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Your goal in essay writing is to convey your message as best as possible. ProWritingAid's essay checker is the first step towards doing this.

Get Rid of Spelling Errors

ProWritingAid’s essay checker will show you what it thinks are spelling errors and present you with possible corrections. If a word is flagged and it’s actually spelt correctly you can always choose to ignore the suggestion.

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Professors aren’t fans of poor grammar because it interrupts your message and makes your essay hard to understand. ProWritingAid will run a grammar check on your paper to ensure that your message is precise and is being communicated the way you intended.

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A missing period or comma here and there may not seem that serious, but you’ll lose marks for punctuation errors. Run ProWritingAid’s paper checker to use the correct punctuation marks every time and elevate your writing.

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Make sure that in the grand scheme your language is not too complicated. The essay checker's built in readability report will show if your essay is easy or hard to read. It specifically zones in on paragraphs that might be difficult to read so you can review them.

What Else Can the Essay Checker Do?

The editing tool analyzes your text and highlights a variety of key writing issues, such as overused words, incohesive sentence structures, punctuation issues, repeated phrases, and inconsistencies.

You don’t need to drown your essay in words just to meet the word count. ProWritingAid’s essay checker will help to make your words more effective. You'll get to construct your arguments and make sure that every word you use builds towards a meaningful conclusion.

Transition words help to organize your ideas by showing the relationship between them. The essay checker has a built in Transition report that highlights and shows the percentage of transitions used in your essay. Use the results to add transitions where necessary.

An engaging essay has sentences of varying lengths. Don’t bore your professor with long, rambling sentences. The essay checker will show you where you need to break long sentences into shorter sentences, or add more sentence length variation.

Generally, in scholarly writing, with its emphasis on precision and clarity, the active voice is preferred. However, the passive voice is acceptable in some instances. When you run your essay through ProWritingAid’s essay checker, you get feedback on whether you 'r e using the passive or active voice to convey your idea.

There are academic specific power verbs like appraise , investigate , debunk , support , etc., that can add more impact to your argument by giving a more positive and confident tone. The essay checker will check your writing for power verbs and notify you if you have less than three throughout your essay.

It's easy to get attached to certain phrases and use them as crutches in your essays but this gives the impression of boring and repetitive writing. The essay checker will highlight your repeats and suggest contextually relevant alternatives.

Gain access to in-house blog reports on citations, how to write a thesis statement, how to write a conclusion, and more. Venture into a world of resources specific to your academic needs.

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Questions & Answers

1. how do i use the essay checker online tool.

You can either copy and paste your essay in the essay checker field or upload your essay from your computer. Your suggestions will show once you enter text. You’ll see a number of possible grammar and spelling issues. Sign up for free to get unlimited suggestions to improve your writing style, grammar, and sentence structure. Avoid unintentional plagiarism with a premium account.

2. Does the essay checker work with British English and American English?

The essay checker works with both British English and American English. Just choose the one you would like to use and your corrections will reflect this.

3. Is using an essay checker cheating?

No. The essay checker won’t ever write the essay for you. It will point out possible edits and advise you on changes you need to make. You have full autonomy and get to decide which changes to accept.

4. Will the essay checker auto-correct my work?

The essay writing power remains in your hands. You choose which suggestions you want to accept and you can ignore those that you don’t think apply.

5. Is there a student discount?

Students who have an eligible student email address can get 20% off ProWritingAid Premium. Email [email protected] from your student email address to access your discount.

6. Does ProWritingAid have a plagiarism checker?

Yes! ProWritingAid’s plagiarism checker will check your work against over a billion web-pages, published works, and academic papers, so you can be sure of its originality. Find out more about pricing for plagiarism checks here .

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Sentence correction worksheets terms of use, beginning level.

• Beginning Sentence Correction Worksheet 1
• Beginning Sentence Correction Worksheet 1 Answers
• Beginning Sentence Correction Worksheet 2
• Beginning Sentence Correction Worksheet 2 Answers
• Beginning Sentence Correction Worksheet 3
• Beginning Sentence Correction Worksheet 3 Answers
• Beginning Sentence Correction Worksheet 4
• Beginning Sentence Correction Worksheet 4 Answers
• Beginning Sentence Correction Worksheet 5
• Beginning Sentence Correction Worksheet 5 Answers
• Beginning Sentence Correction Worksheet 6
• Beginning Sentence Correction Worksheet 6 Answers
• Beginning Sentence Correction Worksheet 7
• Beginning Sentence Correction Worksheet 7 Answers
• Beginning Sentence Correction Worksheet 8
• Beginning Sentence Correction Worksheet 8 Answers
• Beginning Sentence Correction Worksheet 9
• Beginning Sentence Correction Worksheet 9 Answers
• Beginning Sentence Correction Worksheet 10
• Beginning Sentence Correction Worksheet 10 Answers
• Beginning Sentence Correction Worksheet 11
• Beginning Sentence Correction Worksheet 11 Answers
• Beginning Sentence Correction Worksheet 12
• Beginning Sentence Correction Worksheet 12 Answers
• Beginning Sentence Correction Worksheet 13
• Beginning Sentence Correction Worksheet 13 Answers
• Beginning Sentence Correction Worksheet 14
• Beginning Sentence Correction Worksheet 14 Answers
• Beginning Sentence Correction Worksheet 15
• Beginning Sentence Correction Worksheet 15 Answers
• Beginning Sentence Correction Worksheet 16
• Beginning Sentence Correction Worksheet 16 Answers
• Beginning Sentence Correction Worksheet 18
• Beginning Sentence Correction Worksheet 18 Answers
• Beginning Sentence Correction Worksheet 20
• Beginning Sentence Correction Worksheet 20 Answers

Intermediate Level

• Intermediate Sentence Correction Worksheet 1
• Intermediate Sentence Correction Worksheet 1 Answers
• Intermediate Sentence Correction Worksheet 2
• Intermediate Sentence Correction Worksheet 2 Answers
• Intermediate Sentence Correction Worksheet 3
• Intermediate Sentence Correction Worksheet 3 Answers
• Intermediate Sentence Correction Worksheet 4
• Intermediate Sentence Correction Worksheet 4 Answers
• Intermediate Sentence Correction Worksheet 5
• Intermediate Sentence Correction Worksheet 6 Answers
• Intermediate Sentence Correction Worksheet 7
• Intermediate Sentence Correction Worksheet 8 Answers
• Intermediate Sentence Correction Worksheet 9
• Intermediate Sentence Correction Worksheet 9 Answers

Advanced Level

• Advanced Sentence Correction Worksheet 1
• Advanced Sentence Correction Worksheet 1 Answers
• Advanced Sentence Correction Worksheet 2
• Advanced Sentence Correction Worksheet 2 Answers
• Advanced Sentence Correction Worksheet 3
• Advanced Sentence Correction Worksheet 3 Answers
• Advanced Sentence Correction Worksheet 4
• Advanced Sentence Correction Worksheet 4 Answers
• Advanced Sentence Correction Worksheet 5
• Advanced Sentence Correction Worksheet 5 Answers
• Advanced Sentence Correction Worksheet 6
• Advanced Sentence Correction Worksheet 6 Answers
• Advanced Sentence Correction Worksheet 7
• Advanced Sentence Correction Worksheet 7 Answers

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Essay Writing Practice

Instructions:  Read the passage in the essay writing practice correction exercise below. Choose the best version of the underlined parts of the sentences from the choices provided. You will see your score when you have finished the quiz.

1. [1] The study of the philosophy of human nature is often regarded as an investigation for the meaning of life . [2] This subject deals with four key problem areas:  human choice , human thought, human personality, and the unity of the human being. [3] A consideration of these four problem areas can include scientific also and artistic viewpoints on the nature of human lives.

The word “investigation” takes the preposition “into.”

2. [1] The study of the philosophy of human nature is often regarded as an investigation for the meaning of life . [2] This subject deals with four key problem areas:  human choice , human thought, human personality, and the unity of the human being. [3] A consideration of these four problem areas can include scientific also and artistic viewpoints on the nature of human lives.

The colon is needed before stating items in a list within a sentence like this one.

3. [1] The study of the philosophy of human nature is often regarded as an investigation for the meaning of life . [2] This subject deals with four key problem areas:  human choice , human thought, human personality, and the unity of the human being. [3] A consideration of these four problem areas can include scientific also and artistic viewpoints on the nature of human lives.

The word “nature” is singular, so the word “life” should also be singular.

4. [4] The first problem area human choice, asks us to confront many questions. [5] Among these is the important inquiry as to whether human beings can really make decisions that can change their futures. [6] However, it investigates to what extent the individual’s future is fixed and pre-determined by cosmic forces outside the control of human beings.

The phrase “human choice” defines the first problem area. It is extra information in the sentence (called an appositive phrase). These kinds of phrases need commas before the first word and after the last word of the phrase.

5. [4] The first problem area human choice, asks us to confront many questions. [5] Among these is the important inquiry as to whether human beings can really make decisions that can change their futures. [6] However, it investigates to what extent the individual’s future is fixed and pre-determined by cosmic forces outside the control of human beings.

The noun phrase “human beings” is plural, so the noun (futures) also need to be plural. The pronoun “their” is used in order to be gender-neutral.

6. [4] The first problem area human choice, asks us to confront many questions. [5] Among these is the important inquiry as to whether human beings can really make decisions that can change their futures. [6] However, it investigates to what extent the individual’s future is fixed and pre-determined by cosmic forces outside the control of human beings.

Be careful with questions on linking words like this one. We are changing the subject from decision making to a fixed destiny, so we need a linking word like “conversely.” Note that “in spite of” would not be grammatically correct in this sentence.

7. [7] In the second problem area, human thought, epistemology is considering. [8] Epistemology means the study of knowledge, it should not be confused with ontology, the study of being or existence

We are emphasizing the inquiry, not the people making the inquiry. So we need the passive voice in this sentence. The present simple passive (is considered) should be used here since we are describing a current inquiry.

8. [7] In the second problem area, human thought, epistemology is considering. [8] Epistemology means the study of knowledge, it should not be confused with ontology, the study of being or existence

Here we have two complete sentences that have incorrectly been joined with a comma. This type of error is called a comma splice. To correct it, you need to use a semicolon. Alternatively, you could put in a period and begin a new sentence with “It [. . .]”.

9. [9] The third key issue, human personality, emphasized aspects of human life that are beyond mental processes. [10] They take a look at emotional, spiritual, and communal elements. [11] Yet, the study of the communal aspect focuses on community and communication, instead of the philosophy of the state.

This is a question on using the correct verb tense. In this sentence, we continue to describe a current inquiry. Therefore, the simple present tense (emphasizes) is needed here.

10. [9] The third key issue, human personality, emphasized aspects of human life that are beyond mental processes. [10] They take a look at emotional, spiritual, and communal elements. [11] Yet, the study of the communal aspect focuses on community and communication, instead of the philosophy of the state.

In this sentence, we continue to describe “the third key issue” (which is mentioned in the previous sentence.) The phrase “the third key issue” is singular, so we need the singular pronoun (it) here.

11. [9] The third key issue, human personality, emphasized aspects of human life that are beyond mental processes. [10] They take a look at emotional, spiritual, and communal elements. [11] Yet, the study of the communal aspect focuses on community and communication, instead of the philosophy of the state.

We are continuing the idea of “communal elements” from the previous sentence. So we need a linking word that shows emphasis or the introduction of a new point. The word “importantly” gives emphasis to the idea, so it is the best answer.

12. [12] Finally, the fourth problem, the unity of the human being, explores the first three areas more full. [13] It asks if that there is any unifying basis for human choice, thought, and personality. [14] In other words, while the human is an inherently complex being, there must be a unity or wholeness which underlies these complications.

The sentence needs an adverbial phrase, so we need to use “more fully” rather than “more full.” Remember that adverbs often end in the -ly suffix. Placing the adverbial phrase (more fully) next to the verb (explores) provides the correct emphasis. This sentence structure is also correct grammatically.

13. [12] Finally, the fourth problem, the unity of the human being, explores the first three areas more full. [13] It asks if that there is any unifying basis for human choice, thought, and personality. [14] In other words, while the human is an inherently complex being, there must be a unity or wholeness which underlies these complications.

We need “whether there is” or “if there is” in this sentence since we are describing the conditions of the inquiry.

14. [12] Finally, the fourth problem, the unity of the human being, explores the first three areas more full. [13] It asks if that there is any unifying basis for human choice, thought, and personality. [14] In other words, while the human is an inherently complex being, there must be a unity or wholeness which underlies these complications.

When you see “or” in a sentence you need to use the singular form (underlies) of the verb. We need to continue to use the present simple tense here. So the sentence is correct as it is written.

[1] The study of the philosophy of human nature is often regarded as an investigation for the meaning of life . [2] This subject deals with four key problem areas:  human choice, human thought, human personality, and the unity of the human being. [3] A consideration of these four problem areas can include scientific also and artistic viewpoints on the nature of human lives.

[4] The first problem area human choice, asks us to confront many questions. [5] Among these is the important inquiry as to whether human beings can really make decisions that can change their futures. [6] However, it investigates to what extent the individual’s future is fixed and pre-determined by cosmic forces outside the control of human beings.

[7] In the second problem area, human thought, epistemology is considering. [8] Epistemology means the study of knowledge, it should not be confused with ontology, the study of being or existence

[9] The third key issue, human personality, emphasized aspects of human life that are beyond mental processes. [10] They take a look at emotional, spiritual, and communal elements. [11] Yet, the study of the communal aspect focuses on community and communication, instead of the philosophy of the state.

[12] Finally, the fourth problem, the unity of the human being, explores the first three areas more full. [13] It asks if that there is any unifying basis for human choice, thought, and personality. [14] In other words, while the human is an inherently complex being, there must be a unity or wholeness which underlies these complications.

The student wants to add a sentence to the second paragraph emphasizing the reasons for the importance of human choice. Which of the following sentences accomplishes this?

Paragraph two talks about whether or not human beings have control over their futures. Accordingly, we need a sentence that links the idea of control to the idea of the future. Sentence E is the only choice that accomplishes this.

More Essay Writing Practice

Instructions: Look at each of the numbered clauses and phrases sentences in the essay writing practice exercise below. If the part of the sentence has an error, identify and correct it. Then check your answers in the next section.

[1] Antarctica is a mysteriously and remote continent [2] one which is often forgotten by virtue of its geographical location. [3] Yet, the Antarctic could even be considered desolate and isolated. [4] Nevertheless, an understanding of the organisms that inhabit this continent was critical [5] to our comprehension of the world as a global community. [6] For this reason, the southernmost continent has the source of a great deal of scientific investigation.

[7] Many notable recent research has come from America and Great Britain. [8] The British Antarctic Survey, sponsored with the Natural Environment Research Council of the United Kingdom, [9] and the United States Antarctic Resource Center, a collaborate of the United States Geological Survey Mapping Division and the National Science Foundation, [10] are forerunners in the burgeoning currently field of research in this area.

[11] This corpus of research has resulted in an abundance of factual data on the Antarctic. [12] For example, one now know that more than ninety nine percent of the land is completely covered by snow and ice, [13] which making Antarctica the coldest continent on the planet. [14] This inhospitable climate, has not surprisingly, brought about the adaptation [15] of a plethora of plants and biological organisms on the continent present.

[16] An investigation for the sedimentary geological formations provides testimony to the process of adaptation. [17] Ancient sediment’s recovered from the bottom of Antarctic lakes, [18] bacteria as well as discovered in ice, [19] has reveal the history of climate change over the past 10,000 years. [20] Hopefully, this important research will continue into the future.

Essay Practice – Answers

• Change the adverb “mysteriously” to the adjective “mysterious”.

2. Remove the word “one” or put a comma after the word “continent”.

3. Remove the word “yet” at the head of the sentence and replace it with an emphatic phrase linker, like “Indeed” or “In fact”.

4. The sentence should be in the present tense since we are talking about the current relevance of the research. Therefore, “was” should be changed to “is”.

5. This phrase does not have an error.

6. Put the word “been” after the word “has”.

7. The word “many” should be changed to “much” since research is a non-countable noun.

8. Change the word “with” to the word ‘by”.

9. We are speaking about organizations (which are nouns), so the word “collaborate” should be changed to “collaboration” to use the noun form.

10. Move the word “currently” and put it after the word “are”.

11. There is no mistake in this sentence.

12. Subject-verb agreement is a problem in this part of the sentence. Change the word “one” to “we”. Alternatively, change “know” to “knows”.

13. Remember to use the present simple tense, so change “making” to “make”.

14. Remove the comma after “climate” and place it after “has” instead.

15. Place the word “present” before the word “on”.

16. There is a problem with the proposition “for”, which should be changed to “into”.

17. This is a question about unnecessary punctuation. Remove the apostrophe in the word “sentiment’s”.

18. Move the words “as well as” in front of the word “bacteria” in order to set up the comparison correctly.

19. Change the word “reveal” to “revealed” in order to correctly form the present perfect tense.

20. This sentence is correct as is is written.

Essay Writing – Practice Your Structure

You may be asked to write an essay as part of your standardized test. The essay may be human-read by an examiner, but many essays nowadays are written on a computer and graded by software.

The six following characteristics of your essay will be assessed:

Focus and purpose

This means that your essay should answer the question that has been posed. You will need to express your main idea in a clear way in the introduction of the essay.

The examiner or software assesses this aspect of your essay by searching for a thesis statement in the first paragraph of your essay, which should clearly indicate what you are going to speak about in the remainder of the essay.

Organization

Your essay should be divided into paragraphs, which have been set out in an organized manner. Each body paragraph should contain a point that supports your main idea. You should also include a conclusion that sums up the essay.

The examiner or software will look for logical paragraph divisions, as well as for linking words and phrases which indicate that a new paragraph is beginning.

Development and support

It is extremely important to elaborate on the main idea of your essay and maintain your point of view throughout your writing. Your essay should include examples and explanations that illustrate and support your viewpoint. Remember that if your essay topic presents a contentious issue, you need to take a stance on only one side, rather than stating both the pro’s and con’s.

Be sure to use linking words and phrases that signal that examples or reasons are being provided in the essay. These linking words and phrases include the following: such as, for example, for this reason, because of.

Sentence construction

You should write long and developed sentences that demonstrate a mastery of the English language.

Use advanced writing strategies like subordination and coordination to improve your writing style.

Avoid repeatedly beginning your sentences in the same way, such as “I think that.”

Remember to use a variety of sentence patterns, using other linking words and phrases like the following: therefore, in addition, furthermore, moreover, in conclusion.

Mechanics refers to the “rules” of English, particularly those of spelling, capitalization, and punctuation.

Your essay should be grammatically accurate and punctuated correctly.

Your spelling should also be correct.

Exercises to Improve your English

Try our free grammar exercises

Look at our essay writing topics

See “General Writing” at Purdue OWL (Online Writing Lab)

Reading Worksheets, Spelling, Grammar, Comprehension, Lesson Plans

Editing and Proofing Worksheets

A vital skill for young writers is to be able to revise and edit their writing. Recognizing an error in spelling, punctuation, grammar, and word usage takes some practice. The worksheets listed below give your student this important practice. You may use them for free in your classroom or at home. To read more about them or to download a printable PDF, simply click on the title. Check out all of our writing worksheets !

Make the Spelling Corrections

Encourage your students to look for spelling corrections with this “Correcting, Proofing, and Editing” worksheet.

Correct It!

Use this “Correcting, Proofing, and Editing” activity to teach your students the importance of proofreading by correcting spelling mistakes.

Correct the Paragraph

Have your students proofread and correct paragraphs with this helpful editing worksheet.

Correct the Spelling

Teaching your students to correct spelling is made easier with this helpful, printable writing activity.

Correcting Mistakes: Rewrite the Sentences

Encourage your students to check for sentence mistakes with this “Rewrite the Sentences” classroom activity.

Spot It: Unnecessary Words

Practice identifying unnecessary words with this printable worksheet on editing and proofing. Students will be asked to read through a series of sentences and circle the ones that contain unnecessary words. This activity is great for use both at home and in the classroom.

Spot It! Faulty Coordination

Help your students with their reading and writing skills by using this printable activity in class. With this worksheet on editing and proofing, students will be asked to read through ten sentences and identify the ones that contain faulty coordination. Ideal for 5th – 8th grade, but can be used where appropriate.

Correcting Mistakes in Sentences

Use these printable learning materials to teach your students how to correct sentence mistakes.

Editing and Proofing a Paragraph

Your students will further their editing and proofing skills by correcting a paragraph in this printable classroom worksheet.

Find the Misplaced Modifiers

See if you can identify the other misplaced modifiers in this printable grammar worksheet. This grammar activity for middle school students is great for improving reading and writing skills. While it is ideal for 7th – 9th grade, it can be used where needed. This misplaced modifiers activity is perfect for both parents and teachers to use in the classroom or at home.

Spelling: What’s Wrong, and What’s Right?

Your students will learn the difference between right and wrong in spelling with this “Proofing and Editing” worksheet.

Spot it! Which Are Grammatically Correct?

With this printable worksheet on editing and proofing, students will be asked to circle the number of the sentence that is grammatically correct. Ideal for 6th – 12th grade students, but can be used where needed.

Correct Spelling: Right or Wrong

In this “Right or Wrong” classroom activity, your students will correct spelling mistakes while proofreading the sentences on this worksheet.

Find It! Faulty Parallel Construction

Practice recognizing faulty parallel construction by completing this printable worksheet. This activity focuses on refining editing and proofing skills. It is ideal for high school students, but can be used where appropriate. Because it is made easy to print, this worksheet is great for use both at home and in the classroom by parents, teachers, or students. Click the link below to download and print the worksheet to get started.

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Cramming for an exam isn’t the best way to learn – but if you have to do it, here’s how

Senior Teaching Fellow in Education, University of Strathclyde

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Jonathan Firth does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Around the country, school and university students are hitting the books in preparation for exams. If you are in this position, you may find yourself trying to memorise information that you first learned a long time ago and have completely forgotten – or that you didn’t actually learn effectively in the first place.

Unfortunately, cramming is a very inefficient way to properly learn. But sometimes it’s necessary to pass an exam. And you can incorporate what we know about how learning works into your revision to make it more effective.

Read more: Exams: seven tips for coping with revision stress

A great deal of research evidence on how memory works over time shows that we forget new information very quickly at first, after which the process of forgetting slows down.

In practice, this means that very compressed study schedules lead to a catastrophic amount of forgetting.

A better option is to space out learning a particular topic more gradually and over a longer period. This is called the “spacing effect” and it leads to skills and knowledge being retained better, and for longer.

Research has found that we remember information better when we leave a gap of time between first studying something and revisiting it, rather than doing so straight away. This even works for short timescales – a delay of a few seconds when trying to learn a small piece of information, such as a pair of words, for instance. And it also works when the delay between study sessions is much longer .

In the classroom , spacing out practice could mean reviewing and practising material the next day, or delaying homework by a couple of weeks, rather than revisiting it as soon as possible. As a rule, psychologists have suggested that the best time to re-study material is when it is on the verge of being forgotten – not before, but also not after.

But this isn’t how things are learned across the school year. When students get to exam time, they have forgotten much of what was previously studied.

Better cramming

When it comes to actually learning – being able to remember information over the long term and apply it to new situations – cramming doesn’t work. We can hardly call it “learning” if information is forgotten a month later. But if you need to pass an exam, cramming can lead to a boost in temporary performance. What’s more, you can incorporate the spacing effect into your cramming to make it more efficient.

It’s better to space practising knowledge of a particular topic out over weeks, so if you have that long before a key exam, plan your revision schedule so you cover topics more than once. Rather than allocating one block of two hours for a particular topic, study it for one hour this week and then for another hour in a week or so’s time.

If you don’t have that much time, it’s still worth incorporating smaller gaps between practice sessions. If your exam is tomorrow, practice key topics in the morning today and then again in the evening.

Learning is also more effective if you actively retrieve information from your memory, rather than re-reading or underlining your notes. A good way to do this, incorporating the spacing effect, is to take practice tests. Revise a topic from your notes or textbook, take a half-hour break, and then take a practice test without help from your books.

An even simpler technique is a “brain dump” . After studying and taking a break, write down everything you can remember about the topic on a blank sheet of paper without checking your notes.

Change the way we teach

A shift in teaching practices may be needed to avoid students having to cram material they only half-remember before exams.

But my research suggests that teachers tend to agree with the idea that consolidation of a topic should happen as soon as possible, rather than spacing out practice in ways that would actually be more effective.

Teachers are overburdened and make heroic efforts with the time they have. But incorporating the spacing effect into teaching needn’t require radical changes to how teachers operate. Often, it’s as simple as doing the same thing on a different schedule .

Research has shown the most effective way to combine practice testing and the spacing effect is to engage in practice testing in the initial class, followed by at least three practice opportunities at widely spaced intervals. This is quite possible within the typical pattern of the school year.

For example, after the initial class, further practice could come via a homework task after a few days’ delay, then some kind of test or mock exam after a further gap of time. The revision period before exams would then be the third opportunity for consolidation.

Building effective self-testing and delayed practice into education would spell less stress and less ineffective cramming. Exam time would be for consolidation, rather than re-learning things that have been forgotten. The outcome would be better long-term retention of important knowledge and skills. As a bonus, school students would also gain a better insight into how to study effectively.

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When Prison and Mental Illness Amount to a Death Sentence

The downward spiral of one inmate, Markus Johnson, shows the larger failures of the nation’s prisons to care for the mentally ill.

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By Glenn Thrush

Photographs by Carlos Javier Ortiz

Glenn Thrush spent more than a year reporting this article, interviewing close to 50 people and reviewing court-obtained body-camera footage and more than 1,500 pages of documents.

• Published May 5, 2024 Updated May 7, 2024

Markus Johnson slumped naked against the wall of his cell, skin flecked with pepper spray, his face a mask of puzzlement, exhaustion and resignation. Four men in black tactical gear pinned him, his face to the concrete, to cuff his hands behind his back.

He did not resist. He couldn’t. He was so gravely dehydrated he would be dead by their next shift change.

Listen to this article with reporter commentary

“I didn’t do anything,” Mr. Johnson moaned as they pressed a shield between his shoulders.

It was 1:19 p.m. on Sept. 6, 2019, in the Danville Correctional Center, a medium-security prison a few hours south of Chicago. Mr. Johnson, 21 and serving a short sentence for gun possession, was in the throes of a mental collapse that had gone largely untreated, but hardly unwatched.

He had entered in good health, with hopes of using the time to gain work skills. But for the previous three weeks, Mr. Johnson, who suffered from bipolar disorder and schizophrenia, had refused to eat or take his medication. Most dangerous of all, he had stealthily stopped drinking water, hastening the physical collapse that often accompanies full-scale mental crises.

Mr. Johnson’s horrific downward spiral, which has not been previously reported, represents the larger failures of the nation’s prisons to care for the mentally ill. Many seriously ill people receive no treatment . For those who do, the outcome is often determined by the vigilance and commitment of individual supervisors and frontline staff, which vary greatly from system to system, prison to prison, and even shift to shift.

The country’s jails and prisons have become its largest provider of inpatient mental health treatment, with 10 times as many seriously mentally ill people now held behind bars as in hospitals. Estimating the population of incarcerated people with major psychological problems is difficult, but the number is likely 200,000 to 300,000, experts say.

Many of these institutions remain ill-equipped to handle such a task, and the burden often falls on prison staff and health care personnel who struggle with the dual roles of jailer and caregiver in a high-stress, dangerous, often dehumanizing environment.

In 2021, Joshua McLemore , a 29-year-old with schizophrenia held for weeks in an isolation cell in Jackson County, Ind., died of organ failure resulting from a “refusal to eat or drink,” according to an autopsy. In April, New York City agreed to pay $28 million to settle a lawsuit filed by the family of Nicholas Feliciano, a young man with a history of mental illness who suffered severe brain damage after attempting to hang himself on Rikers Island — as correctional officers stood by.

Mr. Johnson’s mother has filed a wrongful-death suit against the state and Wexford Health Sources, a for-profit health care contractor in Illinois prisons. The New York Times reviewed more than 1,500 pages of reports, along with depositions taken from those involved. Together, they reveal a cascade of missteps, missed opportunities, potential breaches of protocol and, at times, lapses in common sense.

Prison officials and Wexford staff took few steps to intervene even after it became clear that Mr. Johnson, who had been hospitalized repeatedly for similar episodes and recovered, had refused to take medication. Most notably, they did not transfer him to a state prison facility that provides more intensive mental health treatment than is available at regular prisons, records show.

The quality of medical care was also questionable, said Mr. Johnson’s lawyers, Sarah Grady and Howard Kaplan, a married legal team in Chicago. Mr. Johnson lost 50 to 60 pounds during three weeks in solitary confinement, but officials did not initiate interventions like intravenous feedings or transfer him to a non-prison hospital.

And they did not take the most basic step — dialing 911 — until it was too late.

There have been many attempts to improve the quality of mental health treatment in jails and prisons by putting care on par with punishment — including a major effort in Chicago . But improvements have proved difficult to enact and harder to sustain, hampered by funding and staffing shortages.

Lawyers representing the state corrections department, Wexford and staff members who worked at Danville declined to comment on Mr. Johnson’s death, citing the unresolved litigation. In their interviews with state police investigators, and in depositions, employees defended their professionalism and adherence to procedure, while citing problems with high staff turnover, difficult work conditions, limited resources and shortcomings of co-workers.

But some expressed a sense of resignation about the fate of Mr. Johnson and others like him.

Prisoners have “much better chances in a hospital, but that’s not their situation,” said a senior member of Wexford’s health care team in a deposition.

“I didn’t put them in prison,” he added. “They are in there for a reason.”

Markus Mison Johnson was born on March 1, 1998, to a mother who believed she was not capable of caring for him.

Days after his birth, he was taken in by Lisa Barker Johnson, a foster mother in her 30s who lived in Zion, Ill., a working-class city halfway between Chicago and Milwaukee. Markus eventually became one of four children she adopted from different families.

The Johnson house is a lively split level, with nieces, nephews, grandchildren and neighbors’ children, family keepsakes, video screens and juice boxes. Ms. Johnson sits at its center on a kitchen chair, chin resting on her hand as children wander over to share their thoughts, or to tug on her T-shirt to ask her to be their bathroom buddy.

From the start, her bond with Markus was particularly powerful, in part because the two looked so much alike, with distinctive dimpled smiles. Many neighbors assumed he was her biological son. The middle name she chose for him was intended to convey that message.

“Mison is short for ‘my son,’” she said standing over his modest footstone grave last summer.

He was happy at home. School was different. His grades were good, but he was intensely shy and was diagnosed with attention deficit hyperactivity disorder in elementary school.

That was around the time the bullying began. His sisters were fierce defenders, but they could only do so much. He did the best he could, developing a quick, taunting tongue.

These experiences filled him with a powerful yearning to fit in.

It was not to be.

When he was around 15, he called 911 in a panic, telling the dispatcher he saw two men standing near the small park next to his house threatening to abduct children playing there. The officers who responded found nothing out of the ordinary, and rang the Johnsons’ doorbell.

He later told his mother he had heard a voice telling him to “protect the kids.”

He was hospitalized for the first time at 16, and given medications that stabilized him for stretches of time. But the crises would strike every six months or so, often triggered by his decision to stop taking his medication.

His family became adept at reading signs he was “getting sick.” He would put on his tan Timberlands and a heavy winter coat, no matter the season, and perch on the edge of his bed as if bracing for battle. Sometimes, he would cook his own food, paranoid that someone might poison him.

He graduated six months early, on the dean’s list, but was rudderless, and hanging out with younger boys, often paying their way.

His mother pointed out the perils of buying friendship.

“I don’t care,” he said. “At least I’ll be popular for a minute.”

Zion’s inviting green grid of Bible-named streets belies the reality that it is a rough, unforgiving place to grow up. Family members say Markus wanted desperately to prove he was tough, and emulated his younger, reckless group of friends.

Like many of them, he obtained a pistol. He used it to hold up a convenience store clerk for $425 in January 2017, according to police records. He cut a plea deal for two years of probation, and never explained to his family what had made him do it.

But he kept getting into violent confrontations. In late July 2018, he was arrested in a neighbor’s garage with a handgun he later admitted was his. He was still on probation for the robbery, and his public defender negotiated a plea deal that would send him to state prison until January 2020.

An inpatient mental health system

Around 40 percent of the about 1.8 million people in local, state and federal jails and prison suffer from at least one mental illness, and many of these people have concurrent issues with substance abuse, according to recent Justice Department estimates.

Psychological problems, often exacerbated by drug use, often lead to significant medical problems resulting from a lack of hygiene or access to good health care.

“When you suffer depression in the outside world, it’s hard to concentrate, you have reduced energy, your sleep is disrupted, you have a very gloomy outlook, so you stop taking care of yourself,” said Robert L. Trestman , a Virginia Tech medical school professor who has worked on state prison mental health reforms.

The paradox is that prison is often the only place where sick people have access to even minimal care.

But the harsh work environment, remote location of many prisons, and low pay have led to severe shortages of corrections staff and the unwillingness of doctors, nurses and counselors to work with the incarcerated mentally ill.

In the early 2000s, prisoners’ rights lawyers filed a class-action lawsuit against Illinois claiming “deliberate indifference” to the plight of about 5,000 mentally ill prisoners locked in segregated units and denied treatment and medication.

In 2014, the parties reached a settlement that included minimum staffing mandates, revamped screening protocols, restrictions on the use of solitary confinement and the allocation of about $100 million to double capacity in the system’s specialized mental health units.

Yet within six months of the deal, Pablo Stewart, an independent monitor chosen to oversee its enforcement, declared the system to be in a state of emergency.

Over the years, some significant improvements have been made. But Dr. Stewart’s final report , drafted in 2022, gave the system failing marks for its medication and staffing policies and reliance on solitary confinement “crisis watch” cells.

Ms. Grady, one of Mr. Johnson’s lawyers, cited an additional problem: a lack of coordination between corrections staff and Wexford’s professionals, beyond dutifully filling out dozens of mandated status reports.

“Markus Johnson was basically documented to death,” she said.

‘I’m just trying to keep my head up’

Mr. Johnson was not exactly looking forward to prison. But he saw it as an opportunity to learn a trade so he could start a family when he got out.

On Dec. 18, 2018, he arrived at a processing center in Joliet, where he sat for an intake interview. He was coherent and cooperative, well-groomed and maintained eye contact. He was taking his medication, not suicidal and had a hearty appetite. He was listed as 5 feet 6 inches tall and 256 pounds.

Mr. Johnson described his mood as “go with the flow.”

A few days later, after arriving in Danville, he offered a less settled assessment during a telehealth visit with a Wexford psychiatrist, Dr. Nitin Thapar. Mr. Johnson admitted to being plagued by feelings of worthlessness, hopelessness and “constant uncontrollable worrying” that affected his sleep.

He told Dr. Thapar he had heard voices in the past — but not now — telling him he was a failure, and warning that people were out to get him.

At the time he was incarcerated, the basic options for mentally ill people in Illinois prisons included placement in the general population or transfer to a special residential treatment program at the Dixon Correctional Center, west of Chicago. Mr. Johnson seemed out of immediate danger, so he was assigned to a standard two-man cell in the prison’s general population, with regular mental health counseling and medication.

Things started off well enough. “I’m just trying to keep my head up,” he wrote to his mother. “Every day I learn to be stronger & stronger.”

But his daily phone calls back home hinted at friction with other inmates. And there was not much for him to do after being turned down for a janitorial training program.

Then, in the spring of 2019, his grandmother died, sending him into a deep hole.

Dr. Thapar prescribed a new drug used to treat major depressive disorders. Its most common side effect is weight gain. Mr. Johnson stopped taking it.

On July 4, he told Dr. Thapar matter-of-factly during a telehealth check-in that he was no longer taking any of his medications. “I’ve been feeling normal, I guess,” he said. “I feel like I don’t need the medication anymore.”

Dr. Thapar said he thought that was a mistake, but accepted the decision and removed Mr. Johnson from his regular mental health caseload — instructing him to “reach out” if he needed help, records show.

The pace of calls back home slackened. Mr. Johnson spent more time in bed, and became more surly. At a group-therapy session, he sat stone silent, after showing up late.

By early August, he was telling guards he had stopped eating.

At some point, no one knows when, he had intermittently stopped drinking fluids.

‘I’m having a breakdown’

Then came the crash.

On Aug. 12, Mr. Johnson got into a fight with his older cellmate.

He was taken to a one-man disciplinary cell. A few hours later, Wexford’s on-site mental health counselor, Melanie Easton, was shocked by his disoriented condition. Mr. Johnson stared blankly, then burst into tears when asked if he had “suffered a loss in the previous six months.”

He was so unresponsive to her questions she could not finish the evaluation.

Ms. Easton ordered that he be moved to a 9-foot by 8-foot crisis cell — solitary confinement with enhanced monitoring. At this moment, a supervisor could have ticked the box for “residential treatment” on a form to transfer him to Dixon. That did not happen, according to records and depositions.

Around this time, he asked to be placed back on his medication but nothing seems to have come of it, records show.

By mid-August, he said he was visualizing “people that were not there,” according to case notes. At first, he was acting more aggressively, once flicking water at a guard through a hole in his cell door. But his energy ebbed, and he gradually migrated downward — from standing to bunk to floor.

“I’m having a breakdown,” he confided to a Wexford employee.

At the time, inmates in Illinois were required to declare an official hunger strike before prison officials would initiate protocols, including blood testing or forced feedings. But when a guard asked Mr. Johnson why he would not eat, he said he was “fasting,” as opposed to starving himself, and no action seems to have been taken.

‘Tell me this is OK!’

Lt. Matthew Morrison, one of the few people at Danville to take a personal interest in Mr. Johnson, reported seeing a white rind around his mouth in early September. He told other staff members the cell gave off “a death smell,” according to a deposition.

On Sept. 5, they moved Mr. Johnson to one of six cells adjacent to the prison’s small, bare-bones infirmary. Prison officials finally placed him on the official hunger strike protocol without his consent.

Mr. Morrison, in his deposition, said he was troubled by the inaction of the Wexford staff, and the lack of urgency exhibited by the medical director, Dr. Justin Young.

On Sept. 5, Mr. Morrison approached Dr. Young to express his concerns, and the doctor agreed to order blood and urine tests. But Dr. Young lived in Chicago, and was on site at the prison about four times a week, according to Mr. Kaplan. Friday, Sept. 6, 2019, was not one of those days.

Mr. Morrison arrived at work that morning, expecting to find Mr. Johnson’s testing underway. A Wexford nurse told him Dr. Young believed the tests could wait.

Mr. Morrison, stunned, asked her to call Dr. Young.

“He’s good till Monday,” Dr. Young responded, according to Mr. Morrison.

“Come on, come on, look at this guy! You tell me this is OK!” the officer responded.

Eventually, Justin Duprey, a licensed nurse practitioner and the most senior Wexford employee on duty that day, authorized the test himself.

Mr. Morrison, thinking he had averted a disaster, entered the cell and implored Mr. Johnson into taking the tests. He refused.

So prison officials obtained approval to remove him forcibly from his cell.

‘Oh, my God’

What happened next is documented in video taken from cameras held by officers on the extraction team and obtained by The Times through a court order.

Mr. Johnson is scarcely recognizable as the neatly groomed 21-year-old captured in a cellphone picture a few months earlier. His skin is ashen, eyes fixed on the middle distance. He might be 40. Or 60.

At first, he places his hands forward through the hole in his cell door to be cuffed. This is against procedure, the officers shout. His hands must be in back.

He will not, or cannot, comply. He wanders to the rear of his cell and falls hard. Two blasts of pepper spray barely elicit a reaction. The leader of the tactical team later said he found it unusual and unnerving.

The next video is in the medical unit. A shield is pressed to his chest. He is in agony, begging for them to stop, as two nurses attempt to insert a catheter.

Then they move him, half-conscious and limp, onto a wheelchair for the blood draw.

For the next 20 minutes, the Wexford nurse performing the procedure, Angelica Wachtor, jabs hands and arms to find a vessel that will hold shape. She winces with each puncture, tries to comfort him, and grows increasingly rattled.

“Oh, my God,” she mutters, and asks why help is not on the way.

She did not request assistance or discuss calling 911, records indicate.

“Can you please stop — it’s burning real bad,” Mr. Johnson said.

Soon after, a member of the tactical team reminds Ms. Wachtor to take Mr. Johnson’s vitals before taking him back to his cell. She would later tell Dr. Young she had been unable to able to obtain his blood pressure.

“You good?” one of the team members asks as they are preparing to leave.

“Yeah, I’ll have to be,” she replies in the recording.

Officers lifted him back onto his bunk, leaving him unconscious and naked except for a covering draped over his groin. His expressionless face is visible through the window on the cell door as it closes.

‘Cardiac arrest.’

Mr. Duprey, the nurse practitioner, had been sitting inside his office after corrections staff ordered him to shelter for his own protection, he said. When he emerged, he found Ms. Wachtor sobbing, and after a delay, he was let into the cell. Finding no pulse, Mr. Duprey asked a prison employee to call 911 so Mr. Johnson could be taken to a local emergency room.

The Wexford staff initiated CPR. It did not work.

At 3:38 p.m., the paramedics declared Markus Mison Johnson dead.

Afterward, a senior official at Danville called the Johnson family to say he had died of “cardiac arrest.”

Lisa Johnson pressed for more information, but none was initially forthcoming. She would soon receive a box hastily crammed with his possessions: uneaten snacks, notebooks, an inspirational memoir by a man who had served 20 years at Leavenworth.

Later, Shiping Bao, the coroner who examined his body, determined Mr. Johnson had died of severe dehydration. He told the state police it “was one of the driest bodies he had ever seen.”

For a long time, Ms. Johnson blamed herself. She says that her biggest mistake was assuming that the state, with all its resources, would provide a level of care comparable to what she had been able to provide her son.

She had stopped accepting foster care children while she was raising Markus and his siblings. But as the months dragged on, she decided her once-boisterous house had become oppressively still, and let local agencies know she was available again.

“It is good to have children around,” she said. “It was too quiet around here.”

Read by Glenn Thrush

Audio produced by Jack D’Isidoro .

Glenn Thrush covers the Department of Justice. He joined The Times in 2017 after working for Politico, Newsday, Bloomberg News, The New York Daily News, The Birmingham Post-Herald and City Limits. More about Glenn Thrush

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• Correctional Health
• Reentry for Formerly Incarcerated
• CDC Recommendations

Public Health Considerations for Correctional Health

• To provide people who are justice system-involved, correctional facility staff, public health professionals, community organizations, and anyone else with an interest in correctional health with resources.
• Review CDC resources, guidelines, and data on correctional health and justice-involved populations

Correctional health is community health

Correctional health encompasses all aspects of health and well-being for adults and juveniles who are justice system*-involved. This starts at the point of arrest, continues at detention or incarceration, and carries through after they return to their community (called "reentry"). Correctional health also includes the health of families and communities of persons who are justice system-involved, as well as the health administrators and staff who work in facilities.

Justice System-Involved‎

Persons who are justice system-involved are more likely to experience risk factors for HIV, viral hepatitis, sexually transmitted infections (STIs), tuberculosis (TB), latent TB infection (LTBI), and traumatic brain injuries (TBI) and concussions . The prevalence of these infections, diseases, and injuries is higher than in the general population. Additionally, a high proportion of people with justice system involvement have a history of unstable housing and mental health and substance use disorders, which increases vulnerability and risk for HIV, viral hepatitis, STIs, tuberculosis/latent tuberculosis infection, and injuries like TBI. This puts many in need of linkage to substance use and mental health treatment, employment, and permanent housing upon release. Justice-involvement also leads to family and community instability and adverse childhood events , with 1 in 28 children having a caregiver who is incarcerated.

Taken together, these multiple health conditions and social determinates of health contribute to the health disparities found in this population and their communities.

CDC has worked to provide people who are justice system-involved, correctional facility staff, public health professionals, community organizations, and anyone else with an interest in correctional health with data, testing and treatment guidelines, educational materials, and other correctional health resources.

How CDC supports correctional health

Community support.

• Funds partners working with health departments to improve health in the communites of justice-involved persons, particularly related to priority pathogens such as HIV, hepatitis, STIs, and TB.
• Develops programs and guidance that address community health disparities and social determinants of health (SDOH).

Intake / entry

• Develops intake screening and treatment guidance for use by clinicians/administrators of correctional health services and health departments.

During incarceration

• Works with state, tribal, local, and territorial health departments to investigate disease outbreaks.
• Develops and provides useful health education materials for staff and justice-involved persons.
• Supports projects that improve the continuity of care for people returning to their communities.
• Offers policy and planning guidance that support efforts to improve the continuity of care within communities.

Surveillance

• Identifies/monitors cases and potential exposures to HIV, viral hepatitis, STIs, TB, and other pathogens among persons who are justice-involved or work in correctional facilities.

According to the U.S. Bureau of Justice Statistics , over 5 million people are estimated to be under the supervision of U.S. adult correctional systems (in prison or jail, or on probation or parole). Many persons who are justice-involved experience multiple risk factors for HIV, viral hepatitis, sexually transmitted infections (STIs), tuberculosis (TB) and latent TB infection (LTBI), and traumatic brain injuries (TBI) and concussions . The prevalence of these infections, diseases, and injuries among people who are incarcerated is higher than in the general population.

• In 2021, about 1.1% of persons incarcerated in state and federal prisons were known to be persons with HIV; this rate was three times higher than the prevalence in the general U.S. population.
• In 2021, 16 U.S. states conducted mandatory HIV testing of all persons under state law enforcement custody, and 23 states and the U.S. Federal Bureau of Prisons offered opt-out HIV testing, accounting for 84% of all persons admitted and sentenced to more than 1 year in the custody of state and federal correctional authorities.
• In a 2013 survey of women across 20 metropolitan areas with high HIV prevalence, women who were recently incarcerated were significantly more likely to have factors that increase their risk for HIV infection than those who were never incarcerated, including receiving money or drugs in exchange for sex with a partner, multiple casual partners, multiple casual condomless partners, and sexually transmitted infection (STI) diagnosis.

More information on HIV Surveillance in the United States .

Viral hepatitis

• In 2009, a systematic review of 23 studies from incarcerated populations in the U.S. reported a wide chronic hepatitis B virus (HBV) prevalence range of 0.9%–11.4%.
• HBV prevalence has been estimated to be 3 to 38 times higher in correctional settings than in the general population in 2009.
• From 2013–2016, people who were incarcerated were estimated to have a rate of current hepatitis C virus (HCV) infection 10 times higher (10.7% vs 1%) than persons in the general population.
• Approximately 30% of all persons infected with HCV in the United States spend at least part of the year in correctional facilities.

More information on viral hepatitis surveillance in the United States.

• Males and females 35 years of age and younger in juvenile and adult detention facilities have been reported to have higher rates of chlamydia and gonorrhea than nonincarcerated persons in the community.
• Jail-based chlamydia screen-and-treat programs can potentially decrease chlamydia prevalence in communities with higher incarceration rates —as much as 13% in large communities and 54% in small communities.

More information on STIs among persons detained or incarcerated .

Tuberculosis (TB)

• In 2021, 2.4% of persons 15 years of age or older diagnosed with tuberculosis were current residents of correctional facilities at the time of diagnosis.
• From 2003–2013, annual median tuberculosis incidence was about 6 times higher for persons in jails and federal prisons compared with the general population.
• An analysis during 2011–2019 demonstrated that large tuberculosis outbreaks still occur in state prisons and account for a large proportion of total tuberculosis cases in some states.

For more information on Tuberculosis cases by residence in and type of correctional facility .

Traumatic brain injury (TBI)

• Research in the United States and from other countries suggests almost half (46%) of people in correctional or detention facilities such as prisons and jails have a history of TBI, but the exact number is not known.
• Studies show an association between people in correctional or detention facilities with a history of TBI and mental health problems, such as severe depression and anxiety, substance use disorders, difficulty controlling anger, and suicidal thoughts and/or attempts.
• People in correctional or detention facilities with TBI-related problems may not be screened for a TBI or may face challenges with getting TBI-related care. These challenges may continue after a person is released from the facility.

Find more information about TBI and other brain injuries .

CDC guidance and resources

HIV, viral hepatitis, STIs, and tuberculosis

• At-A-Glance: CDC Recommendations for Correctional and Detention Settings for Testing, Vaccination, and Treatment for HIV, Viral Hepatitis, TB, and STIs – Summary of current CDC guidelines and recommendations for testing, vaccination, and treatment of HIV, viral hepatitis, TB, and STIs for persons who are detained or incarcerated. Links to full guidance documents are included.
• Guidance on Management of COVID-19 in Homeless Service Sites and in Correctional and Detention Facilities – Guidance that can be used to inform COVID-19 prevention actions in homeless service sites and correctional and detention facilities.

Worker safety

• Safe and Proper Use of Disinfectants to Reduce Viral Surface Contamination in Correctional Facilities – Steps to reduce viral surface contamination through safe and proper use of disinfectants for persons who work in correctional facilities, including a companion printable poster to be displayed throughout the facility. The poster is available in English and Spanish.
• Reducing Work-Related Needlestick and Other Sharps Injuries Among Law Enforcement Officers (PDF) – Provides recommendations for reducing needlesticks and other sharps injuries to law enforcement officers, which specifically includes guidance for correctional employees.

Overdose prevention

• Partnerships Between Public Health and Public Safety – Overview of CDC partnerships built through multiple public health and public safety collaborations to strengthen and improve efforts to reduce drug overdoses.
• Public Health and Public Safety Resources – Resources for jails and prisons that support public health and public safety related to overdose prevention and medication-assisted treatment (MAT) for opioid use disorder.
• What Health Departments Need to Know When Responding to Mumps Outbreaks in Correctional and Detention Facilities – Job-aid with guidance for health departments and facilities during mumps outbreaks.
• LM Maruschak. HIV in Prisons, 2021—Statistical Tables. U.S. Department of Justice, Bureau of Justice Statistics, Washington, DC (Published May 2022). https://bjs.ojp.gov/document/hivp21st.pdf , Accessed 16 Mar 2023
• Wise A, Finlayson T, Nerlander L, Sionean C, Paz-Bailey G; NHBS Study Group. Incarceration, Sexual Risk-related Behaviors, and HIV Infection Among Women at Increased Risk of HIV Infection, 20 United States cities. J Acquir Immune Defic Syndr. 2017 Jul 1;75 Suppl 3:S261-S267. Incarceration, Sexual Risk-Related Behaviors, and HIV Infection Among Women at Increased Risk of HIV Infection, 20 United States Cities – PubMed (nih.gov)
• Harzke AJ, Goodman KJ, Mullen PD, Baillargeon J. Heterogeneity in Hepatitis B Virus (HBV) Seroprevalence Estimates from U.S. Adult Incarcerated Populations. Ann Epidemiol. 2009;19(9):647-650. doi:10.1016/j.annepidem.2009.04.001. Heterogeneity in Hepatitis B Virus (HBV) Seroprevalence Estimates from U.S. Adult Incarcerated Populations | Elsevier Enhanced Reader
• Roberts H, Kruszon-Moran D, Ly KN, Hughes E, Iqbal K, Jiles RB, Holmberg SD. Prevalence of Chronic Hepatitis B Virus (HBV) Infection in U.S. Households: National Health and Nutrition Examination Survey (NHANES), 1988-2012. Hepatology. 2016 Feb;63(2):388-97. doi: 10.1002/hep.28109. Epub 2015 Oct 27. PMID: 26251317. Prevalence of chronic hepatitis B virus (HBV) infection in U... : Hepatology (lww.com)
• Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013-2016. Hepatology. 2019;69(3):1020-1031. doi:10.1002/hep.30297. Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013-2016 – PubMed (nih.gov)
• CDC 2021 Sexually Transmitted Infections (STI) Treatment Guidelines: Persons in Correctional Facilities
• Bernstein KT, Chow JM, Pathela P, Gift TL. Bacterial Sexually Transmitted Disease Screening Outside the Clinic–Implications for the Modern Sexually Transmitted Disease Program. Sex Transm Dis. 2016;43(2 Suppl 1):S42-S52. Bacterial Sexually Transmitted Disease Screening Outside the Clinic–Implications for the Modern Sexually Transmitted Disease Program – PubMed (nih.gov)
• Owusu-Edusei K Jr, Gift TL, Chesson HW, Kent CK. Investigating the potential public health benefit of jail-based screening and treatment programs for chlamydia. Am J Epidemiol. 2013 Mar 1;177(5):463-73. doi: 10.1093/aje/kws240. Epub 2013 Feb 12. PMID: 23403986. Investigating the potential public health benefit of jail-based screening and treatment programs for chlamydia – PubMed (nih.gov)
• CDC Tuberculosis Data & Statistics: Reported Tuberculosis in the United States, 2021 in Residents of Correctional Facilities https://www.cdc.gov/tb/statistics/reports/2020/risk_factors.htm Lambert LA, Armstrong LR, Lobato MN, Ho C, France AM, Haddad MB. Tuberculosis in Jails and Prisons: United States, 2002-2013. Am J Public Health. 2016 Dec;106(12):2231-2237. doi: 10.2105/AJPH.2016.303423. Epub 2016 Sep 15. PMID: 27631758; PMCID: PMC5104991. Tuberculosis in Jails and Prisons: United States, 2002-2013 – PubMed (nih.gov)
• Stewart RJ, Raz KM, Burns SP, Kammerer JS, Haddad MB, Silk BJ, Wortham JM. Tuberculosis Outbreaks in State Prisons, United States, 2011 – 2019. Am J Public Health. 2022, 112(8), 1170-1179. PMID: 35830666; PMCID: PMC934802. Doi: 10.2105/AJPH.2022.306864
• Hunter S, Kois L, Peck A, Elbogen E, LaDuke C. (2023). The prevalence of traumatic brain injury (TBI) among people impacted by the criminal legal system: An updated meta-analysis and subgroup analyses. Law and Human Behavior , 47(5), 539–565.
• Moore E, Indig D, Haysom L. Traumatic brain injury, mental health, substance use, and offending among incarcerated young people. Journal of Head Trauma Rehabilitation. 2014;29(3):239-247.
• Ray B, Sapp D, Kincaid A. Traumatic brain injury among Indiana state prisoners. Journal of Forensic Sciences. 2014;59(5):1248-1253.
• Walker R, Hiller M, Staton M, Leukefeld C. Head injury among drug abusers: An indicator of co-occurring problems. Journal of Psychoactive Drugs. 2003;35(3):343-353.
• Slaughter B, Fann J, Ehde D. Traumatic brain injury in a county jail population: Prevalence, neuropsychological functioning and psychiatric disorders. Brain Injury. 2003;17(9):731-741.
• Blaauw E, Arensman E, Kraaij V, Winkel F, Bout R. Traumatic life events and suicide risk among jail inmates: The influence of types of events, time period and significant others. Journal of Traumatic Stress. 2002;15(1):9-16.
• Allely C. Prevalence and assessment of traumatic brain injury in prison inmates: A systematic PRISMA review. Brain Injury. 2016;30(10):1161-1180.
• Williams W, Mewse A, Tonks J, Mills S, Burgess C, Cordan G. Traumatic brain injury in a prison population: Prevalence and risk for re-offending. Brain Injury. 2010;24(10):1184-1188.
• “Criminal legal system” may also be used as an alternative to “justice system” to reflect historic and current challenges to achieving justice in the U.S. criminal legal system.

CDC provides health resources to protect the health of people in correctional settings who are at higher risk for HIV, Viral Hepatitis, STIs, and Tuberculosis.