People with severe mental illness (SMI) face significant challenges when reintegrating from correctional facilities back to the community. These include increased recidivism risk, homelessness and mental health deterioration. Although specialised reintegration programmes were developed to address the needs of this vulnerable population, their effectiveness remains unclear owing to mixed findings reported in the literature.

We performed a systematic review to synthesise and evaluate available evidence on reintegration programmes designed specifically for people with SMI.

Studies were included if they focused on adults with SMI transitioning from correctional facilities to community settings. The search was conducted through 10 January 2026. Two reviewers independently screened eligible studies and scored the appropriate risk of bias tools under supervision. A narrative analysis was adopted given the heterogeneity of methodologies and outcomes.

We identified 26 eligible studies, of which 11 were longitudinal, seven were randomised controlled trials, 3 had an AB design, 2 quasi-experimental, 2 retrospective and 1 brief report. The median number of participants involved in these studies was 207 (range: 22–3086). Studies employed various interventions, including peer mentoring, critical time intervention models, case management and therapeutic community. Results showed mixed effectiveness: some programmes demonstrated reduced recidivism and improved mental health service engagement, whereas others had minimal impact or even counterintuitive increases in re-imprisonment. Programmes generally showed better outcomes with a longer duration and comprehensive aftercare components.

Reintegration programmes show promise, but current approaches demonstrate variable efficacy. Successful interventions appear to require comprehensive, sustained support addressing multiple domains including mental health treatment, housing, employment and social support.

Although the United States incarcerates nearly two million people, the epidemiology of psychiatric disorders in correctional populations is not well understood, and no study has examined temporal trends in psychiatric disorder prevalences within a single correctional system. This study assessed how psychiatric disorder prevalences have changed in the Texas Department of Criminal Justice (TDCJ), the largest American state prison system housing post-conviction, sentenced individuals.

This retrospective cohort study of TDCJ electronic medical record data from 1 January 2016 through 31 December 2023 included all persons incarcerated for any duration during that period. Diagnoses were based on International Classification of Disease (ICD-10) diagnostic codes. Outcomes were annual prevalences of depressive, bipolar and schizophrenia spectrum disorders stratified by age, race and sex. Cochran-Armitage Tests were used to assess temporal trends within each stratum. Two-way interactions were assessed by fitting Generalized Estimating Equations models using autoregressive correlation with repeated subjects.

The overall population ranged from 170,269 to 222,798 individuals. Approximately, one-third were White (34.5–35.4%), one-third Black (31.0–32.3%), and one-third Hispanic (32.7–33.5%). Most were aged 30–49 (52.8–57.3%), and men (88.9–90.7%) outnumbered women (9.3–11.1%). The prevalences (per 100 [95% CI]) of psychiatric disorders generally increased when comparing 2016 to 2023. Depressive disorders increased the most among those aged 30–49 (5.23 [5.10–5.35] to 6.71 [6.56–6.86]), Hispanic individuals (3.86 [3.72–4.00] to 5.72 [5.53–5.90]), and men (4.72 [4.63–4.82] to 6.53 [6.42–6.65]). Bipolar disorders increased the most among those aged ≥50 (2.57 [2.42–2.72] to 3.46 [3.29–3.63]), Hispanic individuals (1.31 [1.23–1.40] to 2.23 [2.11–2.35]), and men (2.26 [2.20–2.33] to 3.12 [3.04–3.20]). Schizophrenia spectrum disorders increased the most among those aged ≤29 (1.33 [1.24–1.42] to 2.52 [2.35–2.68]), Hispanic individuals (1.53 [1.44–1.62] to 3.21 [3.35–4.40]), and women (1.27 [1.56–1.89] to 4.24 [3.95–4.53]). When stratified by demographic variables, trend tests were significant for nearly all comparisons (P < 0.0001), and all two-way interactions were significant (P < 0.0001).

The prevalences of major psychiatric disorders in the Texas prison system increased when comparing 2016 to 2023, with certain disorders rising more rapidly than others within specific subgroups. These findings emphasize the need for expanded mental health treatment options and resources within correctional settings.