CHAPTER13Mental Health2Mental HealthEighth Amendment issues related to mentalhealth present unique challenges forECUs. It may even be constitutionallyimpossible to keep certain inmates in <strong>the</strong> ECU,<strong>and</strong> it may not be enough for institutions simplyto say “we deliver mental health care within ourfour walls.”This chapter focuses on <strong>the</strong>se issues. It considers<strong>the</strong> possibility that <strong>the</strong> ECU environment canactually cause an inmate’s mental health to deteriorate.It also looks at mental status as a factor inECU placement <strong>and</strong> removal. Before turning to<strong>the</strong>se specific issues, <strong>the</strong> chapter discusses generallegal requirements for providing medical care toprison inmates.Providing Medical Care in<strong>Prisons</strong>: Guidance From <strong>the</strong>CourtsIn 1976, in Estelle v. Gamble, <strong>the</strong> Supreme Courtmade it clear that <strong>the</strong> prison has a constitutionalduty to provide medical care to inmates: “[O]fficialsmay not be deliberately indifferent to
14<strong>Supermax</strong> <strong>Prisons</strong> <strong>and</strong> <strong>the</strong> <strong>Constitution</strong>: LIABILITY CONCERNS IN THE EXTENDED CONTROL UNIT[inmate] serious medical needs.” 16 This protectionextends to ECU inmates. The duty from Estelleapplies to mental health needs of inmates, as wellas <strong>the</strong>ir physical health needs. 17 Although <strong>the</strong>re isno unique legal test for assessing medical or mentalhealth care in ECUs, <strong>the</strong>se facilities can haveunique problems in delivering adequate care.What Is a “Serious Medical Need”?Courts use various definitions of “serious medicalneed.” These definitions are inherently subjective,<strong>and</strong> all are somewhat vague. Probably <strong>the</strong> clearesttest says that a need is “serious” when a doctor oro<strong>the</strong>r medical professional has diagnosed a conditionas “m<strong>and</strong>ating treatment [or <strong>the</strong> condition issuch that] even a lay person would easily recognize<strong>the</strong> necessity of a doctor’s attention.” 18But what if a medical professional has not seenan inmate to make a diagnosis, <strong>and</strong> <strong>the</strong> inmate’scondition is not obvious to a lay person? TheNinth Circuit has said a condition is serious iffailure to treat it “could result in fur<strong>the</strong>r significantinjury or <strong>the</strong> unnecessary <strong>and</strong> wanton inflictionof pain.” 19 The court elaborated:<strong>the</strong> existence of an injury that a reasonabledoctor or patient would feelimportant <strong>and</strong> worthy of comment ortreatment, <strong>the</strong> presence of a medicalcondition that significantly affects aninmate’s daily activities, or <strong>the</strong> existenceof chronic <strong>and</strong> substantial pain…are examples of indications thata prisoner has a “serious” need fortreatment. 20Thus, general factors relevant in defining seriousmedical need include <strong>the</strong> following:■ Presence of ongoing pain.■ Diagnosis by a competent medicalprofessional.■ Threat that <strong>the</strong> condition will worsen if nottreated.■ Problem obvious to a lay person.Many physical conditions are easily categorizedusing one or more of <strong>the</strong>se criteria. Anyone cansee that a broken bone is serious. Medical professionalswill usually agree on many, if not most,diagnoses. But when it comes to mental conditions,gray areas are more likely. In The MentallyDisordered Inmate <strong>and</strong> <strong>the</strong> Law, Fred Cohenacknowledges this <strong>and</strong> cites <strong>the</strong> following definitionadopted by <strong>the</strong> Ohio Department of Correctionsas part of a consent decree:Serious mental illness means a substantialdisorder of thought or moodwhich significantly impairs judgment,behavior, capacity to recognize realityor cope with <strong>the</strong> ordinary dem<strong>and</strong>s oflife within <strong>the</strong> prison environment <strong>and</strong>is manifested by substantial pain ordisability. Serious mental illness requiresa mental diagnosis, prognosis,<strong>and</strong> treatment, as appropriate, by mentalhealth staff. 2116Estelle v. Gamble, 429 U.S. 97 (1976).17Fred Cohen, The Mentally Disordered Inmate <strong>and</strong> <strong>the</strong> Law, Kingston, NJ: Civic Research Institute, 1998, p. 4-3. Thisencyclopedic work is an excellent resource for use in analyzing legal requirements applicable to mentally ill inmates <strong>and</strong><strong>the</strong> related practical dem<strong>and</strong>s on corrections agencies.18Hill v. DeKalb Regional Youth Detention Center, 40 F.3d 1176 (11th Cir. 1994); Gaudreault v. Municipality of Salem,923 F.2d 203 (1st Cir. 1990).19McGuckin v. Smith, 974 F.2d 1050 (9th Cir. 1992).20Id. at 1059–1060.21Cohen, The Mentally Disordered Inmate <strong>and</strong> <strong>the</strong> Law, p. 2-6, n. 5.
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