Over the past 40 years, the United States (US) has witnessed a 500 percent increase in the number of people sentenced to correctional institutions, resulting in a current incarcerated population of approximately 2.2 million people, which is the largest incarcerated population in the world (Sentencing Project 2021). This extraordinary rise in mass incarceration was coupled with a reduction in the number of public mental health hospitals across the US, making correctional agencies one of the primary mental health institutions available in the country (Brinkley-Rubinstein 2013; Fellner 2006). Today, correctional agencies across the US are facing a mental health crisis. Rates of mental health problems among incarcerated individuals are staggering, with over half of incarcerated people reporting some sort of mental health condition (James and Glaze 2006). Those with diagnosed mental health disorders are overrepresented within prisons (Prins 2014), and several report using psychiatric mediation while incarcerated (Wilper et al. 2009).

The high rates of inmates with poor mental health have created noticeable impacts. Already strained prison budgets must grapple with the increased costs associated with mental health care (Kim et al. 2015; Kinsella 2004), and correctional institutions have been forced to take on functions more associated with therapeutic programs for which they were not originally designed (Prins 2014). People with mental health problems are more likely to re-offend, adding increased pressure to already overcrowded institutions (Baillargeon et al. 2009). Beyond the prison walls, those who have poor mental health at release are less likely to secure stable employment (Mallik-Kane and Visher 2013), and have higher rates of general disability (Schnittker et al. 2012). In all, this evidences a need for research that investigates the reasons behind the high rates of poor mental health among correctional populations. Traditionally, studies examining the potential causes of inmate mental health and other behavioral outcomes have been implicitly or explicitly organized around either the importation or the deprivation theoretical models. Importation theory argues that individual characteristics and life experience factors that the individual “imports” into the prison environment explain inmate behavioral outcomes, while deprivation theory emphasizes the role of the depriving aspects of the prison environment (dubbed the “pains of imprisonment”) as being crucial for understanding inmate behavioral outcomes (Dye 2010). A third theoretical model referred to as the integrated/combined theory attempts to combine the importation and deprivation models (Dear 2006; Liebling 2006). As a synthesis of the importation and deprivation models, the integrated/combined model places special emphasis on the interplay between imported characteristics and prison deprivations. Here, it is argued that individual characteristics interact with prison deprivations, creating conditional impacts of deprivations on inmate behavioral outcomes. These conditional impacts are often understood