SUMMARY OF PROFESSIONAL STANDARDS
GOVERNING MENTAL HEALTH SERVICES
IN PRISONS AND JAILS

Prepared by:
James R. Pingeon
Daniel Crane-Hirsch
Center for Public Representation
246 Walnut Street
Newton, MA 02160
September 30, 1997

TABLE OF CONTENTS
1.

Introduction ................................................................................................ v

2.

Bibliography of Professional Standards and Other Sources ..................... vii

3.

General Principles...................................................................................... 1

a.
b.

Mental health care must be available to all inmates who need it. .............. 1
Mental health care provided to inmates must be equivalent to care
available in community............................................................................... 1
Mental Health decision-makers must be independent of
other prison officials. .................................................................................. 2

c.

4.

Preliminary Mental Health Screening of Incoming Prisoners and Referrals
for Treatment ............................................................................................. 2

a.

d.

Correctional facilities must have a system to screen incoming
inmates to identify those with mental illness .............................................. 2
Contents of the Preliminary Mental Health Screening................................ 4
Preliminary screenings must be conducted in a
confidential atmosphere............................................................................. 5
Screeners need training in mental illnesses............................................... 6

5.

Mental Health Assessment of all Prisoners................................................ 6

a.

All newly committed inmates should receive a detailed ............................ 6
mental health evaluation shortly after admission.
Contents of Mental Health Assessment ..................................................... 7

b.
c.

b.

6.

Follow up Referrals from Preliminary Screening and Mental Health
Assessment ............................................................................................... 8

a.

Inmates should receive a thorough psychiatric evaluation within
a short period after staff make a referral.................................................... 8

7.

Monitoring and Diagnosis of Inmates with Mental Illness........................... 9

a.

Every correctional facility must have procedures for custody
staff and inmates to refer inmates needing mental health
i

treatment or evaluation. ............................................................................. 9

8.

Mental Health Treatment Modalities ........................................................ 10

a.

Correctional facilities must provide a range of treatment
modalities to inmates with mental disabilities........................................... 10
Treatment must consist of more than just medication.............................. 12
Each inmate must have an individualized treatment plan ........................ 12
Prisons must have written policies to assure timely delivery
of needed mental health services ............................................................ 13
Mental health care should be available on a 24-hour basis. .................... 14
Inmates must be provided with information about mental health
services in a language they can understand............................................ 14

b.
c.
d.
e.
f.

9.

Medication ............................................................................................... 15

a.

h.

Psychotropic medication must be prescribed only by a psychiatrist
and in accordance with contemporary medical standards ....................... 15
Psychiatrists or physicians should monitor all inmates
on psychotropic medications.................................................................... 15
A psychiatrist must re-evaluate prescriptions before renewal .................. 16
The formulary should contain a range of psychotropic medications ........ 16
Prisoners must receive prescribed medications without interruption ....... 17
A system must be in place for the involuntary administration
of psychiatric medications in appropriate circumstances ......................... 17
Prisoners with serious mental disorders must be transfered to
a hospital or to a specialized unit within the prison system,..................... 18
Inmates may not be transferred to a mental hospital without due process20

10.

Informed Consent .................................................................................... 20

a.

Patients must be given the information necessary to make an
informed decision about whether to accept a particular treatment........... 20

11.

Seclusion and Restraint ........................................................................... 21

a.

Correctional Facilities must have policies and procedures
governing the use of seclusion and restraint............................................ 21
Seclusion and restraint may not be used as punishment......................... 23

b.
c.
d.
e.
f.
g.

b.

ii

12.

Suicide Prevention ................................................................................... 24

a.

Correctional facilities must have a basic program for
identifying, treating, and supervising inmates with
suicidal tendencies................................................................................... 24

13.

Mental Health Staff .................................................................................. 25

a.

The correctional facility must have sufficient numbers of
qualified health personnel of varying types to provide
adequate evaluation and treatment consistent with
contemporary standards of care. ............................................................. 25
Mental health staff must receive appropriate training,
including training in the administration of medications. ............................ 27

b.

14.

Training of Custodial Staff........................................................................ 28

a.

All custodial staff must be trained to recognize signs of
mental illness ........................................................................................... 28

15.

Housing, Segregation, and Discipline ...................................................... 29

a.

Mental health staff must be allowed to influence cell
housing decisions .................................................................................... 29
Inmates confined to segregation units must be evaluated and
monitored by mental health professionals................................................ 30
Mental health staff must be consulted about decisions to
discipline mentally ill prisoners................................................................. 31

b.
c.

16.

Mental Health Records ............................................................................ 31

a.

Mental Health Records must be accurate, complete,
and well-organized................................................................................... 31
Past psychiatric records must be obtained ..................................................
Inmate's mental health records must be kept confidential ....................... 33
Only a limited number of factors justify breaching a patient's
confidentiality ........................................................................................... 33
To preserve confidentiality, mental health records must be kept
separate from confinement and custody records ..................................... 34
Mental health providers should have access to inmates'
custodial records when necessary for providing care. ............................. 35
Inmates must have access to their own records ...................................... 36

b.
c.
d.
e.
f.
g.

iii

32

h.

i.

When an inmate is transferred to another institution,
his records must be sent to the receiving facility to insure
continuity of care...................................................................................... 36
Inmates must give written consent before their records are
transferred to third parties outside of the correctional system.................. 37

17.

Discharge Planning.................................................................................. 38

a.

Prison mental health services must provide appropriate discharge
plans. ...................................................................................................... 38

18.

Quality Assurance.................................................................................... 39

a.

The correctional mental health system must have a quality assurance
plan .......................................................................................................... 39

iv

INTRODUCTION:
There are approximately 1.6 million people incarcerated in prisons or jails in the
United States, and the number continues to increase each year. Studies indicate that
the incidence of mental illness is substantially greater in prison than in the community.
At any given time at least 7% of all incarcerated individuals suffer from a major mental
illness, and an additional 10 to 30% of the prison population is likely to require mental
health services at some point during their incarceration. Despite the great need for
mental health treatment in correctional facilities, however, available services in many, if
not most, prisons and jails are woefully inadequate.
Since there is little public or political support for quality mental health care for
offenders with mental illness, prisoners are almost entirely dependent on the courts for
the protection of their right to treatment. However, it is often difficult for advocates who
are not familiar with correctional environments to make an informed assessment of
mental health services within a particular facility. The constitutional law in this area,
although extensive, is often murky and inconsistent. See "Annotated List Of Cases
Relating To Treatment For Persons With Mental Illness In Prisons And Jails," Center for
Public Representation (1997). Moreover, since the Constitution only requires the
absolute minimum level of services, an adequate mental health system may well
demand something better.
In an effort to simplify the task of evaluating whether there are deficiencies in
mental health care in correctional settings, we have compiled a comprehensive
summary of available standards, established by professional organizations and
accrediting bodies, that set forth the basic components of an adequate mental health
system in a prison or jail. It is our hope that the summary can be used by advocates as
a check-list to evaluate services to persons with disabilities in correctional settings.
Although each professional organization has its own views on any particular aspect of
mental health care, we have extracted from the professional standards an outline of the
generally accepted essential components of an adequate correctional mental health
system. We have then annotated each component with references to the relevant
professional standards. Although the annotations generally quote the exact language of
the relevant standard, in order to keep within manageable limits, the complete standard
is not always provided, nor is every relevant standard necessarily listed. We have also
omitted commentary and other supplementary material that appears in the publications
of the professional organizations containing the standards. We therefore urge
advocates to refer to the standards themselves for citation purposes, and to check for
additional information that may not be in the summary. Advocates should also keep in
mind that many states have their own statutes and regulations governing some or all
aspects of prison mental health care. These statutes and regulations are often modeled
on the professional standards.
Although the professional standards may well exceed the constitutional floor,
v

courts often utilize them both to analyze the quality of mental health care and to devise
remedies for conditions found to be unlawful. Accordingly, the annotations contain
citations to a selection of cases where the court has ruled that the substance of the
standard coincides with constitutional mandate. The annotations also reference a
selection of useful articles from law reviews or professional journals that bear on the
subject.
We hope that this summary is helpful to advocates working in prisons and jails,
and we welcome questions and comments from all who have the opportunity to use it.

BIBLIOGRAPHY OF PROFESSIONAL STANDARDS AND OTHER SOURCES

ABA Criminal Justice Mental Health Standards (American Bar Association 1984)
ACA Manual of Correctional Standards, ch.26, § 14, reprinted in Medical Care of
Prisoners and Detainees app. (Ciba Found. Symposium 16 (n.s.), 1973)
American Ass'n of Correctional Psychologists, Standards for Psychological Services in
Adult Jails and Prisons, 7 Crim. Just. & Behav. 81 (1980)
American Correctional Ass'n & Comm'n on Accreditation for Corrections (3rd ed. 1990)
Standards for Adult Correctional Institutions
American Psych. Ass'n, General Guidelines for Providers of Psychological Services
(1987)
American Pub. Health Ass'n (1986), Standards for Health Servs. in Correctional
Institutions
American Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails and Prisons, in
Psychiatric Services in Jails and Prisons, Task Force Report 29 (1989)
Association of State Correctional Administrators, Policy Guidelines: Health Services,
reprinted in Medical Care of Prisoners and Detainees app. (Ciba Found.
Symposium 16 (n.s.), 1973)
Fed. Standards for Prisons and Jails (U.S. Dept. of Justice 1980)
Foundation/Core Standards for Adult Local Detention Facilities (American Correctional
Ass'n & Comm'n on Accreditation for Corrections 1989)
Joint Comm'n on Accreditation of Healthcare Org., 1 1993 Accreditation Manual for
Mental Health, Chemical Dependency, and Mental Retardation/Developmental
Disabilities Services § FC at 61 (1993) (forensic services)
National Comm'n on Correctional Health Care, Standards for Health Services in Prisons
(1997)
National Comm'n on Correctional Health Care,
Standards for Health Services in Jails (1996)
National Comm'n on Correctional Health Care, Position Statement: Mental Health
Services in Correctional Settings (1992).

vii

Standard Minimum Rules for the Treatment of Prisoners: Resolution of the First United
Nations Congress on the Prevention of Crime and the Treatment of Offenders,
E.S.C. Res. 663C, U.N. ESCOR, 24th Sess., Supp. No. 1, at 11, U.N. Doc.
A/CONF/611 (1955), amended by E.S.C. Res. 2076, U.N. ESCOR, 62d Sess.,
Supp. No. 1, at 35, U.N. Doc. E/5988 (1977)
Cases
Arnold on behalf of H.B. v. Lewis, 803 F.Supp. 246 (D.Ariz. 1992)
Austin v. Pennsylvania Dept. of Corrections, 876 F. Supp.. 1437 (E.D. Pa. 1995)
Balla v. Idaho State Bd. of Corrections, 595 F. Supp. 1558 (D. Idaho 1984)
Barnes v. Government of Virgin Islands, 415 F. Supp. 1218 (D.V.I. 1976)
Casey v. Lewis, 834 F.Supp. 1477 (D.Ariz. 1993)
Coleman v. Wilson, 912 F.Supp. 1282 (E.D. Cal. 1995)
Franklin v. District of Columbia, -- F.Supp. --, 1997 WL 194453 (D.D.C. 1997)
French v. Owens, 777 F.2d 1250 (7th Cir. 1985)
Grubbs v. Bradley, 821 F. Supp. 496 (M.D. Tenn. 1993)
Langley v. Coughlin, 715 F.Supp. 522 (S.D.N.Y. 1988), aff'd, 888 F.2d 252 (2d Cir.
1989).
Lightfoot v. Walker, 486 F. Supp. 504, 524-25 (S.D. Ill. 1980)
Madrid v. Gomez, 889 F.Supp. 1146 (N.D. Cal. 1995)
Ruiz v. Estelle, 503 F.Supp. 1265 (S.D. Tex. 1980), aff'd in part and rev'd in part, 679
F.2d 1115 (5th Cir. 1982), cert. denied, 460 U.S. 1042 (1983).

Secondary Sources
Fred Cohen, Captives' Legal Right to Mental Health Care, 17 Law & Psychol. Rev. 1
(1993)
Fred Cohen & Joel Dvoskin, Inmates With Mental Disorders: A Guide to Law and
Practice
(Part I), 16 MENTAL & PHYSICAL DISABILITY L. REP. 339 (1992).
viii

Fred Cohen & Joel Dvoskin, Inmates With Mental Disorders: A Guide to Law and
Practice
(Part II), 16 MENTAL & PHYSICAL DISABILITY L. REP. 462 (1992).
Deborah L. Dennis, The National Work Session: Recommendations for Action, in Mental
Illness in America's Prisons 213 (Henry J. Steadman and Joseph J. Cocozza
eds. [National Coalition for the Mentally Ill in the Criminal Justice System], 1993)
James R.P. Ogloff et al., Screening, Assessment, and Identification of Services for
Mentally Ill Offenders, in Mental Illness in America's Prisons 61 (Henry J.
Steadman and Joseph J. Cocozza eds. [National Coalition for the Mentally Ill in
the Criminal Justice System], 1993)
James R.P. Ogloff, et al., Mental Health Services In Jails And Prisons: Legal, Clinical,
And Policy Issues, 18 Law & Psychol. Rev. 109 Spring 1994
Marnie E. Rice & Grant T. Harris, Treatment for Prisoners with Mental Disorder, in
Mental Illness in America's Prisons 91 (Henry J. Steadman and Joseph J.
Cocozza eds. [National Coalition for the Mentally Ill in the Criminal Justice
System], 1993)
T. Howard Stone, Therapeutic Implications Of Incarceration For Persons With Severe
Mental Disorders: Searching For Rational Health Policy, 24 Am. J. Crim. L. 283
(1997).

ix

1.

Introductory Principles

a.
Mental health care should be available to all inmates who need it.
Standards for Health Servs. in Correctional Institutions., Mental Health Care Services § A,
at 27 (American Pub. Health Ass'n 1976) ("Principle: Mental health services should be
made available at every correctional institution. Public Health Rationale: Any person should
be able to seek mental health care. Moreover, the very fact of incarceration may create or
intensify the need for mental health services."); Standards for Adult Correctional
Institutions. § 3-4331 (American Correctional Ass'n & Comm'n on Accreditation for
Corrections 3rd ed. 1990) (mandatory) ("Written policy, procedure, and practice provide for
unimpeded access to health care."); ABA Criminal Justice Mental Health Standards § 72.6(a) (American Bar Association 1984) (postarrest obligations of police and custodial
personnel) ("It is the responsibility of custodial officials to ensure that mental health and
mental retardation services are provided for detainees."); Standard Minimum Rules for the
Treatment of Prisoners: Resolution of the First United Nations Congress on the Prevention
of Crime and the Treatment of Offenders, E.S.C. Res. 663C, U.N. ESCOR, 24th Sess.,
Supp. No. 1, ¶ 22(1), U.N. Doc. A/CONF/611 (1955), amended by E.S.C. Res. 2076, U.N.
ESCOR, 62d Sess., Supp. No. 1, at 35, U.N. Doc. E/5988 (1977) (medical services) ("At
every institution there shall be available the services of at least one qualified medical officer
who should have some knowledge of psychiatry. The medical services . . . shall include a
psychiatric service for the diagnosis and, in proper cases, the treatment of states of mental
abnormality."); id., ¶ 62 (prisoners under sentence) ("The medical services of the institution
shall seek to detect and shall treat any physical or mental illnesses or defects which may
hamper a prisoner's rehabilitation. All necessary medical, surgical and psychiatric services
shall be provided to that end."); id., ¶ 82(4) (insane and mentally abnormal prisoners) ("The
medical or psychiatric service of the penal institutions shall provide for the psychiatric
treatment of all other prisoners [than those removed to mental or specialized institutions]
who are in need of such treatment.").

b.
Mental health care available to inmates must be equivalent to that in the
community.
National Comm'n on Correctional Health Care, Position Statement: Mental Health Services
in Correctional Settings § 1 (1992) ("All correctional institutions should be required to meet
recognized community standards for mental health services as promoted by standards set
by organizations such as the National Commision on Correctional Health Care, the
American Psychiatric Association, and the American Public Health Association"); American
Psychiatric Ass'n, Principles Governing the Delivery of Psychiatric Services in Lock-Ups,
Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29,
§ B.1.a (1989) ("The fundamental policy goal should be to provide the same level of mental
health services to patients in the criminal justice process that are available in the
community"); American Ass'n of Correctional Psychologists, Standards for Psychological
Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 32 discussion, at 109
(1980) ("Transfer . . . for clients who require intensive treatment should occur when the
quality of available services within the correctional facility is not equivalent to that found in
1

local community facilities.");
c.

Mental Health decision-makers must be independent of other prison officials.

Standards for Adult Correctional Insts. § 3-4327 (American Correctional Ass'n &
Comm'n on Accreditation for Corrections 3rd ed. 1990) (mandatory) ("Written policy,
procedure, and practice provide that all medical, psychiatric, and dental matters involving
medical judgement are the sole province of the responsible physician and dentist,
respectively."); id., § 3-4331 comment ("No member of the correctional staff shall approve
or disapprove requests for attendance at sick call."); Foundation/Core Standards for Adult
Local Detention Facilities § FC2-5076 (American Correctional Ass'n & Comm'n on
Accreditation for Corrections 1989) (mandatory) ("Medical, dental, and mental health
matters involving medical judgements are the sole province of the responsible physician,
dentist, and psychiatrist or qualified psychologist."); Fed. Standards for Prisons and Jails
§ 5.02 (U.S. Dept. of Justice 1980) ("The designated responsible physician is under no
restrictions imposed by the facility administration regarding medical decisions; however,
security regulations applicable to facility personnel also apply to health personnel"); id.,
§ 5.19 ("No inmate or correctional officer inhibits or delays an inmate's access to medical
services or interferes with medical treatment"); American Ass'n of Correctional
Psychologists, Standards for Psychological Services in Adult Jails and Prisons, 7 Crim.
Just. & Behav. 81, § 05, at 89 (1980) (essential) ("The psychologists, and the staff activities
for which these individuals are responsible, have professional autonomy regarding
psychological services, within the constraints of appropriate security regulations applicable
to all institutional personnel"); id. (discussion) ("Psychological services personnel need to
be granted sufficient autonomy to practice their profession, since in these matters their
training makes them the best qualified to make appropriate psychological judgments.");
American Psych. Ass'n, General Guidelines for Providers of Psychological Services § 3.2,
at 8 (1987) ("Psychologists pursue their activities as members of the independent,
autonomous profession of psychology."); id. (illustrative statement) ("Psychologists, as
member of an independent profession, are responsible both to the public and to their peers
through established review mechanisms. Psychologists are aware of the implications of
their activities for the profession as a whole."). Standards for Health Services in Prisons,
National Comm'n on Correctional Health Care, P-03 (essential)(1997) ("Written policy and
defined procedures require, and actual practice evidences, that clinical decisions and
actions regarding the health services provided to inmates are the sole responsibility of
qualified health care professionals and are not compromised for security reasons.")

Preliminary Mental Health Screening of Incoming Prisoners and
2.
Referrals for Treatment
a.
Prisons and jails must have a system to screen incoming inmates to identify
those with mental illness.
Standards for Adult Correctional Institutions, § 3-4343 (American Correctional Ass'n
& Comm'n on Accreditation for Corrections 3rd ed. 1990);("Written policy, procedure, and
2

practice require medical, dental, and mental health screening to be performed by healthtrained or qualified health care personnel on all inmates, excluding intrasystem transfers,
upon the inmate's arrival at the facility."); id., § 3-4343 (intrasystem transfers are to receive
a health screening upon arrival); Standards for Health Services in Prison, National Comm'n
on Correctional Health Care, P-32, at 41 (1997) ("Written policy and defined procedures
require, and actual practice evidences, that receiving screening is performed by qualified
health care personnel on all inmates immediately upon their arrival at the prison. Persons
who are . . . mentally unstable, or otherwise urgently in need of medical attention are
referred immediately for emergency care."); Standards for Health Services in Jail, National
Comm'n on Correctional Health Care, J-30 (1996) (same);
American Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails and Prisons, in
Psychiatric Services in Jails and Prisons, Task Force Report 29, § C.1.b(1)(a) (jails) (1989)
("Immediately upon admission to the jail, inmates should be asked questions pertaining to
their mental health"); id., § D.1.b(1)(a) (prisons) ("Receiving mental health screening will be
carried out immediately upon admission to the prison . . . ."); American Ass'n of
Correctional Psychologists, Standards for Psychological Services in Adult Jails and
Prisons, 7 Crim. Just. & Behav. 81, § 23, at 103 (1980) (essential) ("Receiving screening is
performed on all inmates upon admission to facility before being placed in the general
population or housing area. . . . Inmates identified as having mental problems are referred
for a more comprehensive psychological evaluation."); id. (discussion) (screening must be
done immediately at the time of booking or admission. Placing two or more inmates in a
holding cell/room pending screening several hours later or the next morning fails to meet
compliance); Fed. Standards for Prisons and Jails § 5.15 (U.S. Dept. of Justice 1980)
("Written policy and procedure provide that receiving screening is performed on all inmates
by qualified health personnel or a specially trained correctional officer upon admission to
the facility before the inmate is placed in the general population or housing area.");
Standard Minimum Rules for the Treatment of Prisoners: Resolution of the First United
Nations Congress on the Prevention of Crime and the Treatment of Offenders, E.S.C. Res.
663C, U.N. ESCOR, 24th Sess., Supp. No. 1, ¶ 24, U.N. Doc. A/CONF/611 (1955),
amended by E.S.C. Res. 2076, U.N. ESCOR, 62d Sess., Supp. No. 1, at 35, U.N. Doc.
E/5988 (1977) (medical services) ("The medical officer shall see and examine every
prisoner as soon as possible after his admission and thereafter as necessary, with a view
particularly to the discovery of physical or mental illness and the taking of all necessary
measures; . . . the noting of physical or mental defects which might hamper rehabilitation
. . . ."); James R.P. Ogloff et al., Screening, Assessment, and Identification of Services for
Mentally Ill Offenders, in Mental Illness in America's Prisons 61, 64 (Henry J. Steadman
and Joseph J. Cocozza eds. [National Coalition for the Mentally Ill in the Criminal Justice
System], 1993) (writing that the mandated medical examination given at admission "must
also include a screening for mental illness."); Fred Cohen, The Legal Context for Mental
Health Services, in Mental Illness in America’s Prisons 25, 56 (Henry J. Steadman and
Joseph J. Cocozza eds. [National Coalition for the Mentally Ill in the Criminal Justice
System], 1993) (stating that to learn how many seriously mentally ill inmates are in their
care, prison officials must have "some type of initial screening and assessment, some
regular follow-up, and some type of decent record-keeping. The epidemiological question is
not satisfactorily answered by simply consulting medication lists, since in many jurisdictions
3

such lists include the dispensing of tranquillizers or sleep aides and, thus, are not parallel to
a list of the mentally ill.").
See also Madrid v. Gomez, 889 F. Supp. 1146, 1218 (N.D. Cal. 1995)("It is
important that a mental health care system effectively identify those inmates in need of
mental health services, both upon their arrival at the prison and during their incarceration.
. . . [M]entally ill prisoners may not seek out help where the nature of their mental illness
makes them unable to recognize their illness or ask for assistance."); Langley v. Coughlin,
715 F. Supp. 522, 540 (S.D.N.Y. 1989), aff'd, 888 F.2d 252 (2nd Cir. 1989) (finding "failure
to take into account the inmate's prior psychiatric history" would be violation of Eighth
Amendment); id. at 541 ("failure to inquire about the patient’s prior history reflects a pattern
of inadequate medical care to the mentally ill inmates housed on SHU [Special Housing
Unit].");
Arnold on behalf of H.B. v. Lewis, 803 F. Supp. 246 (D. Ariz. 1992); Balla v. Idaho State Bd.
of Corrections, 595 F. Supp. 1558, 1577 (D. Idaho 1984) (quoting Ruiz, 503 F. Supp. at
1545) (quoted in Madrid v. Gomez, 889 F. Supp. 1146, 1256-57 (N.D. Cal. 1995)) (stating
that there must be a "systematic program for screening and evaluating inmates in order to
identify those who require mental health treatment."); Barnes v. Government of Virgin
Islands, 415 F. Supp. 1218 (D.V.I. 1976); Coleman v. Wilson, 912 F. Supp. 1282, 1995 WL
559109, *5 (E.D. Cal. 1995) (finding Eighth Amendment violation where "defendants do not
have an adequate mechanism for screening inmates for mental illness, either at the time of
reception or during incarceration."); id. at *12 ("The magistrate judge found that "[i]n order
to provide necessary mental health care to prisoners with serous mental disorders, there
must be a system in place to identify those individuals, both at the time they are admitted to
the Department of Corrections and during their incarceration.'"); Ruiz v. Estelle, 503 F.
Supp. 1265 (S.D. Tex. 1980), aff'd in part and rev'd in part, 679 F.2d 1115 (5th Cir. 1982),
cert. denied, 460 U.S. 1042 (1983).

b.

Contents of the Preliminary Mental Health Screening
Standards for Adult Correctional Institutions. § 3-4344 (American Correctional Ass'n
& Comm'n on Accreditation for Corrections 3rd ed. 1990) (mandatory) (preliminary
screening) ("All findings are recorded on a screening form approved by the health authority.
The screening includes at a minimum the following: Inquiry into whether the inmate is being
treated for a medical, dental, or mental health problem; whether the inmate is presently on
medication; whether the inmate has a current medical, dental, or mental health complaint;
Observation of general appearance and behavior . . "); National Comm'n on Correctional
Health Care, Standards for Health Services in Prison P-32, at 41 (1997)(essential)
(Receiving Screening) ("At minimum, the screening process includes the following: (1)
Inquiry into current and past illnesses, health problems, and conditions including . . . mental
illness including suicide risk. . . (2) Observation of the following: behavior, which includes
state of consciousness, mental status (including suicidal ideation), appearance, conduct,
tremors, [other indicators of medical problems] and needle marks or other indications of
drug abuse. 4) Notation of the disposition of the patient, such as immediate referral to an
appropriate health care service, placement in the general inmate population and the later
referral to an appropriate health care service, or placement in the inmate population. 5)
4

Documentation of the date and time when referral/placement actually takes place.");
National Comm'n on Correctional Health Care, Standards for Health Services in Jail J-30,
at 41 (1996) (same); American Psychiatric Ass'n, Guidelines for Psychiatric Services in
Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29,
§ C.1.a(1) (jails) (1989) ("Receiving mental health screening consists of observation and
structured inquiry designed to prevent newly arrived inmates, who may be acutely or
chronically mentally ill, from being admitted to the facility's general population and to refer
these inmates rapidly for a more full scale mental health evaluation."); id., § C.1.b(1)(a)
(jails) ("Immediately upon admission to the jail, inmates should be asked questions
pertaining to their mental health, i.e., suicide potential, prior psychiatric hospitalizations, and
current medications, both being taken and prescribed."); id., § D.1.a(1) (prisons)
("Receiving mental health screening consists of observation and structured inquiry
designed to assure that the prisoner newly arriving at the facility or reception center, who
may require mental health evaluation as a result of mental illness or developmental
disability, is referred for mental health evaluation and is placed in the proper living
environment."); id., § D.1.b(1)(a) (prisons) ("Receiving mental health screening . . . will
include the review of pertinent records accompanying the inmate. It will also include inquiry
into past mental health treatment and screening questions designed to identify the signs of
severe emotional, intellectual, and/or behavioral problems such as hallucinations, suicidal
and/or homicidal thinking, severe thought disorganization, or bizarre behavior."); American
Ass'n of Correctional Psychologists, Standards for Psychological Services in Adult Jails and
Prisons, 7 Crim. Just. & Behav. 81, § 23, at 103 (1980) (discussion) ("The method of
receiving screening should include: (a) a review of papers or records accompanying the
inmate; (b) completion of the receiving screening form with the help of the inmate—i.e., a
review of the inmate's history concerning suicidal behavior, sexual deviancy, mental health
history (including alcohol and other substance abuse), mental hospitalizations, seizures,
patterns of violence and aggression; and (c) visual observation of the inmate's behavior
(looking for signs of delusions, hallucinations, communication difficulties, peculiar speech
and/or posturing, impaired level of consciousness, disorganization, memory deficits,
depression, and evidence of self-mutilation)."); Fed. Standards for Prisons and Jails § 5.15
(U.S. Dept. of Justice 1980) ("Where receiving screening is performed by a correctional
officer and full exposure of the body is required, the officer is of the same sex as the
inmate. The findings are recorded on a printed screening form approved by the health
authority. The screening includes the following: . . . Behavioral observation, including state
of consciousness and mental status, appearance, conduct, tremor and sweating.").
c.

Preliminary screenings must be conducted in a confidential atmosphere.
Deborah L. Dennis, The National Work Session: Recommendations for Action, in
Mental Illness in America’s Prisons 213, 215 (Henry J. Steadman and Joseph J. Cocozza
eds. [National Coalition for the Mentally Ill in the Criminal Justice System], 1993)
("Screening should be conducted in a setting respectful of the privacy and dignity of the
inmate, and where sensitive and valid information may be obtained."). See also American
Ass'n of Correctional Psychologists, Standards for Psychological Services in Adult Jails and
Prisons, 7 Crim. Just. & Behav. 81, § 06, at 90 (1980) (discussion) ("Physical arrangements
should be conducive to human dignity, self-respect, and promoting the optimal functioning
5

of both the inmate clients and the professional staff members. [Necessary equipment
includes] a desk, a desk chair, . . . at least one comfortable chair (preferably with armrests)
for the clients, . . . an office with walls to the ceiling and no windows (or with drapes which
can be drawn for privacy).").
d.

Screeners need training in mental illnesses.
American Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails and Prisons,
in Psychiatric Services in Jails and Prisons, Task Force Report 29, § C.1.b(1)(c) (1989)
(jails) ("Receiving mental health screening is usually done primarily by the booking officer.
Special training in mental health screening should be provided to the officers who perform
this task."); id., § b(1)(e) (jails) ("Psychiatrists [role includes] (ii) training officers to use the
screening instrument."); id., b(2)(c) (jails) ("The intake mental health screening should be
performed by a member of the health care staff."); id., § D.1.b(1)(c) (prisons) ("Receiving
mental health screening should be performed by a qualified mental health professional or
by a trained correctional officer at the time of admission."); id., b(1)(e) ("Psychiatrists' role in
the provision of receiving mental health screening [includes (ii)] ongoing training of
correctional officers and health and mental health personnel in the use of receiving mental
health screening forms and procedures."); id., b(2)(c) (prisons) ("The intake mental health
screening should be performed by a member of the health care staff."); id., b(2)(e) (stating
that psychiatrists' primary roles in intake mental health screening includes "(i) the
development of the appropriate intake mental health screening forms and informational
material [and] (ii) the training of health care staff in the use of mental health screening
forms and the informational (orientation) materials."); id., b(3)(c) ("Mental health evaluations
or consultations are performed by an appropriately trained mental health professional").
See also Langley v. Coughlin, 715 F. Supp. 522 (S.D.N.Y. 1989), aff'd, 888 F.2d 252
(2nd Cir. 1989); Madrid v. Gomez, 889 F. Supp. 1146 (N.D. Cal. 1995) (stating that
screening must be performed by people with proper training and background).

3.

Mental Health Assessment of All Inmates

a.
All newly committed inmates should receive a detailed mental health
evaluation shortly after admission.
Standards for Adult Correctional Institution § 3-4345 (American Correctional Ass'n &
Comm'n on Accreditation for Corrections 3rd ed. 1990) (Full Health Appraisal) ("Written
policy, procedure, and practice require that health appraisal for each inmate, excluding
intrasystem transfers, is completed within 14 days after arrival at the facility."); Standards
for Health Services in Prison, National Comm'n on Correctional Health Care P-35, at 46
(1997)(essential) (mental health evaluation) ("Written policies and defined procedures
require, and actual practice evidences, post-admission evaluation of all inmates by qualified
mental health personnel [physicians, psychiatrists, psychologists, nurses, physician
assistants, psychiatric social workers, and others who by virtue of their education,
credentials, and experience are permitted by law to evaluate and care for the mental health
needs of patients] within 14 days of admission."); Standards for Health Services in Jail,
National Comm'n on Correctional Health Care P-39, at 50 (1996) (same); American
6

Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails and Prisons, in Psychiatric
Services in Jails and Prisons, Task Force Report 29,§ C.1.b(2)(a) (1989) (jails) ("Intake
mental health screening should take place within 24 hours of admission to a jail."); id.,
§ D.1.a(2) (prisons) ("Intake mental health screening may take place somewhat later [than
receiving mental health screening]."); id., § D.1.b(2)(a) (prisons) ("Intake mental health
screening should take place within seven days of admission to a prison or reception
center."); Fed. Standards for Prisons and Jails § 5.16 (U.S. Dept. of Justice 1980) ("Health
appraisal data collection is completed for each inmate within fourteen days after admission
to the facility . . . If a health appraisal as required herein has been completed within the
previous 90 days prior to admission to the facility and all results have been transferred, the
recollection of this data may be waived at the discretion of the responsible physician.");
American Ass'n of Correctional Psychologists, Standards for Psychological Services in
Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 24, at 104 (1980) (essential) ("In a
prison setting, all newly committed inmates with sentences over one year shall be given a
psychological evaluation within one month of admission.").
b.

Contents of Mental Health Assessment
National Comm'n on Correctional Health Care, Standards for Health Services in
Prison P-34, at 44 (1997)(essential) (health assessment) ("A full health assessment . . .
includes these items: a review of the receiving results; the collection of additional data to
complete the medical, dental, and mental health histories; . . . a physical examination
including comments about mental status . . . ."); id., P-35, at 46 (mental health
evaluation)(discussion)("The post-admission mental health assessment includes: (1) a
structured interview by mental health staff in which inquiries into the items listed below are
made: history of psychiatric hospitalization and outpatient treatment; current psychotropic
medications; suicidal ideation and history of suicidal behavior, drug usage, alcohol usage,
history of sex offenses; history of expressly violent behavior; history of victimization, special
education placement, history of cerebral trauma or seizures, and emotional response to
incarceration"); National Comm'n on Correctional Health Care, Standards for Health
Services in Jail, J-39, at 50-51 (1996) (same); Standards for Adult Correctional Institutions.
§ 3-4345 (American Correctional Ass’n & Comm'n on Accreditation for Corrections 3rd ed.
1990) (Full Health Appraisal) ("Health appraisal includes the following: review of the earlier
receiving screening; collection of additional data to complete the medical, dental, mental
health, and immunization histories; . . . other tests and examinations as appropriate;
medical examination, including review of mental and dental status; . . . initiation of therapy
when appropriate."); American Psychiatric Ass'n, Guidelines for Psychiatric Services in
Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29,
§ C.1.a(2) (1989) (jails) ("Intake mental health screening is a component of the full scale
admission workup and consists of a detailed medical and mental health examination."); id.,
§ D.1.a(2) (prisons) "Intake mental health screening . . . consists of a more detailed,
thorough, and structured mental health examination which is administered to all recently
arriving prisoners as part of the facility's admission process."); Fed. Standards for Prisons
and Jails § 5.16 (U.S. Dept. of Justice 1980) ("Health appraisal data collection . . . includes
. . . additional data to complete the medical, immunization, and mental health history.");
American Ass'n of Correctional Psychologists, Standards for Psychological Services in
7

Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 24, at 104 (1980) (essential) ("Such
routine [psychological] evaluations are brief and include (but are not necessarily limited to)
behavioral observation, a records review, group testing to screen for emotional and
intellectual abnormalities, and a written report of initial findings. Referral for more intensive,
individual assessment is made when appropriate.").
Follow up Referrals from Preliminary Screening and Mental Health
4.
Assessment
a.
Inmates should receive a thorough psychiatric evaluation within a short period
after staff make a referral
Standards for Adult Correctional Insts. § 3-4349 (American Correctional Ass'n &
Comm'n on Accreditation for Corrections 3rd ed. 1990) ("Written policy, procedure, and
practice, approved by the health authority, provide for comprehensive individual evaluation
by a multidisciplinary mental health team for specially referred inmates. The evaluation is
completed within 14 days after the date of referral and includes at least the following:
review of mental health screening and appraisal data; direct observations of behavior;
collection and review of additional data from individual diagnostic interviews and tests
assessing personality, intellect, and coping abilities; compilation of the individual's mental
health history; development of an overall treatment/management plan with appropriate
referral."); American Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails and
Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29, § D.1.b(1)(c)
(1989) ("Where receiving mental health screening is done primarily by a trained correctional
officer, written policies and procedures will define a mechanism for prompt referral to and
evaluation by a mental health professional where appropriate."); id., b(2)(e)(iii) (stating that
psychiatrists' primary role in intake mental health screening includes "the development of
written referral procedures for inmates identified during the intake mental health screening
as [sic] process as requiring mental health evaluation"); id., b(3)(a) ("Specific written
procedures providing for . . . referral shall be part of the facilities [sic] mental health
services plan."); id., § C.1.a(3) (1989) (jails) ("Mental health evaluation is a comprehensive
mental health examination which is appropriate to the particular, suspected level of
disability and which is focused on the suspected mental illness or developmental
disability."); id., § C.1.b(3)(a) (jails) ("Mental health evaluation shall be provided within 24
hours from the time of referral. In cases of urgency, provision shall be made for immediate
evaluation upon referral. Referral may be made by (i) a screening procedure, (ii) custodial
staff, or (iii) self-referral."); id., § D.1.b(3)(a) (prisons) ("Mental health evaluation or an
appropriate alternative response shall be provided in no more than 24 hours from the time
of referral. In cases of urgency, provision shall be made for immediate evaluation upon
referral."); American Ass'n of Correctional Psychologists, Standards for Psychological
Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 27, at 106 (1980)
(essential) ("Crisis evaluations should be conducted as soon as possible, but not later than
24 hours after the staff member has been notified. Subsequently, a report of the session(s)
is written and appropriately filed."); id. (discussion) ("Qualified psychological services
personnel conduct these crisis evaluations. Facility staff should have sufficient training to
provide adequate supportive care until the evaluation can be made."); id., § 26, at 105-06
8

(essential) ("The individual assessment of all inmates referred for a special comprehensive
psychological appraisal is completed within 14 days after the date of the referral. . . . This
standard as applied in a prison setting includes: (a) Reviewing earlier screening information
and psychological evaluation data. (b) Collecting and reviewing any additional data to
complete the individual's mental health history, (c) collecting additional data from
observations by correctional staff, (d) administering tests which assess levels of cognitive
and emotional functioning and the adequacy of coping mechanisms, (e) writing a report
describing the results of the assessment procedures, including an outline of a
recommended plan of treatment which mentions any indication by the inmate of a desire for
help, (f) communicating results to referral source, and (g) writing and filing a report of
findings and recommendations.").

5.

Monitoring and Diagnosis of Inmates with Mental Illness

a.
Every correctional facility must have procedures for custody staff and inmates
to refer inmates needing mental health treatment or evaluation.
American Ass'n of Correctional Psychologists, Standards for Psychological Services
in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 22, at 102 (1980) (essential)
("There is a written, implemented policy approved by the chief psychologist (and in
accordance with headquarters guidelines in a multifacility system) regarding access to
psychological services for (1) postadmission inmates with emergency problems and for (2)
daily referrals of nonemergency problems covering both scheduled and unscheduled
care."); id. (discussion) ("Institution staff should refer to psychological services personnel
those inmates in the general population who are suspected of emotional disturbance.
Correctional officers or jailers, all of whom should be trained in recognition of symptoms of
mental disturbance, provide 24-hour-a-day observation and are available to receive
complaints of this nature from inmates. The obligation of these staff members is to pass
this information along to psychological services personnel for screening/triaging or
assignment of treatment priorities, followed by referrals for treatment as indicated.");
Foundation/Core Standards for Adult Local Detention Facilities § C2-5182 (American
Correctional Ass'n & Comm'n on Accreditation for Corrections 1989) (certification standard)
("Written policy and procedure require postadmission screening and referral for care of
mentally ill or retarded inmates whose adaptation to the correctional environment is
significantly impaired."); American Psychiatric Ass'n, Guidelines for Psychiatric Services in
Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29,
§ C.1.b(3)(a) (1989) (jails) ("Mental health evaluation shall be provided within 24 hours from
the time of referral. In cases of urgency, provision shall be made for immediate evaluation
upon referral. Referral may be made by . . . (ii) custodial staff, or (iii) self-referral. Specific
written procedures providing for these types of referral shall be part of the facility’s mental
health services plan."); ABA Criminal Justice Mental Health Standards § 7-2.6(b) (American
Bar Association 1984) (postarrest obligations of police and custodial personnel) ("When
arresting or custodial officers or other personnel observe a detainee whose conduct or
demeanor is indicative of mental illness or mental retardation, mental disturbance,
disorientation or distress, or whose behavior is self-injurious or is indicative of the possibility
9

of suicide, such officers or personnel have a duty to report those observations promptly to
the official in charge of the detention or holding facility. Such official, after promptly
confirming the need to do so, should summon a mental health or mental retardation
professional to provide emergency evaluation, treatment, or habilitation."); Fed. Standards
for Prisons and Jails § 5.29 (U.S. Dept. of Justice 1980) ("Written policy and procedure
require that screening and referral for care are provided to mentally ill or retarded inmates
whose adaptation to the correctional environment is significantly impaired.").
See also Madrid v. Gomez, 889 F. Supp. 1146, 1219 (N.D. Cal. 1995)(It is
insufficient for a prison to rely upon mental health referrals from custody staff and inmates;
staff psychiatrists and psychologists should visit the cellblocks regularly.); Langley v.
Coughlin, 715 F. Supp. 522, 541 (finding that "an absence of criteria for DOCS [Department
of Correctional Services] personnel to follow concerning when to make referrals to OMH
[Office of Mental Health" "reflects a pattern of inadequate medical care to the mentally ill
inmates housed on SHU [Special Housing Unit]."); James R.P. Ogloff et al., Screening,
Assessment, and Identification of Services for Mentally Ill Offenders, in Mental Illness in
America's Prisons 61, 64 (Henry J. Steadman and Joseph J. Cocozza eds. [National
Coalition for the Mentally Ill in the Criminal Justice System], 1993) ("[M]any inmates, who
develop mental health problems after being incarcerated, or whose problems become more
severe under those circumstances, fall between the cracks left open by limiting mental
health assessments to the time of admission and following crisis episodes. For this reason,
it is important for prisons to implement a comprehensive screening and evaluation program,
and to involve all personnel working with inmates in prisons in the process of continuously
identifying inmates who may display symptoms of mental illness and who may require
intervention." "[I]t is important for mental health programs in prisons to include formal and
informal mechanisms for personnel to make referrals to the programs. For example,
corrections officers should be able to talk with mental health personnel about an inmate
who they notice to have undergone serious changes in mood or behavior. Likewise, there
should be a formal process for staff and duty officers to refer inmates to the mental health
program").

6.

Mental Health Treatment Modalities

a.
Correctional facilities must provide a range of treatment modalities to inmates
with mental disabilities.
Standards for Adult Correctional Institutions. § 3-4380 (American Correctional Ass'n
& Comm'n on Accreditation for Corrections 3rd ed. 1990), § 3-4386 ("Treatment offerings
should include group therapy and group and individual counseling."); Fed. Standards for
Prisons and Jails § 5.30 (U.S. Dept. of Justice 1980) ("Special programs exist for . . . (2)
inmates with severe emotional disturbances, and (3) retarded and developmentally disable
inmates who require close medical, psychiatric, psychological, or habilitative supervision. A
written individualized plan for each of these inmates is approved by a physician or qualified
mental health professional after appropriate multidisciplinary consultation and in accord
with written policy. The plan includes directions to medical and nonmedical personnel
regarding their roles in the care, supervision and habilitation of these inmates."); American
10

Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails and Prisons, in Psychiatric
Services in Jails and Prisons, Task Force Report 29, § D.3.a(1) (1989) (prisons) ("Given
the relatively long-term nature of prison confinement, a wider range of mental health
treatment modalities [than needed in lock-ups and jails] will be called for. These include:
(1) a full range of appropriate mental health treatment services as described in the
principles." (citing American Psychiatric Ass'n, Principles Governing the Delivery of
Psychiatric Services in Lock-Ups, Jails and Prisons, in Psychiatric Services in Jails and
Prisons, Task Force Report 29, § F.5 (referring to "a. an acute care program, b. a chronic
care program, c. a transitional care program, and d. an outpatient treatment program." As
part of providing a therapeutic milieu, prisons must assure "the availability of mental health
personnel and regular access to such personnel by the inmate population."
"Psychotherapies of different types, including individual and group, supportive, and insight,
should be available as needs require and resources can provide. Group therapy programs
have been found to be especially suitable in these settings and to particular patient
populations including substance abusers, sex offenders, etc. . . . Behavior modification
programs may be helpful, but they must require informed consent and must have external,
independent, professional monitoring. Family therapy programs are to be especially
encouraged."))); American Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails
and Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29, § C.3.a
(jails) ("Considering the short-term nature of most jail confinements, treatment will generally
emphasize the prescription of psychotropic medications. For those inmates whose pre-trial
confinements or sentences may be of longer term, some verbal therapies may also become
part of the treatment regimen."); Standards for Health Servs. in Correctional Institutions.,
Mental Health Care Services § C, at 31-32 (American Pub. Health Ass"n 1976) ("Principle:
Direct treatment services should be provided in a context of varied modalities, with
emphasis on eclectic breadth. . . . Satisfactory Compliance: The following direct treatment
services shall be made available as a minimum: 1. Crisis intervention . . . 2. Brief and
extended evaluation/assessment. 3. Short-term Therapy: Group and individual. 4. Longterm Therapy: Group and Individual. 5. Therapy with family and significant others. 6.
Counseling must be available for all inmates. . . . 7. Medication. . . . 8. De-toxicification. 9.
In-patient hospitalization for the severely disturbed."); American Ass'n of Correctional
Psychologists, Standards for Psychological Services in Adult Jails and Prisons, 7 Crim.
Just. & Behav. 81, § 37, at 112 (1980) (essential) ("The facility will provide a multiplicity of
appropriate programs."); id. (discussion) ("The requirement that there be a reasonable
number of alternative programs is intended to recognize the complexity and uniqueness of
each inmate client and to prevent exclusive reliance upon any particular treatment modality,
such as group or milieu therapy. This is not intended to mandate that every facility provide
every conceivable treatment program; it does require a reasonable number of alternatives
based upon the institution's characteristics and the needs of its inmates.").
b.

Treatment must consist of more than just medication.
Standards for Adult Correctional Institutions. § 3-4341 (American Correctional Ass'n
& Comm'n on Accreditation for Corrections 3rd ed. 1990) (mandatory) ("Written policy,
procedure, and practice provide for the proper management of pharmaceuticals and
address the following subjects: . . . prescription practices, including requirements that (1)
11

psychotropic medications are prescribed only when clinically indicated as one facet of a
program of therapy."); Foundation/Core Standards for Adult Local Detention Facilities
§ FC2-5087 (American Correctional Ass'n & Comm'n on Accreditation for Corrections 1989)
(mandatory) (Prescription practices that require "(a) psychotropic medications are
prescribed only when clinically indicated as one facet of a program of therapy."); National
Comm'n on Correctional Health Care P-27.5(h), at 34 (1997) (essential) (Pharmaceuticals)
("The prescribing of psychotropic or behavior-modifying medications only when clinically
indicated (as one facet of a program of therapy) and not for disciplinary reasons.");
Standards for Health Services in Jail, National Comm'n on Correctional Health Care, J30.5(h) (1996) (same).
See also Marnie E. Rice & Grant T. Harris, Treatment for Prisoners with Mental
Disorder, in Mental Illness in America’s Prisons 91, 97 (Henry J. Steadman and Joseph J.
Cocozza eds. [National Coalition for the Mentally Ill in the Criminal Justice System], 1993)
("[I]n the end, though an essential part of the clinical arm[am]entarium, it must be
concluded that drugs will not suffice as the only clinical tool for prisoners with mental
disorder." (citing G.T. Harris, The Relationship Between Neuroleptic Drug Dose and the
Performance of Psychiatric Patients in Maximum Security Token Economy Program, 20 J.
Behavior Therapy & Experimental Psychiatry 57 (1989), M.E. Rice et al., Violence in
Institutions: Understanding, Prevention, and Control (1989), M.E. Rice et al., Planning
Treatment Programs in Secure Psychiatric Facilities, in Law and Mental Health:
International Perspectives 162 (D. Weisstub ed., 1990))).
See also Langley v. Coughlin, 715 F. Supp. 522, 540 (S.D.N.Y. 1989), aff'd, 888
F.2d 252 (2nd Cir. 1989) (finding "failure to provide any meaningful treatment other than
medication" would violate Eighth Amendment); Madrid v. Gomez, 889 F. Supp. 1146, 1218
(N.D. Cal. 1995) (finding constitutional violations in system where "[t]reatment for seriously
ill inmates is primarily limited to medication management through use of antipsychotic or
psychotropic drugs, and intensive outpatient treatment is not available").
c.

Each inmate must have an individualized treatment plan.
American Ass'n of Correctional Psychologists, Standards for Psychological Services
in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 31 at 108 (1980) (essential) ("A
written treatment plan exists for all inmates requiring psychological services. This is
developed by a psychologist in collaboration with other personnel and includes directions
for nonpsychological services personnel regarding their roles in the care and supervision of
these prisoners."); id. (discussion) ("A treatment plan is a series of written statements which
specify the particular course of therapy and the roles of all personnel in carrying out the
plan. It should also include future planning for the management of a specific condition. The
plan may be brief or as long as necessary to provide proper care. Jail inmates with short
stays may have less detailed plans than prisoners confined in long-term facilities. The
treatment plan should be goal-oriented and should specify, in addition to any
nonpsychological activities, at least the following: the extent and nature of the formal
psychotherapeutic modality being used, provision for interim progress notes, and a
termination summary."); Standards for Health Services in Prison, National Comm'n on
Correctional Health Care P-51 at 65 (1997)(Special Needs Treatment Plans (essential)
("Written policy and defined procedures guide the care of inmates with special needs
12

requiring close medical supervision and/or multidisciplinary care. Included among special
needs patients are the following: . . . inmates with serious mental health needs and the
developmentally disabled. For each of these special needs patients there is a written
individualized treatment plan, developed by a physician or other qualified health
practitioner."); id (discussion) ("Inmates with serious mental health needs include people
with basic psychotic disorders (e.g. manic-depressives); self-mutilators; the aggressive
mentally ill; and suicidal inmates. . . A treatment plan is a series of written statements
specifying the particular course of therapy and the roles of qualified health care
professionals in carrying it out. It is individualized, typically multidisciplinary, and based on
an assessment of the patients needs, a statement of short and long-term goals as well as
the methods by which these goals will be pursued. When clinically indicated, the treatment
plan gives inmates access to the range of supportive and rehabilitative services (such as . .
. individual or group counseling, and self-help groups) that the treating practioner deems
appropriate."); Standards for Health Services in Jails, National Comm'n on Correctional
Health Care, J-49 at 63 (1996)(same); Fed. Standards for Prisons and Jails § 5.30 (U.S.
Dept. of Justice 1980)(Inmates with mental disabilities must have a "written individualized
plan . . . approved by a physician or qualified mental health professional after appropriate
multidisciplinary consultation and in accord with written policy. The plan includes directions
to medical and nonmedical personnel regarding their roles in the care, supervision and
habilitation of these inmates.").
See also Coleman v. Wilson, 912 F. Supp. 1282, 1995 WL 559109, *5 (E.D. Cal.
1995) (finding Eighth Amendment violation where magistrate judge found that medical
records contained incomplete or nonexistent treatment plans).

d.
Prisons must have written policies to assure timely delivery of needed mental
health services.
Fed. Standards for Prisons and Jails § 5.19 (U.S. Dept. of Justice 1980) ("Written
policy and procedure require that inmates' medical complaints are processed, reviewed and
responded to daily by health trained personnel according to priority of need. In all cases,
inmates receive treatment for medical problems promptly by the appropriate level of health
personnel. No inmate or correctional officer inhibits or delays an inmate’s access to medical
services or interferes with medical treatment.").
See also Coleman v. Wilson, 912 F. Supp. 1282, 1995 WL 559109, *5 (E.D. Cal.
1995) (finding Eighth Amendment violation where "[t]here are significant delays in, and
sometimes complete denial of, access to necessary medical attention.").

e.

Mental health care should be available on a 24-hour basis.
Standards for Adult Correctional Institutions. § 3-4350 (American Correctional Ass'n
& Comm'n on Accreditation for Corrections 3rd ed. 1990) (mandatory) ("Written policy,
procedure, and practice provide for 24-hour emergency medical, dental, and mental health
care availability as outlined in a written plan. The plan includes arrangements for . . . use of
one or more designated hospital emergency rooms or other appropriate health facilities;
emergency on-call physician, dentist, and mental health professional services when the
13

emergency health facility is not located in a nearby community; security procedures
providing for the immediate transfer of inmates when appropriate."); American Psychiatric
Ass'n, Guidelines for Psychiatric Services in Jails and Prisons, in Psychiatric Services in
Jails and Prisons, Task Force Report 29, § C.2.b (1989) (jails) (crisis intervention)
("Essential [crisis intervention] mental health services [include] (2) twenty-four hour
availability of mental health professionals to conduct evaluations, . . . (5) twenty-four hour
availability of a psychiatrist to clinically evaluate patients, after initial evaluation, and to
prescribe emergency medication."); id., § D.2.b (prisons) (crisis intervention) ("Essential
[crisis intervention] mental health services [include] (2) availability of a psychiatrist to
consult with on a 24-hour basis with reference to inmate management, (3) twenty-four hour
availability of a qualified physician to prescribe emergency medications when indicated.");
American Pub. Health Ass'n 36 (1986)("It shall be the responsibility of the Mental Health
Unit to insure that a program is developed which will be capable of responding 24 hours a
day, seven days a week, to inmates in acute emotional or mental distress. This program
shall include . . . the capability for immediate hospitalization of severely psychotic
individuals or suicide risks . . .").

f.
Inmates must be provided with information about mental health services in a
language they can understand.
Fed. Standards for Prisons and Jails § 5.18 (U.S. Dept. of Justice 1980) ("At the time
of admission to the facility, inmates are informed orally and in writing of the procedures for
gaining access to health care services and the processing of complaints regarding health
care services. This information is made available to non-English speaking inmates in a
language they can understand. Where the number of non-English speaking inmates is
significant and there is another language known to a substantial number of them, the
information is provided in writing in that language."); Standard Minimum Rules for the
Treatment of Prisoners: Resolution of the First United Nations Congress on the Prevention
of Crime and the Treatment of Offenders, E.S.C. Res. 663C, U.N. ESCOR, 24th Sess.,
Supp. No. 1, ¶ 51, U.N. Doc. A/CONF/611 (1955), amended by E.S.C. Res. 2076, U.N.
ESCOR, 62d Sess., Supp. No. 1, at 35, U.N. Doc. E/5988 (1977) (institutional personnel)
("(1) The director, his deputy, and the majority of the other personnel of the institution shall
be able to speak the language of the greatest number of prisoners, or a language
understood by the greatest number of them. (2) Whenever necessary, the services of an
interpreter shall be used."); American Psych. Ass'n, General Guidelines for Providers of
Psychological Services § 1.3, at 3 (1987) (illustrative statement) ("To facilitate the
effectiveness of services by increasing the level of staff sensitivity and professional skills,
the psychologist who is designated as director participates in the selection of professional
and support personnel whose quaifications include sensitivity and consideration for the
language, cultural and experiental background, affectional orientation, ethnic identification,
age, and gender of the users . . ."). See also, Franklin v. District of Columbia, -- F.Supp. --,
1997 WL 194453 (D.D.C. 1997).

14

7.

Medication

a.
Psychotropic medication must be prescribed only by a psychiatrist and in
accordance with contemporary medical standards
Standards for Health Servs. in Correctional Institutions., Mental Health Care
Services § B.1, at 28 (American Pub. Health Ass'n 1976) ("Psychotropic medication must
be prescribed only by a psychiatrist in accordance with generally accepted pharmacological
principals and contemporary national standards."); id, § C, at 31, 32 ("The following direct
treatment services shall be made available as a minimum: . . . 7. Medication. In all
instances psychotropic medication shall be prescribed in accordance with generally
accepted pharmacological principles and standards of good practice in the general
community, including biochemical monitoring where indicated and evaluation of efficacy in
all cases."). Standards for Health Services in Prison, National Comm'n on Correctional
Health Care P-27 at 34 (1997)(essential) (Policy should require the "prescribing of
psychotropic or behavior-modifying medications only when clinically indicated (as one facet
of a program of therapy) and not for disciplinary reasons."); Fed. Standards for Prisons and
Jails § 5.35 (U.S. Dept. of Justice 1980) ("Written policy and procedure require that
psychotropic medications are prescribed only by a psychiatrist who has examined the
inmate and only when clinically indicated."); Standards for Adult Correctional Institutions.
§ 3-4342 (American Correctional Ass'n & Comm'n on Accreditation for Corrections 3rd ed.
1990) ("Psychotropic drugs, such as antipsychotics, antidepressants, and drugs requiring
parenteral administration, are prescribed only by a physician or authorized health provider
by agreement with the physician, and only following a physical examination of the inmate
by the health provider.")
b.
Psychiatrists or physicians should monitor all inmates on psychotropic
medications.
Fed. Standards for Prisons and Jails § 5.35 (U.S. Dept. of Justice 1980) ("Written
policy and procedure require that psychotropic medications are prescribed only by a
psychiatrist who has examined the inmate and . . . that there is an appropriate procedure
for monitoring reactions."); American Psychiatric Ass'n, Guidelines for Psychiatric Services
in Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29,
§ C.3.b(5) (1989) (jails) (stating that essential mental health services include requiring that
"the prescription and monitoring of psychotropic medications should be done by a
psychiatrist, rather than a general practitioner."); id., § D.3.a(6) (prisons) ("Prescribing and
monitoring of psychotropic medications is carried out by a qualified psychiatrist except in
emergency situations when a non-psychiatrist physician may prescribe these
medications."); American Pub. Health Ass'n 40 (1986) ("Every inmate receiving
psychotropic medication shall be seen and evaluated by a psychiatrist at least once a week
until stabilized and thereafter at least every two weeks.");
Madrid v. Gomez, 889 F. Supp. 1146, 1258 (N.D. Cal. 1995) ("Psychotropic or behavioraltering medication should only be administered with appropriate supervision and periodic
evaluation."); Coleman v. Wilson, 912 F. Supp. 1282, 1995 WL 559109, *17 (E.D. Cal.
1995) (finding constitutional violations in part because "inmates on psychotropic medication
are not adequately monitored"); Ruiz, 503 F. Supp. at 1339.
15

c.

A psychiatrist must re-evaluate prescriptions before renewal.
Fed. Standards for Prisons and Jails, § 5.34 (U.S. Dept. of Justice 1980) ("The
facility's standard operating procedures for the proper management of pharmaceuticals
include . . . [r]e-evaluation by the prescribing provider prior to renewal of a prescription.");
Standards for Adult Correctional Insts. § 3-4341 (American Correctional Ass'n & Comm'n
on Accreditation for Corrections 3rd ed. 1990) (mandatory) ("Written policy, procedure, and
practice provide for the proper management of pharmaceuticals and address the following
subjects: . . . prescription practices, including requirements that . . . (3) the prescribing
provider reevaluates a prescription prior to its renewal."); Foundation/Core Standards for
Adult Local Detention Facilities § FC2-5087 (American Correctional Ass'n & Comm'n on
Accreditation for Corrections 1989) (mandatory) ("Written policy, procedure, and practice
provide for the proper management of pharmaceuticals and address the following subjects:
. . . (2) Prescription practices that require . . . (c) the prescribing provider reevaluates a
prescription prior to its renewal."); Foundation/Core Standards for Adult Local Detention
Facilities § FC2-5087 (American Correctional Ass'n & Comm'n on Accreditation for
Corrections 1989) (mandatory) ("Written policy, procedure, and practice provide for the
proper management of pharmaceuticals and address the following subjects: . . . 2(b) 'Stop
order' time periods are required for all medications.");Standards for Health Services in
Prison, National Comm'n on Correctional Health Care P-27.5(e), at 34 (1997)
(Pharmaceuticals)(essential) ("Automatic drug stop orders or required review of all orders
for DEA-controlled substances, psychotropic drugs, or any other drug that should be
restricted because it lends itself to abuse of [sic] for any other reason dictating that patient
compliance be monitored."); Standards for Health Services in Jails, National Comm'n on
Correctional Health Care J-26.5(e), at 33 (1996) (same).

d.

The formulary should contain a range of psychotropic medications.
American Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails and Prisons,
in Psychiatric Services in Jails and Prisons, Task Force Report 29, § C.3.b(4) (1989) (jails)
(stating that essential mental health services include "a full range of psychotropic
medications."); id., § D.3.a(6) (prisons) (stating that prison mental health systems must
assure "availability of a full range of psychotropic medications"); Coleman v. Wilson, 912 F.
Supp. 1282, 1995 WL 559109, *17 (E.D. Cal. 1995) (finding constitutional violations in part
because "it appears that some very useful medications are not available because there is
not enough staff to do necessary post-medication monitoring. . . . [T]he evidence in the
record demonstrates that some medications that are very effective in the treatment of
serious mental disorders are not available.").

e.

Prisoners must receive prescribed medications without interruption.
Fed. Standards for Prisons and Jails § 5.46 (U.S. Dept. of Justice 1980) ("Inmates
receive all medication in the form and at the times prescribed when they are in the facility,
16

including administrative segregation and disciplinary detention, or when they are
temporarily off the facility grounds."); id., § 5.34 ("The facility's standard operating
procedures for the proper management of pharmaceuticals include . . . [p]rocedures for
medication dispensing and administration or distribution."); American Psychiatric Ass'n,
Guidelines for Psychiatric Services in Jails and Prisons, in Psychiatric Services in Jails and
Prisons, Task Force Report 29, § D.3.a(6) (1989) ("Psychiatrists, along with the facility's
pharmacy, should develop and monitor procedures to assure that psychotropic medications
are appropriately distributed."); Standards for Health Services in Prison, National Comm'n
on Correctional Health Care P-21, at 27 (1997)(essential) (Medication Administration
Training) ("Written policy and defined procedures require, and actual practice evidences,
that personnel who administer medication are trained to do so. They must receive training
approved by the prison administrator, or his/her designee, regarding matters of security. In
addition, they must receive from the responsible physician training regarding accountability
for administering medications in a timely manner according to physicians' orders, and
recording the administration of medications in a manner and on a form approved by the
health authority."); Fed. Standards for Prisons and Jails § 5.36 (U.S. Dept. of Justice 1980)
("The person administering medication has training approved by the health authority; is
accountable for administering medications according to orders; and records the
administration of medications in a manner and on a form approved by the health authority.
In no event does an inmate dispense or administer medication.").

f.
A system must be in place for the involuntary administration of psychiatric
medications in appropriate circumstances.
Standards for Health Services in Prison, National Comm'n on Correctional Health
Care P-67, at 84 (1997) (essential) (forced psychotropic medication) ("Written policy and
defined procedures guide the use of forced psychotropic medication in an emergency
situation. This policy and these procedures, while governed by the laws applicable in the
jurisdiction, include requirements for authorization by a physician and specification of the
duration of the regimen; when, where, and how the procedures may be used; and
treatment plan goals for less restrictive treatment alternatives as soon as possible. Actual
practice is consistent with the policy and procedures."); Standards for Health Services in
Jails, National Comm'n on Correctional Health Care P-65, at 84 (1996) (same); American
Ass'n of Correctional Psychologists, Standards for Psychological Services in Adult Jails and
Prisons, 7 Crim. Just. & Behav. 81, § 15, at 97 (1980) (essential) ("Written policies and
procedures exist and are implemented which outline the provision of involuntary treatment
in accordance with state and federal laws and regulations applicable to the jurisdiction.
These are approved by the chief psychologist and are in conformity with professional ethics
and principles promulgated by the American Psychological Association . . . The decision to
apply such techniques shall be documented and based on (or, if time pressure precludes
this, followed by) interdisciplinary review."); id. (discussion) ("In those instances when an
involuntary treatment technique is applied, it should be one which has evidence of being
effective, without side effects, of the least restrictive nature appropriate to the problems
being dealt with, and productive of changes that, had the client been more rational, the
individual would have sought."); Standards for Health Servs. in Correctional Institutions.,
17

Mental Health Care Services § B.1, at 28 (American Pub. Health Ass'n 1976) ("When by
virtue of mental disorder, the public safety is threatened, the public, including the individual
who is mentally disordered, shall be protected [by imposing involuntary treatment]. . . .
Satisfactory Compliance: 1. Each correctional facility shall provide for the hospitalization
and treatment of persons who require it because of mental illness."); ABA Criminal Justice
Mental Health Standards § 7-2.7(b) (American Bar Association 1984) (voluntary and
involuntary transfer) ("A detainee who is unable to make the kind of informed decision set
forth in paragraph (a), or who objects to treatment or habilitation, or who objects to transfer
to a mental health, mental retardation, or other appropriate facility should not be transferred
or required to accept treatment or habilitation services except: . . . (ii) when reasonably
believed by the responsible professional to be necessary in an emergency to prevent death
or serious physical injury to the detainee or others. An involuntary transfer hearing should
be initiated not later than [forty-eight] hours after an emergency transfer is effected.")
(brackets in original) (emphasis added).
See also Madrid v. Gomez, 889 F. Supp. 1146, 1221 (N.D. Cal. 1995) (ruling that a
prison must have protocols or procedures in place to administer needed involuntary
psychiatric medication promptly, subject to the protections set forth by the Supreme Court
in Washington v. Harper, to prevent inmates from "suffer[ing] for an extended period of time
before they receive treatment that should be provided immediately."); Coleman v. Wilson,
912 F. Supp. 1282, 1995 WL 559109, *19 (E.D. Cal. 1995) (finding constitutional violations
in part because of magistrate judge's finding "(1) that some institutions do not have
protocols for the use of involuntary medication and (2) that involuntary medication is
underutilized, which causes harm to inmates decompensating as a result of mental illness,
which in turn, results in the de facto denial of the procedural safeguards to which mentally
[ill] inmates are entitled.").

g.
Prisoners with serious mental disorders must be transfered to a hospital or to
a specialized unit within the prison system.
Standards for Health Services in Prisons, National Comm'n on Correctional Health
Care P-35, at 46 (1997) (essential) (Mental Health Assessment) ("Inmates thought to be
suffering from serious mental illness or developmental disability are immediately referred
for evaluation by a qualified mental health professional. Those who require acute mental
health services beyond that available at the prison or whose adaptation to the correctional
environment is significantly impaired are transferred to an appropriate facility as soon as
the need for such treatment is determined by qualified mental health personnel.");
Standards for Health Services in Jails, National Comm'n on Correctional Health Care J-39,
at 50 (1996)(same); Standards for Adult Correctional Institutions. § 3-4367 (American
Correctional Ass'n & Comm'n on Accreditation for Corrections 3rd ed. 1990) ("Inmates who
are severely disturbed and/or mentally retarded are referred for placement in appropriate
noncorrectional facilities or in units specially designated for handling this type of
individual."); id., comment ("Inmates who are severely disturbed and/or mentally retarded
are vulnerable to abuse by other inmates and require a inordinate amount of personal
attention. An individual is considered severely disturbed when he or she is a danger to self
or others or is incapable of attending to basic physiological needs."); Standard Minimum
18

Rules for the Treatment of Prisoners: Resolution of the First United Nations Congress on
the Prevention of Crime and the Treatment of Offenders, E.S.C. Res. 663C, U.N. ESCOR,
24th Sess., Supp. No. 1, ¶ 82, U.N. Doc. A/CONF/611 (1955), amended by E.S.C. Res.
2076, U.N. ESCOR, 62d Sess., Supp. No. 1, at 35, U.N. Doc. E/5988 (1977) ("(1) Persons
who are found to be insane shall not be detained in prisons and arrangements shall be
made to remove them to mental institutions as soon as possible. (2) Prisoners who suffer
from other mental diseases or abnormalities shall be observed and treated in specialized
institutions under medical management. (3) During this stay in prison, such prisoners shall
be placed under the special supervision of a medical officer."); American Ass'n of
Correctional Psychologists, Standards for Psychological Services in Adult Jails and
Prisons, 7 Crim. Just. & Behav. 81, § 32, at 109 (discussion) ("Transfer to a more
appropriate institution for clients who require intensive treatment should occur when the
quality of available services within the correctional facility is not equivalent to that found in
local community facilities. Jails and prisons, generally, are inappropriate places to house
mentally ill and mentally retarded individuals."); id, 81, § 30, at 107 (1980) (essential)
("Inmates awaiting emergency evaluation and/or treatment are housed in a specially
designated area with close-staff or trained-volunteer supervision and sufficient security to
protect these individuals."); id. at 108 (discussion) ("In collaboration with the correctional
facility's administration, it is the responsibility of the psychological services staff to make the
necessary provisions which will ensure the safety and security of inmates suspected of
being mentally disturbed. Such individuals are particularly vulnerable to abuse in jail and
prison settings."); id., § 33, at 109 (important) ("Prison systems will have their own
resources for handling severely disturbed inmates, either in a separate facility or specially
designated units."); id., discussion ("Psychotic inmates should be transferred to mental
health institutions. However, many state mental hospitals are becoming more open facilities
and resist the admission of disturbed inmates for whom secure housing is required. This
standard . . . recognizes a growing trend for correctional systems to develop their own
psychiatric facilities. "Severe disturbance" means that, in response to mental processes,
the individual is a danger to hm/herself, to others, or is incapable of attending to basic
physiological needs."); ABA Criminal Justice Mental Health Standards § 7-9.7(a) (American
Bar Association 1984) (treatment for mentally ill and mentally retarded offenders sentenced
to imprisonment) ("Mental health and mental retardation services should be available within
the adult correctional facility for offenders whose mental illness or retardation is not severe
enough to necessitate commitment to a mental health or mental retardation facility.");
American Pub. Health Ass'n 37 (1986) ("Appropriately staffed and designated special
housing areas should be provided for inmates in need of mental health observation or
awaiting mental health evaluation, or in alcohol or drug withdrawal. Mental health
observation areas shall allow for maximum observation of all patients and constant
observation of persons who are potentially suicidal. All inmates placed in mental
observation areas shall be evaluated by a mental health professional within 12 hours and,
in the event that they remain there, shall have a treatment plan developed for them. All
patients housed in mental observation shall be interviewed initially by a psychiatrist and
evaluated at least every other day by a mental health professional.").

19

h.

Inmates may not be transferred to a mental hospital without due process
American Ass'n of Correctional Psychologists, Standards for Psychological Services
in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 34, at 109-10 (1980) (essential)
("Transfers which result in inmates being placed in either facilities (or special units within
institutions) which are specifically designated for the care and treatment of the severely
mentally disturbed shall follow due process procedures, as specified in state/federal
statutes, prior to the move being effected."); Standards for Health Services in Prisons,
National Comm'n on Correctional Health Care P-35, at 44 (1992) (Mental Health
Evaluation) (discussion) ("Acutely suicidal and psychotic inmates are emergencies and
should be placed immediately in a treatment setting within the prison if one is available, or
transferred to an appropriate facility if not."); Fred Cohen, The Legal Context for Mental
Health Services, in Mental Illness in America's Prisons 25, 49-50 (Henry J. Steadman and
Joseph J. Cocozza eds. [National Coalition for the Mentally Ill in the Criminal Justice
System], 1993) (summarizing the minimum safeguards established by the Supreme Court
in Vitek v. Jones, 445 U.S. 480, 493-94 (1980)). See also Madrid v. Gomez, 889 F. Supp.
1146, 1220 (N.D. Cal. 1995) (Prisoners who have been sent to other institutions for
psychiatric care should not be returned in the condition which required care, and should not
be allowed quickly to relapse into the same condition once returned); Arnold on behalf of
H.B. v. Lewis, 803 F.Supp. 246 (D.Ariz. 1992) (characterizing as "barbaric" treatment of
female prisoner who was shuffled back and forth between prison and mental facility).

8.

Informed Consent

a.
Patients must be given the information necessary to make an informed
decision about whether to accept a particular treatment.
Standards for Health Services in Prison, National Comm'n on Correctional Health
Care P-70, at 86 (1997)(important) ("written policy and defined procedures require, and
actual practice evidences, that all examinations, treatment, and procedures governed by
informed consent practices applicable in the state are observed for inmate care. The
informed consent of next of kin, guardian, or legal custodian applies when required by
law."); Fed. Standards for Prisons and Jails § 5.51 (U.S. Dept. of Justice 1980)
("Therapeutic medical treatment specifically designed to benefit an individual inmate is
permitted provided that . . . (2) the inmate gives full voluntary and informed written consent
after being informed of the treatment's likely effects, the likelihood and degree of
improvement and/or remission, the hazards of the treatment, the reasonable alternatives to
the treatment, and the inmate's ability to withdraw from the treatment without penalty at any
time."); id., § 5.44 ("Informed consent of inmates is required for all examinations,
treatments, and medical procedures for which informed consent is required in the
jurisdiction."); American Ass'n of Correctional Psychologists, Standards for Psychological
Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 14, at 96 (1980) (essential)
("All psychological examinations, treatments, and procedures affected by the principle of
informed consent in the jurisdiction are likewise observed for inmate care. . . . An
appropriate form will be used to document compliance."); id. (discussion) ("Informed
consent is the permission granted by the client to a staff member for the performance of a
20

specified treatment, examination, or procedure after receiving the material facts regarding
the nature, consequences, risks, alternatives, and the level of confidentiality surrounding
the proposed technique."); Foundation/Core Standards for Adult Local Detention Facilities
§ FC2-5085 (American Correctional Ass'n & Comm'n on Accreditation for Corrections 1989)
("All examinations, treatments, and procedures affected by informed consent standards in
the community are likewise observed for inmate care."); Standards for Adult Correctional
Insts. § 3-4372 (American Correctional Ass'n & Comm'n on Accreditation for Corrections
3rd ed. 1990) ("Written policy, procedure, and practice provide that all informed consent
standards in the jurisdiction are observed and documented for inmate care."); id., comment
("The facility's policy regarding informed consent . . . should take into account informed
versus implied consent."); American Pub. Health Ass'n 40 (1986) (quoted in Standards:
Legal Issues and the Mentally Disordered Inmate 19 (n.d.)) ("Female inmates shall be
informed of the potential risks of taking psychotropic medication while pregnant . . . .").

9.

Seclusion and Restraint

a.
Correctional Facilities Must Have Policies and Procedures Governing the Use
of Seclusion and Restraint

21

Standards for Adult Correctional Insts. § 3-4362 (American Correctional Ass'n &
Comm'n on Accreditation for Corrections 3rd ed. 1990) ("Written policy and procedure
govern the use of restraints for medical and psychiatric purposes."); id., comment ("Where
restraints are part of a health care treatment regimen, the restraints used should be those
that would be appropriate for the general public within the jurisdiction. Written policy should
identify the authorization needed and when, where, and how restraints may be used and for
how long."); American Correctional Ass'n § 2-4185-1 at 43 (1984 Supp. [sic; other cites in
Standards: Legal Issues to an ACA supplement are to 1994]) (quoted in Standards: Legal
Issues and the Mentally Disordered Inmate 6 (n.d.)) ("Written policy, procedure, and
practice provide that when an offender is placed in a four-point restraint . . . advance
approval must be obtained from the warden/superintendent or designee. Approval must
also be obtained from the designated health authority or designee."); American Correctional
Ass’n § 2-4185-1 at 42 (1994 Supp.) ("Four-point restraints should be used only in extreme
circumstances and only when other types of restraint have proven to be ineffective."); id.,
§ 2-4312 at 53 ("Written policy and procedure govern the use of restraints for medical and
psychiatric purposes. At a minimum, the policy will address the following: conditions under
which restraints may be used types of restraints to be applied for specific conditions,
identification of person or persons who may authorize the use of restraints, monitoring
procedures for inmates in restraints. When restraints are part of a health care treatment
regimen, the restraints used should be those that would be appropriate for the general
public within the jurisdiction. Written policy should identify the authorization needed and
when, where, and how restraints may be used and for how long."); American Psychiatric
Ass'n, Principles Governing the Delivery of Psychiatric Services in Lock-Ups, Jails and
Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29, § F.5.d ("(1)
Written guidelines for the use of seclusions and restraints are necessary. These should
include criteria and indications as well as staff responsibilities, limitations on time, periodic
evaluations, etc., as they apply to that specific facility. Particular attention must be devoted
to distinctions between the use of these modalities for custodial-administrative purposes
and for mental health therapeutic purposes. (2) Orientation of patients should include a
careful delineation of the policies on seclusions and restraints. (3) Custodial staff as well as
mental health staff should receive special and continuing education in regard to these
policies and procedures."); Standards for Health Services in Prisons, National Comm'n on
Correctional Health Care P-66, at 83 (1997) (essential) (Medical Restraints and
Therapeutic Seclusion) ("Written policy and defined procedures require, and actual practice
evidences, the appropriate use of medical restraints and therapeutic seclusion for patients
under treatment for a mental illness. They specify the type(s) of restraint that may be used
and when, where, how, and for how long restraints or seclusion may be used. Use is
authorized in each case by a physician upon reaching the conclusion that no other less
restrictive treatment is appropriate. For restrained or secluded patients, the treatment plan
addresses the goal of removing the inmate from restraint or seclusion as soon as
possible."); id. (discussion) ("This standard applies to those situations where the restraints
are part of health care treatment. Generally an order for therapeutic restraint should not
exceed 12 hours. There should be 15 minute checks by trained personnel or qualified
health professionals. The same kinds of restraints that would be appropriate for individuals
treated in the community may likewise be used for medically restraining incarcerated
22

individuals: for example, fleece-lined leather, rubber, or canvas hand and leg restraints, and
strait-jacket. Mental [sic] or hard plastic devices (such as handcuffs and leg shackles)
should not be used for therapeutic restraint. Persons should not be restrained in an
unnatural position (for instance, hog-tied, face-down, spread eagled)."); Standards for
Health Services in Jails, National Comm'n on Correctional Health Care P-466, at 83
(1996)(same); American Pub. Health Ass'n 41 (1986)("The use of restraints shall be
instituted only when all attempts to calm the inmate have failed and when, in the judgment
of a psychiatrist or physician, the threat of serious injury to self and others is so severe as
to warrant such a response. Restraints shall be used only on the order of a psychiatrist,
physician or licensed health professional."); Fred Cohen, The Legal Context for Mental
Health Services, in Mental Illness in America's Prisons 25, 57 (Henry J. Steadman and
Joseph J. Cocozza eds. [National Coalition for the Mentally Ill in the Criminal Justice
System], 1993) ("Policy and procedure on these practices should encompass the following
matters: 1. Isolation and restraint are temporary measures to combat an individual's danger
to self or others. 2. A properly trained clinician should authorize the measures using a least
intrusive means approach, as well as previously articulated clinical criteria. 3. The time and
frequency of use of these measures must be clearly articulated and of a relatively short
duration. 4. There must be clear policy on monitoring, re-evaluation and documentation. 5.
There must be staff training in all of these aspects of the process."); Standard Minimum
Rules for the Treatment of Prisoners: Resolution of the First United Nations Congress on
the Prevention of Crime and the Treatment of Offenders, E.S.C. Res. 663C, U.N. ESCOR,
24th Sess., Supp. No. 1, ¶ 33, U.N. Doc. A/CONF/611 (1955), amended by E.S.C. Res.
2076, U.N. ESCOR, 62d Sess., Supp. No. 1, at 35, U.N. Doc. E/5988 (1977) (instruments
of restraint) ("[C]hains or irons shall not be used as restraints. Other instruments of restraint
shall not be used except in the following circumstances: (a) As a precaution against escape
during a transfer, provided that they shall be removed when the prisoner appears before a
judicial or administrative authority; (b) On medical grounds by direction of the medical
officer; (c) By order of the director, if other methods of control fail, in order to prevent a
prisoner from injuring himself or others or from damaging property; in such instances the
director shall at once consult the medical officer and report to the higher administrative
authority."); id., ¶ 34 ("The patterns and manner of use of instruments of restraint shall be
decided by the central prison administration. Such instruments must not be applied for any
longer time than is strictly necessary.").

b.

Seclusion and Restraint may not be used as punishment.
Standard Minimum Rules for the Treatment of Prisoners: Resolution of the First
United Nations Congress on the Prevention of Crime and the Treatment of Offenders,
E.S.C. Res. 663C, U.N. ESCOR, 24th Sess., Supp. No. 1, ¶ 33, U.N. Doc. A/CONF/611
(1955), amended by E.S.C. Res. 2076, U.N. ESCOR, 62d Sess., Supp. No. 1, at 35, U.N.
Doc. E/5988 (1977) (instruments of restraint) ("Instruments of restraint, such as handcuffs,
chains, irons and strait-jacket, shall never be applied as a punishment."); American
Correctional Ass'n § 3-4183 at 60 (1994 Supp.)("Instruments of restraint, such as
handcuffs, irons, and straight [sic] jackets, are never applied as punishment."); American
Pub. Health Ass'n 41 (1986) ("Restraints may not be ordered for punitive purposes.");
23

Standards for Health Services in Prison, National Comm'n on Correctional Health Care, P66 (1997) (essential) ("Written policy and defined procedures require, and actual practice
evidences, the appropriate use of therapeutic restraints and therapeutic seclusion for
patients under treatment for mental illness. They specify the types of restraint that may be
used and when, where, how, and for how long restraints or seclusion may be used. Use is
authorized by a physician, or other qualified health care professional where permitted by
law, upon reaching the conclusion that no less restrictive treatment is appropriate. For
restrained or secluded patients, the treatment plan addresses the goal of removing the
inmate from restraint or seclusion as soon as possible. The health care staff does not
participate in the non-medical restraint of inmates except for monitoring their health
status."); American Psychiatric Ass'n, Principles Governing the Delivery of Psychiatric
Services in Lock-Ups, Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task
Force Report 29, § F.5.d(1) (1989) ("Particular attention must be devoted to distinctions
between the use of [restraint and seclusion] for custodial-administrative purposes and for
mental health therapeutic purposes.").

10.

Suicide Prevention

a.
Correctional facilities must have a basic program for identifying, treating, and
supervising inmates with suicidal tendencies.

24

Standards for Adult Correctional Insts. § 3-4364 (American Correctional Ass'n &
Comm'n on Accreditation for Corrections 3rd ed. 1990) ("There is a written suicide
prevention and intervention program that is reviewed and approved by a qualified medical
or mental health professional. All staff with responsibility for inmate supervision are trained
in the implementation of the program."); id., ("The program should include specific
procedures for intake screening, identification, and supervision of suicide-prone inmates.");
Foundation/Core Standards for Adult Local Detention Facilities § C2-5180 (American
Correctional Ass'n & Comm'n on Accreditation for Corrections 1989) (certifiable standard)
("There is a written suicide and intervention program that is reviewed and approved by a
qualified medical or mental health professional. All staff with responsibility for inmate
supervision are trained in the implementation of the program."); Standards for Health
Services in Prison, National Comm'n on Correctional Health Care P-53, at 68 (1997)
(essential) (Suicide Prevention) ("Written policy and defined procedures require, and actual
experience evidences, that the prison has a program for identifying and responding to
suicidal individuals. The program components include: identification, training, assessment,
monitoring, housing, referral, communication, intervention, notification, reporting, review
and critical incident debriefing"); id. (discussion) ("Key components of a suicide prevention
program include the following: (1) Training. All staff members who work with inmates should
be trained to recognize verbal and behavioral cues that indicate potential suicide. (2)
Identification. The receiving screening form should contain observation and interview items
related to the inmate's potential suicide risk. (3) Monitoring. The plan should specify the
facility's procedures for monitoring an inmate who has been identified as potentially
suicidal. Regular, documented supervision should be maintained. (4) Referral. The plan
should specify the procedures for referring potentially suicidal inmates and attempted
suicides to mental health care providers or facilities. (5) Evaluation. This should be
conducted by a qualified mental health professional, who designates the inmate's level of
suicide risk. (6) Housing. A suicidal inmate should not be housed or left alone unless
constant supervision can be maintained. If a sufficiently large staff is not available that
constant supervision can be provided when needed, the inmate should not be isolated.
Rather, s/he should be housed with another resident or in a dormitory and checked every
10-15 minutes by correctional staff. The room should be as nearly suicide-proof as possible
(that is, without protrusions of any kind that would enable the inmate to hang him/herself).
(7) Communication. Procedures for communication between health care and correctional
personnel regarding the status of the inmate should exist, to provide clear and current
information. (8) Intervention. The plan should address how to handle a suicide in progress,
including appropriate first-aid measures. (9) Notification. Procedures for notifying prison
administrators, outside authorities, and family members of potential, attempted, or
completed suicides should be in place. (10) Reporting. Procedures for documenting the
identification and monitoring of potential or attempted suicides should be detailed, as
should procedures for reporting a completed suicide. (11) Review. The plan should specify
procedures for medical and administrative review if a suicide does occur."). Standards for
Health Services in Prison, National Comm'n on Correctional Health Care P-51, at 65
(1996)(same).
See also Fred Cohen, The Legal Context for Mental Health Services, in Mental
Illness in America's Prisons 25, 58 (Henry J. Steadman and Joseph J. Cocozza eds.
25

[National Coalition for the Mentally Ill in the Criminal Justice System], 1993) ("Suicide
screening instruments are easily available through the National Center on Institutions and
Alternatives and just as easily used."); James R.P. Ogloff et al., Screening, Assessment,
and Identification of Services for Mentally Ill Offenders, in Mental Illness in America’s
Prisons, supra, 61, 63 ("Suicide is one of the most severe threats to inmates' safety in
prisons. Therefore, any mental health evaluation program must attempt to identify those
inmates who are at a risk for suicide. Unfortunately, due to the low base-rate of suicides in
prisons, it is difficult to identify inmates who will likely attempt to take their own lives.").
See also Madrid v. Gomez, 889 F. Supp. 1146, 1222 (N.D. Cal. 1995) (finding
inadequate a suicide prevention training program consisting of "a three-hour course entitled
"Unusual Inmate Behavior," which includes a short section on how to identify inmates
susceptible to suicide and what to do after identifying such an inmate or discovering an
attempted suicide . . . a "Suicide Prevention Handbook" [where all staff] were required to
read the handbook and complete an accompanying quiz[,] and some [sporadic] additional
in-service training."); Coleman v. Wilson, 912 F. Supp. 1282 1995 WL 559109, *5 (E.D. Cal.
1995).

11.

Mental Health Staff

a.
The correctional facility must have sufficient numbers of qualified health
personnel of varying types to provide adequate evaluation and treatment consistent
with contemporary standards of care.
Standards for Adult Correctional Institutions. § 3-4336, comment (American
Correctional Ass'n & Comm'n on Accreditation for Corrections 3rd ed. 1990) ("An adequate
number of qualified staff members should be available to deal directly with inmates who
have severe mental health problems as well as to advise other correctional staff in their
contacts with such individuals."); Association of State Correctional Administrators, Policy
Guidelines: Health Services, reprinted in Medical Care of Prisoners and Detainees app. at
220 (Ciba Found. Symposium 16 (n.s.), 1973) ("Each facility should have available
appropriate mental health personnel or services to diagnose, prescribe and treat mental
health problems."); Standards for Health Services in Prisons, National Comm'n on
Correctional Health Care P-24, at 28 (1997)(important) (Staffing Levels) ("Written policies
and defined procedures require, and actual practice evidences, that there is a written
staffing plan that assures a sufficient number of health services staff of varying types is
available to provide adequate evaluation and treatment consistent with contemporary
standards of care."); id. (discussion) ("The number and types of health care professionals
required at a facility depend upon the size of the facility, the types (medical, nursing, dental,
mental health) and scope (outpatient, specialty care, inpatient) of services delivered, the
needs of the inmate population, and the organizational structure (e.g., hours of service, use
of assistants, scheduling). Also, special consideration should be given to the number of
patients in segregated housing, since the more restricted inmates' movement is, the more
demands there are on staff time. These factors should be addressed in the facility's health
service staffing plan. It is important to ensure that there is sufficient physician time.");
Standards for Health Services in Jails, National Comm'n on Correctional Health Care P-23,
26

at 29 (1996) American Ass'n of Correctional Psychologists, Standards for Psychological
Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 12, at 94 (1980) (essential)
("The ratio of staff to inmates is at least one full-time psychologist for every 200-250
prisoners. In specialized units (e.g., drug treatment) the minimally acceptable ratio is one
full-time psychologist for every 100-125 inmates. Additionally, staff shall reflect ethnic,
racial, and lin[g]uistic characteristics of clients, to the greatest degree possible."); American
Psych. Ass'n, General Guidelines for Providers of Psychological Services, § 2.1.2, at 4
(1987) ("A psychological service unit strives to include sufficient numbers of professional
psychologists and support personnel to achieve its goals, objectives, and purposes.");
Standard Minimum Rules for the Treatment of Prisoners: Resolution of the First United
Nations Congress on the Prevention of Crime and the Treatment of Offenders, E.S.C. Res.
663C, U.N. ESCOR, 24th Sess., Supp. No. 1, ¶ 49(1), U.N. Doc. A/CONF/611 (1955),
amended by E.S.C. Res. 2076, U.N. ESCOR, 62d Sess., Supp. No. 1, at 35, U.N. Doc.
E/5988 (1977) (institutional personnel) ("So far as possible, the personnel shall include a
sufficient number of specialists such as psychiatrists, psychologists, social workers,
teachers and trade instructors."); American Psychiatric Ass'n, Guidelines for Psychiatric
Services in Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task Force
Report 29, § C.3.b(2) (jails) (1989) ("[Essential mental health services include] seven-daya-week mental health coverage (including at least three days with board-certified or boardeligible psychiatrist)."); id., § D.3.a(4) (prisons) ("[Required mental health modalities
include] seven-day-a-week mental health coverage which includes 24 hour availability of
consultation with a psychiatrist (Unless otherwise demonstrated as unnecessary, the
presence of a psychiatrist on site should be at least once a week. Larger facilities or
facilities with in-patient care will require considerably more on-site psychiatric coverage.).");
National Comm'n on Correctional Health Care P-20, at 23 (1992) ("It is recommended that
there be at least one full-time-equivalent physician in prisons with an average daily
population of 750 or greater."); American Psych. As'n, General Guidelines for Providers of
Psychological Services § 1.1, at 3 (1987) ("Each psychological service unit offering
psychological services has available at least one professional psychologist and as many
more professional psychologists as are necessary to assure the quality of services
offered.").
See also Coleman v. Wilson, 912 F. Supp. 1282, 1995 WL 559109, *16 (E.D. Cal.
1995) (finding Eighth Amendment violation where Department of Corrections "is seriously
and chronically understaffed in the area of mental health care"); Arnold on behalf of H.B. v.
Lewis, 803 F. Supp. 246 (D. Ariz. 1992); Balla v. Idaho State Bd. of Corrections, 595 F.
Supp. 1558 (D. Idaho 1984); Ruiz v. Estelle, 503 F. Supp. 1265, 1339 (S.D. Tex. 1980),
aff’d in part and rev’d in part, 679 F.2d 1115 (5th Cir. 1982), cert. denied, 460 U.S. 1042
(1983) (ruling that trained mental health professionals must be employed in "sufficient
numbers to identify and treat in an individualized manner those treatable inmates suffering
from serious mental disorders"); Madrid v. Gomez, 889 F. Supp. 1146, 1218 (N.D. Cal.
1995) (finding "particularly problematic [that] staffing levels are not sufficient to enable
mental health staff to quickly and effectively respond when inmates exhibit serious mental
health problems"); French v. Owens, 777 F.2d 1250, 1254 (7th Cir. 1985) (finding that
gross deficiencies in staffing may constitute deliberate indifference); Lightfoot v. Walker,
486 F. Supp. 504, 524-25 (S.D. Ill. 1980)(finding that staff shortages may render medical
27

services below constitutional level).

b.
Mental health staff must receive appropriate training, including training in the
administration of medications.
Standards for Health Services in Prisons, National Comm'n on Correctional Health
Care P-19, at 25 (1997) (essential) (Continuing Education for Qualified Health Services
Personnel) ("Written policy and defined procedures require, and actual practice evidences,
that all qualified health care professionals annually receive at least 12 hours of continuing
education or staff development appropriate to their positions; American Ass'n of
Correctional Psychologists, Standards for Psychological Services in Adult Jails and
Prisons, 7 Crim. Just. & Behav. 81, § 13, at 95 (1980) (essential) ("A written plan, approved
by the chief psychologist, exists, is implemented . . . , and requires psychology staff to
receive orientation training and regular continuing education appropriate to their activities.
Documentation of these training experiences will be maintained."); ; American Correctional
Ass'n [Standards for Adult Correctional Institutions, § 3-4082, at 24 ("Written policy,
procedure, and practice provide that all professional specialist employees who have inmate
contact receive 40 hours of training in addition to orientation training during their first year
of employment and 40 years [sic] of training each year thereafter."); American Psychiatric
Ass'n, Principles Governing the Delivery of Psychiatric Services in Lock-Ups, Jails and
Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29, § C.2 (1989)
(Specialty Education and Training) ("Ideally, the practitioner should receive specialty
education and training at various levels prior to undertaking employment in a correctional
setting. Education and training in correctional psychiatry should be available in medical
schools and psychiatric residencies. The correctional psychiatrist should seek out relevant
courses as continuing medical education, or, at minimum, the literature that is to be found
in textbooks and journals."); Standards for Health Services in Prisons, National Comm'n on
Correctional Health Care P-21 (1997), at 27 (essential) (Medication Administration Training)
("Written policy and defined procedures require, and actual practice evidences, that
personell who administer medications are trained to do so.")

12.

Training of Custodial Staff

a.

All custodial staff must be trained to recognize signs of mental illness
Standards for Health Services in Prisons, National Comm'n on Correctional Health
Care P-20, at 26 (1997)(Training for Correctional Officers) ("Written policy and defined
procedures require, and actual practice evidences, that a training program established or
approved by the responsible health authority in cooperation with the prison administrator
guides the health related training of all correctional officers who work with inmates. Training
is ongoing (i.e., each officer is trained at least every two years), documented, and includes
at least the following areas: . . . recognizing the signs and symptoms of mental illness,
suicide prevention . . .");Fed. Standards for Prisons and Jails § 5.29 (U.S. Dept. of Justice
1980) ("All staff with custodial and program responsibility are trained regarding recognition
of symptoms of mental illness and retardation."); ABA Criminal Justice Mental Health
28

Standards § 7-2.6(a) (American Bar Association 1984) (postarrest obligations of police and
custodial personnel) ("[T]raining for all custodial personnel . . . should include instruction in
the identification of symptoms and behavior indicative of mental illness and mental
retardation."); id., § 7-2.8(c) (specialized training) ("All custodial personnel, whether civilian
or sworn, should receive training in identifying and responding to the symptoms and
behaviors, including self-injurious behavior, associated with mental illness and mental
retardation. Emphasis should be placed on those symptoms and behaviors that arise or are
aggravated by the fact of incarceration, particularly as they relate to suicide prevention.");
American Ass'n of Correctional Psychologists, Standards for Psychological Services in
Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 44, at 116 (1980) (important) ("Written
standard operating procedures are implemented which provide for and require
psychological services to participate in training facility staff with respect to the following:
types of
potential psychological emergency situations, signs and symptoms of various mental
disturbances, procedures for making referrals to psychological services, and program areas
(e.g., drug treatment, counseling"); id. (discussion) ("Facility personnel must be made
aware of potential emergency situations and of their responsibility for the early detection of
mental disturbance. Emergencies include (but are not limited to) such conditions as:
suicidal behavior, acute psychosis, changes in consciousness, disorientation, acute
regression states, and self-mutilation. . . . Care must be exercised to include in training
programs continuing staff psychologist supervision and instruction in recognition of signs
which warrant referral to the professional psychologist."); Joint Comm'n on Accreditation of
Healthcare Org., 1 1993 Accreditation Manual for Mental Health, Chemical Dependency,
and Mental Retardation/Developmental Disabilities Services § FC.3 at 62 (1993) (forensic
services) ("[S]taff with no clinical training or experience who may become involved in
activities that could support or hinder the therapeutic goals for individuals served, apply . . .
FC.3.1.2 knowledge of procedures for responding to unusual clinical events and incidents;
FC.3.1.3 knowledge of the organization's channels of clinical, security, and administrative
communication; . . . FC3.1.5 understanding of the range of treatment needed by individuals
served; and FC.3.1.6 knowledge of available treatment resources and their appropriate
use."); Foundation/Core Standards for Adult Local Detention Facilities § FC2-5080
(American Correctional Ass'n & Comm'n on Accreditation for Corrections 1989)
(mandatory) ("A training program is established by the responsible health authority in
cooperation with the facility administrator to provide instruction in the following areas: . . .
(5) Recognition of signs and symptoms of mental illness, retardation, emotional
disturbance, and chemical dependency."); American Pub. Health Ass'n 38 (1986)("Because
medical and correctional personnel are in frequent and close contact with the inmate
population, they shall receive special training from the mental health staff in the
identification of individuals with possible emotional and mental disorders."); ABA Criminal
Justice Mental Health Standards § 7-2.8(c) (American Bar Association 1984) (specialized
training) ("All custodial personnel, whether civilian or sworn, should receive training in
identifying and responding to the symptoms and behaviors, including self-injurious
behavior, associated with mental illness and mental retardation. Emphasis should be
placed on those symptoms and behaviors that arise or are aggravated by the fact of
incarceration, particularly as they relate to suicide prevention.").
29

See also James R.P. Ogloff et al., Screening, Assessment, and Identification of
Services for Mentally Ill Offenders, in Mental Illness in America’s Prisons 61, 65-66 (Henry
J. Steadman and Joseph J. Cocozza eds. [National Coalition for the Mentally Ill in the
Criminal Justice System], 1993) ("All staff who work with inmates in prisons should receive
adequate training in identifying symptoms of mental illness and managing inmates with
mental illness. Although corrections officers are likely to be the ones who have the most
day-to-day contact with inmates, other personnel, including teachers, librarians, nurses and
others, should also receive this training."); Coleman v. Wilson, 912 F. Supp. 1282, 1995 WL
559109, *28 (finding constitutional violations in part because of "inadequate training of the
custodial staff so that they are frequently unable to differentiate between inmates whose
conduct is the result of mental illness and inmates whose conduct is unaffected by
disease.").

13.

Housing, Segregation, and Discipline

a.

Mental health staff must be allowed to influence cell housing decisions.
Standards for Adult Correctional Insts. § 3-4369 (American Correctional Ass'n &
Comm'n on Accreditation for Corrections 3rd ed. 1990) ("Written policy and practice require
that, except in emergencies, there shall be joint consultation between the
warden/superintendent (or designee) and the responsible physician (or designee) prior to
taking action regarding identified mentally ill or retarded patients in the following areas:
housing assignments . . . . When an emergency action has been required, joint consultation
to review the appropriateness of the action occurs as soon as possible but no later than the
next work day."); Foundation/Core Standards for Adult Local Detention Facilities § C2-5183
(American Correctional Ass'n & Comm'n on Accreditation for Corrections 1989)
(certification standard) ("Written policy and procedure require consultation between the
facility administrator and the responsible physician or designee prior to the following actions
being taken regarding patients who are diagnosed as having a psychiatric illness: (1)
housing assignments."); American Ass'n of Correctional Psychologists, Standards for
Psychological Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 35, at 110
(1980) (important) ("There are written and implemented policy and procedure which require
that the responsible psychologist be consulted prior to taking the following actions with
respect to emotionally disturbed inmates: housing assignment changes, program
assignment changes, disciplinary sanctions, transfers in and out of the facility."); Fed.
Standards for Prisons and Jails § 5.16 discussion (U.S. Dept. of Justice 1980) ("Information
regarding the inmate's physical and mental status [identified during health appraisal within
fourteen days of admission] may dictate housing and activity assignments."); American
Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails and Prisons, in Psychiatric
Services in Jails and Prisons, Task Force Report 29, § D.1.a(1) (1989) (stating that
receiving mental health screening should assure that a newly arriving prisoner "who may
require mental health evaluation as a result of mental illness or developmental disability . . .
is placed in the proper living environment."); Standards for Health Services in Prison,
National Comm'n on Correctional Health Care P-08, at 10 (1997) (essential) ("Written policy
and defined procedure require, and actual practice evidences, communications between
30

the prison administration and the treating clinician regarding patients who have significant
special needs that should be taken into account in deciding the following: housing
assignments, work assignments, program assignments, disciplinary measures, and
admissions to and transfers from institutions. Included among those who have special
needs are the following: . . . inmates with serious mental health needs, and the
developmentally disabled.")
See also Madrid v. Gomez, 889 F. Supp. 1146, 1221 (N.D. Cal. 1995) ("There are
instances where it may be critical, from a medical standpoint, to alter an inmate’s housing
assignment (e.g., from the SHU [Segregated Housing Unit] to another environment or from
double to single cell housing), in order to effectively address an inmate's serious mental
health problems. [P]sychiatrists and psychologists [should be] allowed input into cell
housing decisions, [especially] when the inmate is suffering acute symptoms and the
mental health staff believe that a change in housing conditions is potentially necessary to
the effective treatment of the inmate's disorder.")
b.
Inmates confined to segregation units must be evaluated and monitored by
mental health professionals.
Standards for Health Services in Prison, National Comm'n on Correctional Health
Care P-39, at 51 (1997) (essential) (Health Evaluation of Inmates in Disciplinary
Segregation) (discussion) ("Inmates placed in disciplinary segregation who have been
receiving mental health treatment should be evaluated by qualified mental health
professionals within 24 hours after being placed there, and followed regularly thereafter.
The evaluation should be documented and placed in the health record. Also, "Daily
evaluations ensure that the inmate's health status does not decline while in segregation.
. . . Owing to the possibility of injury and depression during segregation, the daily
evaluations should include notation of bruises or other trauma markings, comments
regarding the inmate's attitude and outlook (particularly as they might relate to suicide
intention), and any health complaints."); American Correctional Ass'n § 3-4244 at 71 (1994
Supp.)("Written policy, procedure, and practice provide that a qualified mental health
professional personally interviews and prepares a written report on any inmate remaining in
segregation for more than 30 days. If confinement continues beyond 30 days, a mental
health assessment by a qualified mental health professional is made at least every three
months—more frequently if prescribed by the chief medical authority.").
See also Madrid v. Gomez, 889 F. Supp. 1146, 1219 (N.D. Cal. 1995) ("[T]he need
for effective screening and monitoring in the SHU [Security Housing Unit] is particularly
critical in order to ensure that inmates suffering from mental illness are not experiencing a
deterioration in their condition.");
Security and segregation units tend to exacerbate pre-existing mental illnesses. Langley v.
Coughlin, 715 F. Supp. 522, 541 (finding that "placement of inmates on SHU [Special
Housing Unit] when such assignment would predictably cause exacerbation of already
several mental disorders" "reflects a pattern of inadequate medical care to the mentally ill
inmates housed on SHU [Special Housing Unit]."); Coleman v. Wilson, 912 F. Supp. 1282,
1995 WL 559109, *29 (E.D. Cal. 1995) ("use of administrative segregation and segregated
housing at Pelican Bay SHU and statewide to house mentally ill inmates violates the Eighth
Amendment because mentally ill inmates are placed in administrative segregation and
31

segregated housing without any evaluation of their mental status").

c.
Mental health staff must be consulted about decisions to discipline mentally ill
prisoners.
Standards for Adult Correctional Institutions. § 3-4369 (American Correctional Ass'n
& Comm'n on Accreditation for Corrections 3rd ed. 1990) ("Written policy and practice
require that, except in emergencies, there shall be joint consultation between the
warden/superintendent (or designee) and the responsible physician (or designee) prior to
taking action regarding identified mentally ill or retarded patients in the following areas: . . .
disciplinary measures . . . . When an emergency action has been required, joint
consultation to review the appropriateness of the action occurs as soon as possible but no
later than the next work day."); Standards for Health Services in Prison, National Comm'n
on Correctional Health Care P-08, at 10 (1997) (essential).

14.

Mental Health Records

a.

Mental Health Records must be accurate, complete, and well-organized.
Standards for Adult Correctional Institutions. § 3-4376 (American Correctional Ass'n
& Comm'n on Accreditation for Corrections 3rd ed. 1990) ("The health record file contains
the following items: completed receiving screening form; health appraisal data forms; all
findings diagnoses, treatments, dispositions; record of prescribed medications and their
administration; . . . signature and title of documenter; consent and refusal forms; . . . place,
date, and time of health encounters; health service reports, e.g., dental, mental health, and
consultations; treatment plan, including nursing care plan; progress reports; discharge
summary of hospitalization and other termination summaries."); Fed. Standards for Prisons
and Jails § 5.38 (U.S. Dept. of Justice 1980) (discussion) ("The record is to be complete
and all findings recorded including notations concerning psychiatric, dental and consultative
services."); American Ass'n of Correctional Psychologists, Standards for Psychological
Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 49, at 119 (1980)
(essential) ("The psychological record (excluding raw data) is part of the inmate's central
file. It contains the completed receiving screening form, all findings, diagnoses, treatments,
dispositions, and terminations from long- or short-term psychological treatment. The
uniform method of recording entries and the form and format of the psychological record
are approved by the chief psychologist."); id. (discussion) ("The record is complete and all
findings recorded. . . . Any intervention after the initial screening requires the initiation of a
psychological record. The importance of documentation cannot be overemphasized. Not
only do such records provide a sound basis for postrelease continuity of treatment (if
needed), but they also supply protection for staff from litigious inmates."); id. § 50, at 11920 (1980) (discussion) ("Records kept regarding psychological services may include (but
not be limited to) identifying data, dates and types of services, and significant actions taken.
Such information is to be recorded within a specified, reasonable time (not to exceed one
month) after completion of the activity."). Standards for Adult Correctional Institutions. § 34376 (American Correctional Ass'n & Comm'n on Accreditation for Corrections 3rd ed.
32

1990) (comment) ("All findings, including notations concerning mental health, dental, and
consultative services, should be recorded at the time of service delivery or no later than 14
days from the time of discharge or termination of treatment.").
See also Ruiz v. Estelle, 503 F. Supp. 1265 (S.D. Tex. 1980), aff'd in part and rev'd
in part, 679 F.2d 1115 (5th Cir. 1982), cert. denied, 460 U.S. 1042 (1983); Langley v.
Coughlin, 715 F. Supp. 522 (S.D.N.Y. 1989), aff'd, 888 F.2d 252 (2nd Cir. 1989); Madrid v.
Gomez, 889 F. Supp. 1146, 1219 (N.D. Cal. 1995) (finding that notes of mental health
examinations should be substantive, that documentation of monitoring should be
systematic, that entries should always account for prior diagnoses when making discrepant
new diagnoses, and that psychiatric records should include suicide watch records);
Coleman v. Wilson, 912 F. Supp. 1282, 1995 WL 559109, *5 (E.D. Cal. 1995) (finding
Eighth Amendment violation where magistrate judge found that "the medical records
system maintained by defendants is extremely deficient."); id. at *22 ("[a]t most of the
prisons in the class there are serious deficiencies in medical recordkeeping, including
disorganized, untimely and incomplete filing of medical records, insufficient charting, and
incomplete or nonexistent treatment plans.").

b.

Past psychiatric records must be obtained.
Arnold on behalf of H.B. v. Lewis, 803 F. Supp. 246 (D. Ariz. 1992); Madrid v.
Gomez, 889 F. Supp. 1146, 1219 (N.D. Cal. 1995)(Efforts should be made to obtain
important information missing from psychiatric records forwarded other institutions,
especially about prior psychiatric hospitalizations); Coleman v. Wilson, 912 F. Supp. 1282,
1995 WL 559109, *22 (E.D. Cal. 1995) (finding constitutional violations in part because,
although "[t]he evidence of record shows that some physicians on the CDC [California
Department of Corrections] staff can and do take steps to obtain medical records from
county jails when inmates arrive at the CDC without them[, s]uch steps are not standard
practice.") id.

c.

Inmate's mental health records must be kept confidential.
Standards for Adult Correctional Institutions. § 3-4377 (American Correctional Ass'n
& Comm'n on Accreditation for Corrections 3rd ed. 1990) ("Written policy and procedure
uphold the principle of confidentiality of the health record."); id. (comment) ("The principle of
confidentiality protects inmate patients from disclosure of confidences entrusted to a
physician or other health care provider during the course of treatment.");
American Psychiatric Ass'n, Principles Governing the Delivery of Psychiatric Services in
Lock-Ups, Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task Force
Report 29, § E.3 (1989) ("In light of these special considerations [in lock-ups, jails, and
prisons], it is particularly important that specific, written policies should be developed and
maintained in regard to issues relating to confidentiality. In facilities where no written policy
exists, it is the responsibility of the psychiatrist to clarify these issues with the institutional
authorities and to develop working policies as to the degree to which confidentiality of
information can be assured."); American Ass'n of Correctional Psychologists, Standards for
Psychological Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 16 at 98
33

(1980) (essential) ("A written policy exists and is implemented which outlines the degree to
which confidentiality of information can be assured."); id. (discussion) ("It is essential that
psychological service providers be given the authority to maintain the confidentiality of their
client's records."); id. § 50, at 120 (discussion) ("All persons functioning as psychological
services personnel (including paraprofessionals and students) who have access to
psychological records shall have an understanding of, and maintain confidentiality about (to
the extent permitted by law) those records as a condition of continuing employment.");
Standards for Health Services in Prisons, National Comm'n on Correctional Health Care P61, at 78 (1997)(essential) (confidentiality of health information) ("Written policy and defined
procedures establish, and actual practice evidences, the principle of confidentiality of health
records."); Fed. Standards for Prisons and Jails § 5.39 (U.S. Dept. of Justice 1980)
(discussion) ("The principle of confidentiality protects the patient from disclosure of
confidences entrusted to a physician during the course of treatment."); American Ass'n of
Correctional Psychologists, Standards for Psychological Services in Adult Jails and
Prisons, 7 Crim. Just. & Behav. 81, § 48, at 119 (1980) (essential) ("Psychological files
containing test and interview data on pretrial detainees are destroyed if the individual
involved is subsequently adjudicated as being not guilty"); id.

d.

Only a limited number of factors justify breaching a patient's confidentiality.

34

American Psychiatric Ass'n, Principles Governing the Delivery of Psychiatric
Services in Lock-Ups, Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task
Force Report 29, § E.2 (1989) ("The following is a list of situations where the usual rules of
confidentiality might not be applicable: (a) where the patient is suicidal, (b) where the
patient is homicidal or assaultive, or (c) where the patient presents a clear and present risk
of escape or the creation of internal disorder or riot. This list is not meant to be all inclusive
and can be supplemented in accordance with the special needs of the patient or the
institution. Additionally, certain situations that are part of the mental health treatment
process may require changes from the usual rules of confidentiality. Such situations would
include a patient receiving psychotropic medication; a patient requiring movement to a
special unit for observation, evaluation, or treatment of an acute episode; or a patient
requiring transfer to a treatment facility outside the lock-up, jail, or prison; id. at § E.2 (1989)
("A distinction must be drawn between information obtained by a mental health professional
in the course of treatment and information obtained from the inmate in the course of a
forensic or other evaluation for non-treatment purposes (e.g., an evaluation for the parole
board). In the latter case, the usual rules in regard to confidentiality may not apply.").
Standards for Health Servs. in Correctional Institutions., Mental Health Care Services § B.3,
at 30 (American Pub. Health Ass'n 1976) ("Full confidentiality of all information obtained in
the course of treatment should be maintained at all times with the only exceptions being the
normal legal and moral obligations to respond to a clear and present danger of grave injury
to the self or others, and the single issue of escape."); id., § B.3, at 30-31 (satisfactory
compliance) ("In all therapeutic relationships, the mental health professional shall explain
the confidential guarantee, including precise delineation of the limits (as stated in the
exceptions above) and periodically review the guarantee and its limits, to insure continued
awareness. . . The prisoner who reveals information that falls outside the guarantee of
confidentiality shall be told, prior to the disclosure, that such information will be disclosed. If
informing the prisoner of the therapist's intent to disclose information will increase the
likelihood of grave injury, the therapist may delay informing the treated prisoner of that
disclosure."); American Ass'n of Correctional Psychologists, Standards for Psychological
Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 16 at 98 (1980)
(discussion) ("In order to continue an effective working relationship and to satisfy
professional, ethical obligations, psychology staff should not be required (except in lifethreatening emergencies) to disclose their records to correctional officials without the
informed consent of the client. Confidentiality is an ethical principle which protects the client
from disclosure of confidences entrusted to a professional during the course of treatment
unless the professional is required by law to reveal the information to protect the welfare of
the individual or the community. In a correctional setting, potentially life-threatening
situations, such as escape plans, would be included. The psychologist's good common
sense and professional judgment will play a heavy role in making decisions of this nature.");
id., § 16 at 98 (1980) (discussion) ("All involved parties shall be informed, in advance, of
any limitations on maintaining confidentiality, and the inmate should be told, "You will have
to trust my judgment concerning what information I may have to pass." (emphasis in
original)); Fed. Standards for Prisons and Jails § 5.39 (U.S. Dept. of Justice 1980)
(discussion) ("The health authority should share with the facility administrator information
regarding an inmate's medical management and security; the administrator should share
35

that information with staff on a need[-]to-know basis.").

e.
To preserve confidentiality, mental health records must be kept separate from
confinement and custody records.
American Ass'n of Correctional Psychologists, Standards for Psychological Services
in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 50, at 119-20 (1980) (essential)
("Psychological test protocols and other raw data are maintained separately from the
confinement record, are kept in a secured file controlled by the chief psychologist, and are
not made available to untrained laymen or to any inmate."); id. (discussion) ("Records kept
regarding psychological services may include (but not be limited to) identifying data, dates
and types of services, and significant actions taken. . . "Raw data" is test information not
accompanied by interpretive statements made in a report by qualified psychological
services personnel. Computer-generated statements are considered raw data."); id. § 47, at
118 (1980) (essential) ("There is a written, implemented policy approved by the chief
psychologist . . . that specifies which psychological reports are placed in the inmate's
central file. Additionally, it specifies which reports/materials are maintained in other secured
files."); Standards for Health Services in Prisons, National Comm'n on Correctional Health
Care P-61, at 78 (1997) (essential) (confidentiality of health information) ("Health records
stored in the prison are maintained under secure conditions, separate from custody
records. Access to health records is controlled by the health authority consistent with
applicable local, state, and federal law."); Fed. Standards for Prisons and Jails § 5.39 (U.S.
Dept. of Justice 1980) ("Written policy and procedure provide that access to the health
record is controlled by the health authority and that the health record is not in any way part
of the confinement record."); id. (discussion) ("The principle of confidentiality protects the
patient from disclosure of confidences entrusted to a physician during the course of
treatment. Accordingly, it is necessary to maintain health record files under security and
completely separate from the patient's confinement record."); Standards for Adult
Correctional Institutions. § 3-4377 (American Correctional Ass'n & Comm'n on Accreditation
for Corrections 3rd ed. 1990) ("Written policy and procedure uphold the principle of
confidentiality of the health record and support the following requirements: (1) The active
health record is maintained separately from the confinement case record. (2) Access to the
health record is controlled by the health authority. (3) The health authority shares with the
superintendent/warden information regarding an inmate's medical management, security,
and ability to participate in programs."); Standards for Health Servs. in Correctional
Institutions., Mental Health Care Services § B.3, at 30 (American Pub. Health Ass'n 1976)
(satisfactory compliance) ("Mental health data shall be entered into the unit health records
to be handled in accordance with the provisions of the Records Section of the overall
standards. The mental health data shall be restricted to the facts of treatment, diagnosis,
prognosis, treatment plan, and medication. Sensitive or highly personal data shall not be
included in the medical record.").

f.
Mental health providers should have access to inmates' custodial and
confinement records when necessary for providing care.
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Standards for Health Services in Prisons, National Comm'n on Correctional Health
Care P-62, at 79 (1997) (essential) (confidentiality of health information) ("Written policy
provides that the physician or his/her designee has access to information contained in the
inmate's confinement record when the physician believes such information may be relevant
to the inmate's health and course of treatment.").

g.

Inmates must have access to their own records
Fed. Standards for Prisons and Jails § 5.40 (U.S. Dept. of Justice 1980) ("Written
policy and procedure provide that inmates are given access to non-evaluative material in
their medical and dental records and to evaluate [sic] summaries, but not raw data, from
psychiatric and psychological assessments in their health files. All materials in the inmate's
health file are made available to the inmate's private physician upon request, with the
authorization of the inmate."); American Psych. Ass’n, General Guidelines for Providers of
Psychological Services § 2.3.7, at 6-7 (1987) (illustrative statement) ("Users have the right
to information in their agency records and to be informed as to any regulations that govern
the release of such information. . . . Users have the right to examine such psychological
records. Preferably such examination should be in the presence of a psychologist who
judges how best to explain the material in a meaningful and useful manner."); American
Ass'n of Correctional Psychologists, Standards for Psychological Services in Adult Jails and
Prisons, 7 Crim. Just. & Behav. 81, § 47, at 118 (1980) (discussion) ("Since absolute
confidentiality cannot be guaranteed, all psychological reports should be written with the
understanding that they may be read by the inmate involved.").

h.
When an inmate is transferred to another institution, his records must be sent
to the receiving facility to insure continuity of care.
American Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails and Prisons,
in Psychiatric Services in Jails and Prisons, Task Force Report 29, § D.4.b(4) (1989)
(prisons) ("Written policies and procedures, approved by the medical authority of the
facility, govern the transfer of medical records and medical information.");Standards for
Health Services in Prisons, National Comm'n on Correctional Health Care P-64, at 80
(1997)(important) (transfer of health records) ("Written policy and defined procedures
require, and actual practice evidences, that when an inmate is transferred to another
correctional facility within the same correctional system, the inmate's health record is sent
to the facility to which the inmate is transferred either before or at the same time as the
inmate. . . . Summaries or copies of the inmate's health record are sent with the inmate
upon referral to an off-site health care provider."); Fed. Standards for Prisons and Jails
§ 5.43 (U.S. Dept. of Justice 1980) ("When an inmate is transferred from one correctional
facility to another, summaries or copies of the health record file are routinely sent to the
facility to which the inmate is transferred. . . . Health record information is also transmitted
to specific and designated physicians or medical facilities on the written authorization of the
inmate."); American Ass'n of Correctional Psychologists, Standards for Psychological
Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 53, at 121 (1980)
37

(important) ("Implemented, written policies and procedures, approved by the chief
psychologist (and in conformity with headquarters policy in multi-institution systems) require
the transfer of psychological records and summaries within a multifacility system whenever
an inmate is transferred."); id. (discussion) ("It is important that the transfer of psychological
information occur smoothly and rapidly and that all staff members know the procedures.
Transfer of this material helps ensure continuity of treatment and avoids unnecessary
duplication of tests and evaluations."); id. § 54, at 121-22 (essential) ("When mentally
disturbed inmates are transferred . . . to another facility, the prisoner's record arrives at the
receiving institution either before or with the inmate."); id., at 122 (discussion) ("When a
disturbed inmate is transferred, every effort shall be expended to minimize the transfer's
disruptive effects and ensure continuity of treatment. The chief psychologist at the sending
facility should: (a) contact the receiving institution and give advanced notice of the
impending transfer, preferably by letter; (b) ensure that the inmate's psychological records
are forwarded in order to reach the receiving institution before, or at the same time as, the
client; and (c) provide for receiving staff to acknowledge receipt of the records."); Standards
for Adult Correctional Institutions. § 3-4361 (American Correctional Ass'n & Comm'n on
Accreditation for Corrections 3rd ed. 1990) ("When travel is approved [to transfer an inmate
to another facility], pertinent data (including medication, behavior management procedures,
and other treatment or special requirements for observation and care during travel) are
documented in a manner readily accessible to and easily understood by transportation staff
or others who may be called upon to attend inmates during travel and on reception at the
receiving institution. Medications or other special treatment required enroute, along with
specific written instructions for administration, are furnished to transportation staff."); id. § 34378 ("Written policy, procedure, and practice regarding the transfer of health records
require the following: (1) Summaries, originals, or copies of the health record accompany
the inmate to the facility to which he or she is transferred."); id. (comment) ("Transfer of
health records assures continuity of care and avoids duplication of tests and
examinations.").

i.
Inmates must give written consent before their records are transferred to third
parties outside of the correctional system.
Standards for Health Services in Prisons, National Comm'n on Correctional Health
Care P-64, at 80 (1997)(important) (transfer of health records) ("Written authorization by
the inmate is required for the transfer outside the correctional system of medical records
and information, unless otherwise provided by law or administrative regulation."); American
Ass'n of Correctional Psychologists, Standards for Psychological Services in Adult Jails and
Prisons, 7 Crim. Just. & Behav. 81, § 51, at 120 (1980) (essential) ("Written authorization
by the inmate is necessary for transfer of psychological record information to any third
party, unless otherwise provided for by law or administrative regulation having the force and
effect of law."); id. (discussion) ("Even after consent has been obtained to release the
psychological information, such material should clearly indicate to the recipient its
confidential nature."); American Psych. Ass'n, General Guidelines for Providers of
Psychological Services § 2.3.7, at 6 (1987) (illustrative statement) ("Psychologists do not
release confidential information, except with the written consent of the user involved, or of
38

his or her legal representative, guardian, or other holder of the privilege on behalf of the
user, and only after being assured by whatever means may be required that the user has
been assisted in understanding the implications of the release. Even after the consent has
been obtained for the release, psychologists clearly identify such information as confidential
for the recipient of the information."); Standards for Adult Correctional Institutions. § 3-4330
(American Correctional Ass'n & Comm'n on Accreditation for Corrections 3rd ed. 1990)
(comment) ("When health care is transferred to providers in the community, appropriate
health information should be shared with the new providers in accord with consent
requirements.");id., § 3-4378 ("Written policy, procedure, and practice regarding the
transfer of health records require the following: . . . (2) Health record information also is
transmitted to specific and designated physicians or medical facilities in the community
upon the written authorization of the inmate."); id., § 3-4096, at 30 ("The institution uses a
release of information consent form that complies with applicable federal and state
regulations. Unless the release of information is required by statute, the inmate signs the
consent form prior to the release of information and a copy of the form is maintained in the
inmate's case record.").

15.

Discharge planning

a.

Prison mental health services must provide appropriate discharge plans.
Standards for Health Services in Prisons, National Comm'n on Correctional Health
Care P-44, at 54 (1997) (important) (Continuity of Care) ("Written policy and defined
procedures require, and actual practices evidence, continuity of care from admission to the
prison through discharge from it, including referral to community resources when
indicated."); National Comm'n on Correctional Health Care, Position Statement: Mental
Health Services in Correctional Settings § 3 (1992) ("[C]orrectional facilities and community
based programs should work together to assure continuity of care for the inmate after
release. Case management services should be available to assure access to mental health
and substance abuse treatment programs as well as to integrate family oriented treatment
where possible."); American Psychiatric Ass'n, Guidelines for Psychiatric Services in Jails
and Prisons, in Psychiatric Services in Jails and Prisons, Task Force Report 29, § C.4.a
(jails) ("Discharge/transfer planning in a jail setting includes all procedures through which
inmates in need of mental health care at the time of release from jail to community are
linked with appropriate community agencies capable of providing on-going treatment, or at
the time of transfer to a prison, are made known to mental health service providers in the
prison. Case management services include: 1) appointments arranged with mental health
agencies for all mentally ill inmates or a specific subgroup such as those receiving
psychotropic medication; 2) referrals arranged for inmates with a variety of mental health
problems; 3) notification of reception centers at state prisons; and 4) arrangements made
with hometown pharmacies to have prescriptions renewed."); id., § C.4.b (jails) (stating that
essential mental health services require that "(1) Discharge/transfer planning is carried out
by a regularly assigned mental health professional. (2) Every inmate released who has
received mental health crisis intervention or treatment services is assessed for
39

appropriateness of a community referral."); id., § D.4.a (prisons) ("Discharge and/or transfer
planning are those mental health services by which inmates in need of further mental health
services at the time of transfer to another institution or discharge to the community are
assured continuity of care."); id., § D.4.b(1) (1989) (prisons) ("Discharge planning and
transfer planning operations are carried out in a timely fashion by regularly assigned,
qualified mental health personnel."); id, § D.4.b(2) (1989) (prisons) ("The following elements
should be met before a patient is transferred or discharged: (a) Criteria are contained in a
written policy approved by both the mental health authority and the correctional facility
administration. (b) Medications or other special treatments required en route and specific
written instructions for administration are furnished to transportation staff. (c) Appropriate
mental health records accompany the patient with precautions taken to protect
confidentiality."); Standards for Adult Correctional Institutions. § 3-4330 (American
Correctional Ass'n & Comm'n on Accreditation for Corrections 3rd ed. 1990) ("Written
policy, procedure, and practice require continuity of care from admission to discharge from
the facility, including referral to community care when indicated."); Standard Minimum Rules
for the Treatment of Prisoners: Resolution of the First United Nations Congress on the
Prevention of Crime and the Treatment of Offenders, E.S.C. Res. 663C, U.N. ESCOR, 24th
Sess., Supp. No. 1, ¶ 83, U.N. Doc. A/CONF/611 (1955), amended by E.S.C. Res. 2076,
U.N. ESCOR, 62d Sess., Supp. No. 1, at 35, U.N. Doc. E/5988 (1977) (insane and mentally
abnormal prisoners) ("It is desirable that steps should be taken, by arrangement with the
appropriate agencies, to ensure if necessary the continuation of psychiatric treatment after
release and the provision of social-psychiatric after-care");
American Ass'n of Correctional Psychologists, Standards for Psychological Services in
Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 39, at 113 (1980) (important) ("There
are written, implemented policies and procedures which require psychological services
personnel to ensure that provisions are made for postrelease follow-up care where
appropriate."); id. § 38, at 112 (1980) (important) ("There is a written, implemented
procedure which provides for the orderly discharge of inmate clients from treatment. It
includes (but is not limited to) the writing and filing of a treatment summary report within
one month after treatment terminates.") id. (discussion) ("When inmates who have a
continuing need for psychological services are released, the responsible psychologist (in
collaboration with other appropriate staff) should ensure that follow-up treatment services
are arranged as part of the individual's release plan."); Joint Comm'n on Accreditation of
Healthcare Org., 1 1993 Accreditation Manual for Mental Health, Chemical Dependency,
and Mental Retardation/Developmental Disabilities Services § FC.2.3.1.5, at 62 (1993)
(forensic services) (requiring that a mechanism exist to coordinate legal, correctional,
and/or administrative decisions affecting an individual's treatment with clinical decisions
about the individual, including "plan for discharge and continuing care.");

16.

Quality assurance

a.

The correctional mental health system must have a quality assurance plan.
American Psychiatric Ass'n, Principles Governing the Delivery of Psychiatric
Services in Lock-Ups, Jails and Prisons, in Psychiatric Services in Jails and Prisons, Task
40

Force Report 29, § B.2.a (1989) ("Each facility or each administrative authority should have
prepared a quality assurance plan that describes the mission and goals of the mental
health service delivery system, the means by which these goals are to be achieved, and the
means of evaluation of these objectives. This may be regarded as the formal aspect of
quality assurance."); American Ass'n of Correctional Psychologists, Standards for
Psychological Services in Adult Jails and Prisons, 7 Crim. Just. & Behav. 81, § 09, at 92
(1980) (essential) ("The quality of psychological services are [sic] reviewed at least
annually and the results are reported in writing. The chief psychologist is responsible for
overseeing this internal quality assurance program at the institutional level."); id.
(discussion) ("Preferably, such an internal audit would be done semiannually, but under no
circumstances should the chief psychologist permit the service to undergo its annual
external audit (see standard 10) without a prior internal one. Quality assurance should
include (but not necessarily be limited to) a review of procedures, resources, and
outcomes."); id., § 40, at 113 (important) ("There are implemented written policy and
procedures which require formal evaluation of the effectiveness of psychological services
treatment programs."); American Psych. Ass'n, General Guidelines for Providers of
Psychological Services § 3.3, at 8 (1987) ("There are periodic, systematic, and efective
evaluations of psychological services."); id. (illustrative statement) ("When the
psychological service unit is a component of a larger organization, regular assessment of
progress in achieving goals is provided in the service delivery plan. Such evaluation could
include consideration of the effectiveness of psychological services relative to costs in
terms of time, money, and the availability of professional and support personnel. Evaluation
of the psychological service delivery system could be conducted both internally and, when
possible, under independent auspices. Descriptions of therapeutic procedures and other
services as well as outcome measures should be as detailed as possible. This evaluation
might include an assessment of effectiveness (to determine what the service
acccomplished), costs, continuity (to ensure that the services are appropriately linked to
other human services), avaialability (to determine appropriate levels and distribution of
services and personnel), accessibility (to ensure that the services are barrier-free to users),
and adequacy (to determine whether the services meet the identified needs of users). In
such evaluations, care is taken to maintain confidentiality of records and privacy of users. It
is highly desirable that tthere be a periodic reexamination of review mechanisms to ensure
that these attempts at public safeguards are effective and cost-efficient and do not place
unnecessary encumbrances on providers or unnecessary additional expense on users or
sanctioners [sic] for services rendered.");Madrid v. Gomez, 889 F. Supp. 1146, 1222 (N.D.
Cal. 1995) ("[A] Quality Assurance program is designed to enable a medical institution or
department to review, on an ongoing basis, staff medical decisions and practices in order to
assess whether corrective measures are necessary or appropriate. Such a program is
considered 'standard practice' in virtually every health care facility in the country and is
considered a 'fundamental part' of a health care operation."); id. at 1259 ("Defendants'
callous and deliberate indifference to inmates' needs is particularly evinced by their failure
to institute any substantive quality control. Quality control procedures represent the first
critical steps of self-evaluation that could help defendants remedy widespread deficiencies;
yet, at the time of trial, there were still no such procedures in operation."); Coleman v.
Wilson, 912 F. Supp. 1282, 1995 WL 559109, *16 (E.D. Cal. 1995) (finding Eighth
41

Amendment violation where "defendants have no effective method for insuring the
competence of their mental health staff and, therefore, for insuring that inmates have
access to competent care," and holding that "development of a quality assurance program
is an appropriate remedy for constitutional deficiencies in the delivery of prison health
care"); Grubbs v. Bradley, 821 F. Supp. 496, 500 (M.D. Tenn. 1993).

42