Emerging Issues in Behavioral Health and the Criminal Justice System

Learn about specific issues that further complicate the lives of people with behavioral health conditions in U.S. criminal and juvenile justice systems.


One of SAMHSA’s unique contributions to this area is its focus on trauma and violence. SAMHSA recognizes that the majority of people with behavioral health issues that are involved with the justice system have significant histories of trauma and exposure to personal and community violence. Involvement with the justice system further exacerbates the trauma for these individuals. In many of SAMHSA’s programs and initiatives focusing on the intersection of behavioral health and criminal justice, trauma is a key component. Increasing the understanding of traumatic responses enables not only behavioral health providers, but also justice system personnel—from frontline workers to probation and parole officers, judges, lawyers and court administrators—to better respond and develop more effective treatment programs for both adults and juveniles in the justice system. In most of its justice-focused grant programs, SAMHSA provides extensive training and technical assistance on understanding trauma and implementing trauma-informed approaches for both the behavioral health and criminal justice systems.

For more information on how SAMHSA’s programs address this issue, visit the following SAMHSA centers:

The National Child Traumatic Stress Network also offers a number of resources in this area.

Risk-Needs-Responsivity (RNR)

SAMHSA incorporates the evidence-based RNR approach to offender rehabilitation, which is intended to reduce this population’s risk of re-offending and thereby protect the safety of the community. The concept of RNR is considered a best practice for corrections professionals and has been shown to effectively reduce recidivism by as much as 35% in certain settings. Research has shown that non-adherence to the RNR principles in service delivery is not only ineffective but can also be detrimental to offender treatment outcomes.

In conjunction with the Public Welfare Foundation and the Department of Justice’s Bureau of Justice Assistance, SAMHSA supported efforts by the Center for Advancing Correctional Excellence at George Mason University to develop an RNR Simulation Tool targeted for use by local, state, and/or federal agencies. The RNR approach integrates the science around effective screening, assessment, and treatment programs to improve individual and system outcomes. It aims to match various justice-involved individuals to behavioral health services that are appropriate for the needs of the offender.

Medication-Assisted Treatment (MAT)

According to a Legal Action Center report – 2011 (PDF | 815 KB), an estimated 65% of people in U.S. prisons or jails have a substance use disorder, and many of these individuals are addicted to opioids. Rates are at least as high in all other phases of the criminal justice system. This significant amount of substance use among people with criminal justice involvement has far-reaching consequences, including higher recidivism rates, harm to families and children of these individuals, and negative public health effects, including the transmission of infectious diseases and overdose deaths.

Research has firmly established that medication-assisted treatment (MAT) for opioid dependence reduces addiction and related criminal activity more effectively and at far less cost than incarceration. MAT uses medications such as methadone, buprenorphine, or naltrexone. Numerous studies have also shown that MAT reduces drug use, disease rates, and criminal activity among opiate-addicted people. However, the use of MAT with justice-involved offenders is unevenly applied and in some circumstances has been denied due to concerns about costs and diversion of the medication.

SAMHSA encourages the appropriate use of MAT in the justice system through its grant programs and ongoing education and training. SAMHSA convened an expert panel on the Legality of Denying Acess to Medication-Assisted Treatment in the Criminal Justice System (PDF | 6 MB). SAMHSA also contracted with the National Drug Court Institute in 2013 to develop a fact sheet on naltrexone. SAMHSA’s Behavioral Health Treatment Services Locator identifies facilities that offer methadone, buprenorphine, or naltrexone (oral and injectable).

Health Reform

SAMHSA’s work in health reform includes a special focus on justice-involved behavioral health populations. The Affordable Care Act will be critical in resolving the coverage gap for these individuals. Agencies that interact with justice-involved individuals have been provided with training and support for outreach, engagement, and enrollment in health insurance enrollment opportunities. 

Disproportionate Minority Contact (DMC)

DMC has been an ongoing issue in the criminal and juvenile justice system with the over-representation of racial and ethnic population groups detained and incarcerated. This issue is exacerbated for specific populations with mental and substance use disorders that tend to face a disproportionate lack of medical/surgical and behavioral health services; have higher rates of being uninsured; tend not to seek care in the earliest stages of a disorder; or have a regular primary care provider, and tend not to have advocates to help them navigate complex health care systems. Minority youth with behavioral health issues are more readily referred to juvenile justice than to specialty primary care compared to other populations of young people. They are also more likely than Caucasian youth to end up in the juvenile justice system due to harsh disciplinary suspension and expulsion practices in schools. The SAMHSA Office of Behavioral Health Equity has addressed this issue through its efforts to address health disparities.

Last Updated: 12/11/2017