A sample of 3,684 inmates in the New York State prison system was surveyed in May 1986 to determine the prevalence of psychiatric and functional disability and service utilization. It was estimated that 5 percent had a severe psychiatric disability, and 10 percent had significant psychiatric disability. The higher the level of disability, the greater the proportion of inmates that had received mental health services in the last 30 days and in the last year. Still, 45 percent of the severe disability group had no service contacts in the last year. Patterns of utilization differed significantly by sex (a greater proportion of women received services) and by race (a greater proportion of whites received services). The clinical factors associated with receipt of services varied considerably between men and women.