<strong>Purpose</strong>
This study aims to examine the behavioral health disorders and trauma exposure are disproportionately represented among incarcerated men. Historically, prisons have been inadequately equipped to respond to the behavioral health needs of incarcerated people. Given the abundance of behavioral health need and the relatively limited availability of prison-based treatment resources, population health management strategies, particularly need stratification, are vital.

<strong>Design/methodology/approach</strong>
A sample of 943 male inmates from three Spanish prisons completed a structured questionnaire. Need groups are based on current depression, anxiety and stress symptoms assessed by the DASS-21 and were validated using adverse childhood experiences (ACE), prison-based abuse, prison-based substance use, social support and resilience.

<strong>Findings</strong>
Three need groups were identified, namely, minimal, mild/moderate and severe, each representing about one-third of the sample. The severe group had the highest level of all three types of psychological distress, ACE and prison-based adversity and substance use. No statistical differences in social support and resilience were found among the groups. These findings provide a platform for future research to explore how the complexity of behavioral health care need can be identified and stratified for strategic and rational treatment matching. Proving whether a population health management approach improves behavioral health and personal safety outcomes within funding-constrained carceral environments is the next research priority.

<strong>Originality/value</strong>
This study is the first to group co-morbid psychological distress into need categories using a social determinants of health framework for validation.