intake -- prior hospitalizations, diagnoses, and active medications. Roughly half of WV's 11,000 incarcerated people have mental illness and/or SUD, making comprehensive intake screening essential.
What mental health services does WV DCR provide?
DCR provides mental health care through PSIMED clinical staff, including: mental health assessment and evaluation; psychiatric medication management; individual and group mental health counseling; crisis intervention; co-occurring SUD treatment through the G.O.A.L.S. Substance Abuse Treatment Units; MAT for opioid and alcohol use disorders; and mental hygiene commitment applications for prisoners requiring hospital-level psychiatric care at Sharpe Hospital.
Who provides mental health care in WV prisons?
Mental health care in WV DCR facilities is delivered by PSIMED, a private contractor. Dr. Merideth Smith is PSIMED's Director of Clinical Services. Dr. David Clayman (Clayman & Associates) chairs the Dangerousness Assessment Advisory Board. PSIMED provides clinical mental health professionals including psychologists and social workers. All clinical decisions are made by PSIMED employees; grievances go through DCR's administrative process.
What is the mental hygiene transfer process in WV prisons?
West Virginia Code § 15A-4-19 governs transfer of inmates to mental health facilities. A circuit court or mental hygiene commissioner must review evidence on four questions: (1) Is the person mentally ill, addicted, or intellectually disabled? (2) Are they likely to cause serious harm because of that condition? (3) Can the correctional facility not provide the required treatment? (4) Can the designated facility provide treatment with appropriate security? If all four are affirmative, the court may order transfer. DCR Policy Directive 410.19 governs the internal application process.
What is William R. Sharpe Jr. Hospital in West Virginia?
William R. Sharpe Jr. Hospital (Weston, Lewis County) is West Virginia's primary state psychiatric hospital -- a 150-bed Joint Commission-accredited acute care psychiatric facility. It serves civil commitment patients, forensic patients (IST, NGRI), and DCR prisoners transferred for hospital-level inpatient psychiatric care. It has a WVU partnership (Department of Behavioral Medicine and Psychiatry provides clinical staff) and operates a MICA program for the dually diagnosed (mental illness plus chemical addiction).
What is the GOALS substance abuse program at WV DCR?
G.O.A.L.S. (Gaining Opportunities and Achieving Life Skills) Substance Abuse Treatment Units are residential SUD treatment programs operated by DCR at designated facilities. G.O.A.L.S. provides structured SUD treatment addressing the substance use disorders that underlie much of the mental health crisis in WV prisons. Given the co-occurring MH/SUD prevalence of roughly 50% of WV prisoners, G.O.A.L.S. units are relevant for many prisoners with both mental illness and SUD.
What mental health challenges do WV prisoners face?
West Virginia prisoners face documented acute mental health risks: roughly half have mental illness and/or SUD; WV has one of the highest prison death rates in the country (primarily suicides and overdoses); facilities are overcrowded and understaffed; the mental hygiene transfer process is fragmented across counties producing inconsistent outcomes; and WV is a national epicenter of the opioid epidemic, with high rates of co-occurring OUD and mental illness in the prison population.
How does WV handle mental health care at release?
DCR coordinates community reentry mental health connections through West Virginia's Community Behavioral Health Centers (CBHCs) serving each county. CBHCs provide community mental health services, crisis response, and SUD treatment. Upon release, people with mental health needs connect with the CBHC in their county of release. Ask what CBHC has been identified, whether a first appointment has been arranged, and whether Medicaid enrollment is underway. MAT continuity at release should also be specifically arranged for people receiving MAT inside DCR.
What can families do if mental health care is denied in WV?
Provide psychiatric documentation at intake. Know PSIMED is the clinical contractor -- document all care requests and responses. Know the mental hygiene transfer process (WV Code § 15A-4-19; DCR Policy Directive 410.19) for hospital referrals. Know Sharpe Hospital as the primary psychiatric referral. Know the transfer process fragmentation risk -- document all transfer requests and follow up. Ask about MAT for OUD/AUD. Ask about G.O.A.L.S. for co-occurring SUD. Ask about CBHC reentry connections. File DCR grievances. Contact Disability Rights of West Virginia (drofwv.org) for legal advocacy.
Who oversees mental health care in West Virginia prisons?
DCR (Commissioner William Marshall) manages corrections operations; PSIMED provides clinical mental health care under contract. The WV Legislature's Joint Committee on Finance and Administration receives presentations on prison mental health care. No federal court actively exercises oversight of DCR prison mental health. William R. Sharpe Jr. Hospital (Department of Health Facilities) provides inpatient psychiatric care for DCR transfers. Disability Rights of West Virginia (DRoWV, drofwv.org) is the federally mandated P&A organization monitoring conditions for people with mental illness and disabilities in DCR. ---
Stay Connected with InmateAid
Reach Your Loved One in West Virginia
InmateAid helps families stay in touch. Set up discounted calls, send letters and photos, add money, or send approved magazines - all in one place.