Initial Designation Process: Mental Health Care Levels I-IV

Medical Health Mental Health
Before any initial designation decision is made, DSCC staff assess a provisional CARE LEVEL from I – IV for each inmate. BOP institutions also have a Mental Health (MH) care level assignment which reflects the mental healthcare resources available at that facility.


Further the BOP has available their National Programs Psychology Counseling (group or individual), available at a limited number of their facilities. Therefore, it is incumbent upon the legal defense team in preparation of their PSR, to work with the court and prosecution in order to get their client designated appropriately.

The Designation and Sentencing Computation Center (DSCC) designates those inmates with Mental, Care Levels 1 and 2.

For those inmates with Mental Healthcare, Care Levels 3 and 4, the designation decision will be made by The Office of Medical Determinations and Transportation (OMDT).

* Unfortunately, in general the BOP is not equipped to provide any meaningful treatment for the following underlying disorders (just to mention a few) – for example:

  • Post-traumatic stress
  • Major depressive
  • Bipolar

As medical staffing differ from one facility to another, and if the care is available within the BOP; this may necessitate a transfer to a facility further away from their home.

*Alan Ellis and J. Michael Henderson (July 19, 2018); How To Do Time- Part IV.


Mental Health Care Level I
  • No Remarkable Issues.
  • No history of regular Mental Illness Interventions, seeking help should there be a returning episode.
Mental Health Care Level II
  • ‘Routine and/or Crisis Oriented Outpatient’ Care.
  • Outpatient or brief crisis oriented care.
  • Controlled with medication.
  • May require suicide watch or brief observation.
Mental Health Care Level III
  • ‘More Severe Outpatient’ or Residential Mental Healthcare.
  • May require weekly mental healthcare visits or Residential Psychology Treatment.
Mental Health Care Level IV
  • ‘Inpatient’ Psychiatrist Monitored, includes those who are:
    • Gravely disabled and cannot function in general population as in MH III.
    • Have a current or recent historical need for inpatient psychiatric care.
    • Requires psychotropic medication control.