The COVID-19 pandemic has highlighted a lack of access to services as well as exposed systemic barriers, especially for incarcerated populations. The use of technology to address these barriers has seen a recent increase, but this population is often left out of these considerations. Social development responses targeted for this population are critical to meet mental health needs and address human rights concerns. According to the U.S. Department of Justice (Bronson & Berzofsky, 2017), 14% of individuals who are incarcerated in prisons and 26% of those in jails met criteria for serious psychological distress, and 37% in prisons and 44% in jails had a history of mental illness. For individuals with serious mental illnesses, there is a greater risk of recidivism after their release (Baillargeon et al., 2010), resulting in jails and prisons serving as the primary source for mental health services for those individuals who spend more time in facilities than in the community.

Thus, access to high quality mental health services for individuals who are incarcerated is imperative (Kupers & Toch, 1999). Yet, mental health services in jails and prisons are not meeting the need (i.e., only 36% of those who met criteria for serious psychological distress in prisons and 30% of those who met criteria in jails were currently receiving treatment; Bronson & Berzofsky, 2017). Mental health needs are left unrecognized (Trestman et al., 2007) and unaddressed (Bronson & Berzofsky, 2017). Many barriers to adequate treatment exist due to the nature of jails and prisons (e.g., physically distant from populated areas; punitive environment).

This paper seeks to address this need through incorporating technology in jails and prisons as a social innovation approach. Telemental health, or the delivery of mental health services over technological platforms, can serve as one such resource to be leveraged to address these barriers and expand access to mental health care for individuals who are incarcerated. As the research in this area is limited, this presentation aims to serve as a framework for future considerations of the benefits and limitations of telemental health services as a tool for addressing the human rights crisis of mental health care in jails and prisons.

Telehealth addresses major constraints to care for individuals who are incarcerated, including the limited number of clinicians (e.g., Leonard, 2004) particularly for non-English speaking individuals, gaps in care between incarceration and reentry (Baillargeon et al., 2010), lack of resources for training clinicians in jails and prisons (Birmingham et al., 2000), and privacy concerns (e.g., Lexcen et al., 2006). The paper will also address potential drawbacks (e.g., cost; access to the necessary technology) as well as solutions to address these concerns. Overall, the considerations explored call for further examination of implementing telemental health care in jails and prisons. While our paper addresses incarceration in the context of the United States, the framework has the potential to be implemented globally. By leveraging this technology, jails and prisons can address human rights concerns of individuals who are incarcerated by meeting their mental health needs.

With such dire consequences, access to high quality mental health services for all individuals who are incarcerated is imperative (Kupers & Toch, 1999), especially when considering health care as a human right. Yet, mental health services in jails and prisons are not meeting the need (i.e., only 36% of those who met criteria for serious psychological distress in prisons and 30% of those who met criteria in jails were currently receiving treatment; Bronson & Berzofsky, 2017). In some cases, mental health needs are left unrecognized (Trestman et al., 2007), while in others, mental health concerns are left unaddressed (Bronson & Berzofsky, 2017).

Barriers to adequate mental health care include a lack of providers (e.g., Leonard, 2004), insufficient resources for training (Birmingham et al., 2000), privacy and safety concerns (Lexcen et al., 2006), and time constraints (Deslich et al., 2013). Many of these barriers exist due to the nature of jails and prisons (e.g., physically distant from populated areas; punitive environment), so an alternate method of providing services to individuals who are incarcerated that is beyond the walls of jails and prisons should be explored.

First, telehealth addresses one of the major constraints to care for individuals who are incarcerated, the limited number of clinicians (e.g., Leonard, 2004). Since service providers would no longer need to live in close proximity to facilities, telehealth offers an opportunity to expand the network of individuals who can provide mental health care, including the potential to provide greater access to bilingual clinicians. This is especially crucial in rural areas, where there is a lack of providers in the general population (Holzer III et al., 2000), as well as in jails and prisons (Ruddell & Mays, 2007). Some facilities in rural areas have already implemented telehealth for mental health services and preliminary results show positive outcomes (Manfredi et al., 2005; Batastini et al., 2020; Kaftarian, 2020). As an added benefit, in all geographic locations, individuals who were receiving mental health services prior to their incarceration may be able to continue care with their same provider, which is likely to have positive effects given the presence of a strong therapeutic relationship between the clinician and client (Norcross & Lambert, 2018). Additionally, for all individuals who are incarcerated, having a connection to an outside provider over telehealth offers the opportunity for them to continue care with the same clinician upon reentry, addressing the issue of a gap in care between incarceration and reentry (Baillargeon et al., 2010).

Using outside providers through telehealth services can also help address the lack of resources for training clinicians in jails and prisons (Birmingham et al., 2000). The opportunity here is in increasing the quality of care that individuals who are incarcerated are receiving. Even the best-trained clinicians cannot specialize in treating all disorders and all treatment modalities, and with the small number of mental health staff in jails and prisons (e.g., Leonard, 2004), this means that there is a limited number of areas that are these clinicians’ areas of expertise. With the expansion of the clinical network through telehealth, there is an opportunity for more individualized, specialized care that can best fit the needs of clients (Levant & Shlien, 1984). For example, a clinician who specializes in anxiety could be matched with individuals presenting with anxiety symptoms, while a provider who is highly trained in treatments for schizophrenia could serve as the clinician for those diagnosed with this disorder. This vision for care does not negate the training that in-person providers in jails and prisons have, especially their specialized expertise for care in forensic settings, so it is essential that telehealth providers that plan to work with incarcerated populations receive training in this area prior to delivering services.

Another concern in facilities is safety. This may be especially true for individuals who are incarcerated and have a mental health concern, as they are more likely to be written up for or charged with either a verbal or physical assault of correctional staff or another incarcerated individual than the rest of the population in jails and prisons (Bronson & Berzofsky, 2017). Due to these safety concerns, individuals who are incarcerated are often shackled and accompanied from their housing to the location where they will receive treatment. This process takes time, which can be frustrating for both the individual and staff and takes away from time spent in care and the number of individuals which can be seen (Deslich et al., 2013). In cases where telehealth is provided over the incarcerated individual’s own personal tablet, this time constraint is eliminated. Individuals can receive much faster access to care, and it can be on their own schedule as planned with their clinician. This provides the clinical benefit of a greater sense of autonomy for individuals (e.g., Ryan & Deci, 2008) who are incarcerated, which is often devoid in jails and prisons.

Another way that safety concerns are addressed is by correctional officers remaining close by during sessions, which can create privacy concerns when individuals are sharing confidential information with their clinicians (Lexcen et al., 2006). As there are reduced safety concerns when a telehealth platform is used, correctional officers should not need to monitor as closely. Thereby, this allows for the opportunity for more privacy in sessions and increased Health Insurance Portability and Accountability Act (HIPAA) compliance.

While there are benefits to using telehealth for mental health care in jails and prisons, there are concerns of cost and access to the necessary technology (e.g., technological literacy; connectivity). However, studies on telehealth in these facilities have shown a decrease in costs (Deslich et al., 2013). More research in this area is needed specifically for mental health care beyond telepsychiatry. Further exploration is also needed on how the infrastructure of jails and prisons can support the technology for telehealth platforms. Some incarcerated individuals already having access to computer tablets in jails and prisons could make the transition easier (Farley & Murphy, 2012), but research on this is warranted to support the move to telemental health services.

There is also the valid question of the efficacy of care over these platforms when compared to in-person treatment. Overall, the literature shows telemental health in the general population is an effective way of delivering treatment (e.g., Hilty et al., 2013). In addition, research on services for individuals who are incarcerated show that they found their therapeutic relationships over telehealth services just as positive as when services were in person (Morgan et al., 2008).