It has been estimated that as many as 10 to 15 percent of inmates in prisons and jails are seriously mentally ill and in need of psychiatric care, and that up to 5 percent are actively psychotic. For practical purposes, there are no state mental hospitals; jails and prisons have become, by default, the public institutions for care of the mentally ill and must establish programs to provide for the safety, security and humane treatment of that segment of the incarcerated population. This may involve establishing separate mental health units, for the safety of the mental patients and the stability and manageability of the other inmates' quarters. Failure to appreciate the chronicity of mental illness leads to substitution of crisis intervention for regular follow-up care. In addition, standard correctional punishment practices are often inflicted on mentally ill inmates, although punitive methods rarely have helped to control mental patients' disruptive behavior. Treatment teams should employ clinically appropriate strategies in response to difficult and refractory behavior. References