Lost Souls: Constitutional Implications For the Deficiencies in Treatment For Persons With Mental Illness In Custody

This Comment explores systemic deficiencies of access to mental health care in prison systems and the Eighth Amendment implications of those deficiencies. Because the Eighth Amendment prohibits, among other things, infliction of cruel and unusual punishments, when denial of adequate mental health care results in undue suffering, the conditions of confinement may violate the Constitution. Therefore, there must be mechanisms in place to ensure necessary treatment is provided while protecting individual rights. Part I of this Comment addresses the duty a state owes to those it incarcerates (e.g., to provide food, clothing, recreation, education, medical care) and what standards exist for the provision of reasonable care and to ensure that prescribed care is in fact delivered. Part I also summarizes the history of prisoners’ efforts to redress conditions of confinement and the standards that have developed for constitutional challenges. Part II focuses on the legal framework for Eighth Amendment challenges brought by prisoners and how the standard for evaluating those claims has evolved. Part III explores the problems persons with mental illness face in challenging the conditions of their confinement after Estelle v. Gamble, identifies the particular barriers to Eighth Amendment challenges for persons with mental health problems created by Farmer v. Brennan, and addresses the tension between providing mental health care to the incarcerated and the right to refuse treatment. Part IV proposes three systemic changes, applicable to both prisons and the surrounding legal framework, that address the deficiencies and disparities in how the needs of inmates with mental health problems are managed. Cite as: 42 Golden Gate U. L. Rev. 497 (2012)