“As soon as you walk through the doors, you hear people screaming, kicking their doors and crying,” says Matthew Estepp, an inmate at Kentucky State Reformatory and an inmate watcher in CPTU. Although CPTU is located within a reformatory, “it’s like walking into a different world,” he says.

Correctional officers struggle with an inmate to secure him in the chair in order to give him a shower. After 11 months of refusal, the doctors ordered a forced shower and a cleaning of his room.

Jonathon Ponder laughs from within his cell at another inmate across the wing. The number below his name is one given to every inmate upon their entry in Kentucky's Department of Corrections.

An inmate is cuffed and returned to his cell after acting out earlier that day. A spit mask is used to prevent him from spitting at the doctors and correctional officers. "Our priority is security. That mandates that we have certain security measures that can’t be breached. But security can't be a stranglehold on progress," says Larry Chandler, warden of Kentucky State Reformatory.

Even though he has memorized the Bible from front to back, an inmate on 23-hour lock down listens to a correctional officer read a passage to him.

Multiple officers wait by the door before a cell entry. "We use multiple officers to decrease the chances of anyone getting hurt including the inmate," says Sergeant Rioux.

A man stands in the middle of his room for most of the day staring at the 4 walls surrounding him. Almost 555,000 people with mental illness are incarcerated while fewer than 55,000 are being treated in designated mental health hospitals.

The inside of a cell door reveals the writings of inmates who have been housed there in years past. “They are rejects of society and warehousing them in prison isn’t the way to go,” says Dr. Young. “Most of them don’t have life sentences and they will get out some day.”

After banging on his cell door for six hours straight with his fist and head, the officers restrained an inmate who was threatening to kill himself.

Inmates often have to be restrained by officers before medication can be administered. In order to meet the criteria for forced medication, the inmate must be found to be a danger to himself or others.

Keith Bouchard salutes to the CPTU building before entering.

An inmate out of CPTU shows his self-inflicted injury. Sticking pens and sporks through his midsection, he created this wound six months prior.

An inmate is helped back into his cell during a psychotic episode. Correctional officers are not only responsible for securing inmates but now help treatment staff and other mental health professionals identify and manage mentally ill inmates, says Sergeant Jeremy Rioux, correctional officer and first shift supervisor.

Inmates from A wing wait their pills during the afternoon pill call. They come to the pill window three times a day to receive their pills.

An inmate on max assault status and a 23-hour lock down talks to himself in his cell. The max assault status is issued to inmates who have assaulted officers or treatment staff. The inmates have been known to throw a mixture of feces and urine, spit, hit, kick, punch or cut.

Correctional officers hold down an inmate to secure him in cuffs in order to give him a shower. "When an inmate is in a psychotic episode or being disruptive, their strength is amazing," says Sergeant Rioux. Often it takes three to four officers to get his hands restrained.

Handcuffed and behind two panes of glass, Anthony Delaney speaks to his father during a maximum security regulated visitation before meeting the parole board. "I have been doing a lot better and haven't hit anyone in a couple of weeks," Delaney says to his father. Despite his recent behavior, he was not granted parole.

From left, Stephen Davis, Kenneth Buster and Daryl York, friends in A wing were separated when Davis and Buster we transferred to the yard after completing the program.

An inmate waits in the hallway as officers search his room for contraband. Mentally ill inmates often end up spending more time in prison than the average inmate. They have a hard time following the strict rules of prison life and often have a more difficult time getting paroled because of their poor disciplinary records in prison.

Bobby Hall grabs the shirt of another inmate right after the two were laughing together during their one hour of free time outside for the day. "What did you say?" he yells in anger.

Not everybody that ends up in CPTU needs to be in there, Dr. Roby says. Often inmates, who gambled, are in debt on the yard or threatened somebody, emulate the symptoms needed to be referred to the treatment unit. “Those [inmates] are often more problematic than anyone because you have to figure out what their motivation is,” she says.

Diagnosed with delusional paranoia, an inmate walks back and forth all day long on the second floor of A wing in CPTU. "There is an obligation as citizens and as states to fulfill to the mentally ill but the cost raises when they are in prison," says Warden Chandler. "The front end is we are getting more of them. The back door problem is we are going to release them and there is no place to release them to."

Danny Castile holds up drawings and writings he says is invaluable to the Department of Corrections and the judge who sentenced him to life.

A man on suicide watch lays without a blanket. "Isolation works in our favor sometimes but more often than not it works against us," says Dr. Stephanie Roby, psychologist in CPTU.

Standing on the edge of his bed, an inmate threatens to jump.

Correctional officers clean the room of an inmate, searching for possible weapons after he cut himself with a spork earlier that morning.

An inmate admitted to CPTU just days before admits he looks out of his cell all day long to "look for something more." He was brought to CPTU after an unsuccessful suicide attempt in the segregation unit. The system designed for security is now trapped with treating mental illness and the mentally ill are often trapped inside the system with nowhere else to go.

Bobby Slater looks out of his cell to an inmate watcher walking around during his 15-minute watch. "This is a miserable life experience for them but some of them don't want to leave because they have been in society and they saw what happened," says lead psychologist Dr. Tanya Young. For Bobby that day to leave the Reformatory never came. Months after being released from CPTU, he hung himself in his cell.

Julia Lish, a correctional officer, comforts an inmate during one his psychotic episodes. "Its going to be OK," she repeats as he cries and yells to the voices in his head.