Denial of adequate mental health care for serious mental health needs may violate the Eighth Amendment under the same deliberate indifference standard applied to other medical needs. A mental health need is serious if it "has caused significant disruption in an inmate’s everyday life and ... prevents his functioning in the general population without disturbing or endangering others or himself" (Tillery v. Owens, 1989).

Prisons and jails must provide mental health screening at intake to identify serious problems, including potential suicides (Balla v. Idaho Board of Corrections, 1984) and other serious conditions that need attention by mental health professionals (Smith v. Jenkins, 1990). They also must plan for the training of officers to deal with mentally ill inmates (Langley v. Coughlin, 1989).

Additionally, there must be some means of separating severely mentally ill inmates from the mentally healthy. Mixing the two groups may violate the rights of both. Finally, failure to provide treatment for mentally retarded inmates also may violate the constitution, if regression occurs.

Antipsychotic Drugs
In Washington v. Harper (1990) the U.S. Supreme Court ruled that inmates have a "significant liberty interest" in avoiding the unwanted administration of antipsychotic drugs. The Court approved such use of antipsychotic drugs only where certain procedural protections were available, such as those in the Washington State case before it:

• Only a psychiatrist may order the drugs.
• The patient who objects is entitled to an administrative hearing before professional staff not currently involved in his or her treatment.
• The patient may attend the hearing, present and cross-examine witnesses, and have the assistance of a lay advisor with psychiatric knowledge.
• Minutes must be kept, with judicial review available.
• Continuation of the medication is subject to periodic review.

The involuntary administration of antipsychotic drugs also arises in the context of capital punishment in which the condemned prisoner is currently insane: A psychotic inmate, who does not understand what is about to occur, cannot be executed (Ford v. Wainwright, 1986).

The issue in Perry v. Louisiana (1992) was whether the inmate could forcibly be medicated to restore sanity in order to facilitate execution. The U.S. Supreme Court did not decide this case, instead sending it back to Louisiana for disposition under state law. On remand, the Louisiana Supreme Court ruled that forcible medication under these circumstances would violate the prohibition against cruel and unusual punishment (Louisiana v. Perry, 1992). The issues, however, both legal and ethical, will continue to exist in this complex area.

Due Process
Except in cases of short transfers for evaluation purposes, inmates also are entitled to notice and a hearing before being committed to a mental hospital because the stigmatizing consequences of a psychiatric commitment and the possible involuntary subjection to psychiatric treatment constitute a deprivation of liberty requiring due process (Vitek v. Jones, 1980).

Psychiatric treatment may not be imposed for disciplinary purposes (Knecht v. Gillman, 1973), and the use of seclusion and restraint must be based on professional judgment reasonably related to its purpose (Wells v. Franzen, 1985).

Inmates with mental problems frequently find themselves in trouble in prisons and jails for violating institutional rules. The administrative punishment of inmates who are not mentally responsible for their actions has been of concern to administrators and the courts. In People ex rel. Reed v. Scully (1988), a prisoner serving a manslaughter sentence for the stabbing death of his wife believed he was compelled by evil spirits that inhabited his body as a result of a voodoo curse. In prison, he killed another inmate, for which he was found not guilty by reason of insanity. Nevertheless, prison disciplinary charges were brought against him for assaulting the second victim, and the inmate was given seven years solitary confinement and four years loss of good time. The court vacated the punishment, ruling that the inmate could not be punished for acts for which he had already been found insane. The court also ordered a new hearing at which the inmate would be represented by a "counsel substitute."

Value of Training
Training correctional staff and hearing officers to recognize mental health issues in misbehavior can help in avoiding litigation. Conditions that lead to psychiatrically based misbehavior can be addressed, in part, by developing intermediate and chronic care capability for mental health services, closely monitoring the mental health condition of inmates in solitary confinement, and reviewing the disciplinary and administrative classification of inmates who are returned to facilities after psychiatric hospitalization, especially if a return to solitary confinement is being considered.