Poor Access to MH Care Cited in High Court's Prison Ruling

The Supreme Court ruled that the state of California must reduce its prison population by some 33,000 inmates in the next two years, declaring that the extremely overcrowded conditions in California prisons and the resulting substandard state of general and mental health care violate the Eighth Amendment's prohibition against cruel and unusual punishment.

In the justices' majority opinion, Justice Anthony Kennedy noted that "prisoners in California with serious mental illness do not receive minimal, adequate care," and that "inmates awaiting care may be held for months in administrative segregation, where they endure harsh and isolated conditions and receive only limited mental health services. Wait times for mental health care range as high as 12 months."

The decision requires the state to reduce its prison population to 110,000, approximately 137.5 percent of the system's capacity. Although the decision technically applies only to California's prison system, its impact may be felt more broadly.

Late last year, APA submitted, along with several other mental health organizations, an amicus brief in support of the inmates' suit, which claimed that the conditions in which they were housed meant that they had inadequate access to mental health and general medical care.

"In the wake of deinstitutionalization and closure of state hospitals, a growing number of persons with severe mental illnesses have been incarcerated in U.S. jails and prisons, where mental health care is often deficient or lacking altogether," said APA President John Oldham, M.D., in response to the ruling. "By upholding the lower court's ruling in this case, the Supreme Court is signaling that it takes the mental health and other medical needs of prisoners seriously—a matter of constitutional law. APA also believes that creating constitutionally adequate medical and mental health services as ordered in this case is in the interests of all people in the state of California."

Howard Zonana, M.D., an expert in forensic psychiatry, told Psychiatric News that the Supreme Court was attentive to concerns about public safety, emphasizing that the court-ordered reduction in the prison population could be achieved by means that did not require the release of violent criminals into the community.

"The state has a variety of options, but it has to do something," he said. "It can pay to transfer people out of state to other facilities or it can move them into county jails and prisons."

The decision comes after a decades-long fight over the state of health care in California prisons, and Zonana noted that the state has the highest rate of incarceration of any in the country. He added that the prison population, being a literally captive population with no options for receiving general health or mental health care outside of the prison, is the only group that has a constitutional right to state-provided care.

The Court's 5-4 ruling states that "For years the medical and mental health care provided by California's prisons has fallen short of minimum constitutional requirements and has failed to meet prisoners' basic health needs. Needless suffering and death have been the well-documented result. Over the whole course of years during which this litigation has been pending, no other remedies have been found to be sufficient."