Mental health administrators in correctional facilities have the complex task of balancing the clinical needs of incarcerated individuals and the safety and security missions of the facilities. This article describes the various structures of mental health administration within correctional facilities, the tasks commonly required of these professionals, and the skills necessary to be effective in this role. This editorial discusses the legal framework for mental healthcare in jails and prisons, staffing, cost containment, quality assurance and quality improvement, accreditation, peer review, morbidity and mortality reviews, utilization management, medication formularies, electronic health records, and innovative strategies as they apply to administrators of mental health services in correctional facilities. Throughout this article, practices are also included that have been found to be of value for managing a correctional mental health system.