Minorities and Mental Health Care in
Prisons
Annotated Bibliography
Cassandra S. Gerhardt
The University of Dayton School of Law
Spring 1997
Introduction
The original purpose of this bibliography was to examine
mental health care of minorities in prisons. Unfortunately,
the focus was too narrow and perhaps a bit obscure for
practical purposes. An article or a case directly on point
was nowhere to be found. However, the objective of this
undertaking can be found after considering the bibliography
as a whole. The information naturally fell into two discrete
categories. The first group of resources discusses the
disparate outcomes African-Americans experience in mental
health treatment and incarceration. The
second group is a collection of cases that track the
attempts of the judiciary to define a prisoner's right to
adequate mental health care.
First, the reader will understand that
African-Americans make up a majority of this nation's inmate
population. It is proposed that this phenomena is a result
of many factors working simultaneously. The factors include,
but are not limited to, racism, poor health, socio-economic
strains, heavier sentences, and more aggressive
prosecutions. In light of the preceding, one can safely
infer that if more African-Americans are inmates, then more
will need mental health care. Next, the reader will
appreciate that African-Americans are often misdiagnosed and
mistreated for their mental illness. It is thus proposed
that these factors working together are likely to result in
grossly inadequate mental health care for minority inmates.
However, the disparate mental health
care for inmates may change. The judiciary is continuously
broadening the protections of the 8th Amendment. In light of
the recent district court decisions, it is likely that
prisons will begin to attend to the mental health needs of
its inmates. Also, if professionals and policy makers heed
the suggestions of researchers mental health diagnosis and
treatment of African-Americans can only improve.
The following articles/cases are included in this
bibliography:
California
v. Washington, 51 Cal. Rptr. 2d 618 (Cal. Ct. App.
1996).
CLINICAL
ISSUES IN THE PHARMACOTHERAPY OF AFRICAN-AMERICANS,
32(2) Psychopharmacology Bulletin 275 (1996).
Coleman
v. Wilson, 912 F. Supp. 1282 (E.D. Cal. 1995).
Doty v.
County of Lassen, 37 F.3d 540 (9th Cir. 1994).
Estelle
v. Gamble, 97 S.Ct. 285 (1976).
Madrid v.
Gomez, 889 F.Supp. (N.D. Cal. 1995).
Molesky
v. Walter, 931 F.Supp. 1506 (E.D. Wash. 1996).
RACE BIAS IN
DIAGNOSIS AND TREATMENT OF JUVENILE OFFENDERS; FINDINGS AND
SUGGESTIONS, 20 J. CONTEMP. PSYCHOTHERAPY 259 (1990).
RACISM IN THE
INSANITY DEFENSE, 50 U. Miami L.Rev. 209 (1995).
SENTENCING,
DISPOSITIONAL, & TREATMENT, 20 Mental & Physical
Disability Law Reporter 329 (1996).
Smith v.
Jenkins, 919 F.2d 90 (8th Cir. 1990).
THE ART AND
SCIENCE OF THE PSYCHO PHARMACOTHERAPY OF AFRICAN AMERICANS,
63 Mount Sinai Journal of Medicine 301 (1996).
UTILIZATION
OF MENTAL HEALTH SERVICES BY MINORITY VETERANS OF THE
VIETNAM ERA, 182 (12) Journal of Nervous & Mental
Disease 685 (Dec. 1994). Vaughan
v. Lacey, 49 F.3d 1344 (8th Cir. 1995).
ANNOTATIONS
SENTENCING,
DISPOSITIONAL, & TREATMENT, 20 Mental &
Physical Disability Law Reporter 329, 336.
This article gave a brief description
of the most recent cases regarding the law and those with
physical and mental disabilities. Most of the article
focused on various jurisdictions treatment and sentencing of
sex offenders. The theme evident was that sex offenders are
not patently considered to be "mentally ill."
Absent an independent diagnosis of a mental disorder, a
statute is unconstitutional if it provides that a sex
offender can be held indefinitely. A secondary theme was the
procedural difficulties that jurisdictions face when they
are considering the disposition of a mentally ill patient,
after treatment or upon release. An overview of the most
recent cases demonstrate that mentally ill defendants are
entitled to the same amount of procedural due process as a
defendant without these difficulties. [Back]
RACISM
IN THE INSANITY DEFENSE, 50 U.Miami L. Rev. 209, 247
(1995).
This article claimed that this was the
first time the insanity defense was studied as it related to
racism. The article offers a thorough exploration of the
discrepancies in the legal justice system as it is related
to African Americans. The article predominately focuses on
research results as a basis for the discussion. The
foundation was laid systematically. First, research was
discussed regarding the disproportionate large amount of
involuntary detentions of African Americans when compared to
whites. Second, research about the disproportionate share of
African Americans who are involuntarily held in public
mental health institutions. The author admits that
"racism" is nearly impossible to prove. However,
she points to the disparate impact model as proof of its
existence in the legal/mental health care realm. Ultimately,
the author concludes that Not Guilty by Reason of Insanity (NGRI)
is primarily plead and used for acquitting white defendants.
The author supports the assertion by pointing to the racial
trends in mental health care and diagnosis. The article is
concluded by offering some suggestions to help alleviate
this discrepancy. The suggestions all focus on making more
precise diagnosis and arrests of the mentally ill. Calling
the approach a "trickle up" theory, the change
must start with the initial contacts made by police officers
and mental health professional. [Back]
Todd W. Martin & Henry J.
Grubb, RACE BIAS IN
DIAGNOSIS AND TREATMENT OF JUVENILE OFFENDERS; FINDINGS AND
SUGGESTIONS, 20 J. Contemp. Psychotherapy 259,261
(1990).
The authors focus in the article is
juvenile offenders and the effects race has on diagnosing
and treating them. The most telling assertion is that
therapists, who are generally white middle class, will more
likely perceive a white child as having a mental illness
while an African-American child exhibiting the same
behaviors for being a product of his cultural upbringing. On
its face this may not appear terribly shocking or
detrimental. The findings point to some clearly racist
perceptions, however, the harm does not stop at diagnosis.
Because African-American juveniles' behavior is less likely
to be viewed as a treatable mental illness, these offenders
are funneled for intensely into the correctional system.
Thus, the focus is on behavioral problems. The direct result
of this type of misperception is under treatment. The
authors continue to discuss and cite studies that
demonstrate even when African-American juveniles receive
treatment. It is inferior. For example, the therapists see
the children for a shorter period of time. Also, less
interaction occurs between the therapists and the child's
parents. [Back]
R. Rosenheck & A.
Fontana, UTILIZATION
OF MENTAL HEALTH SERVICES BY MINORITY VETERANS OF THE
VIETNAM ERA, 182(12) Journal of Nervous & Mental
Disease 685, 691 (Dec. 1994).
This article was the product of a
purely empirical study. The authors compiled statistics
regarding the use of five different mental health providers.
The data was collected by using a national survey of five
different minority groups. The purpose was to ascertain what
groups used what type of mental health services during the
Vietnam Era. The study produced two findings worth
mentioning. First, nonwhite veterans were significantly less
likely to use non-VA mental health services. All groups
tended to use the VA mental health services at an equal
rate. The study presented one question worthy of further
study regarding this subject. Exploration into the factors
that result in minorities using non-VA mental health
services is necessary to fully understand and appreciate the
full force of the findings herein. [Back]
W.B. Lawson, CLINICAL
ISSUES IN THE PHARMACOTHERAPY OF AFRICAN-AMERICANS,
32(2) Psychopharmacology Bulletin 275, 281 (1996).
This article addressed the many
variables that result in the poorer mental health care of
minorities. The scope of this article was to focus on the
medication issues in mental health care. Because
African-Americans are more likely to be diagnosed with
psychotic disorders, they are prescribed antipsychotic
medication far more frequently. Also, the article asserts
that African-Americans are more likely to experience some of
the negative side effects of this type of medication. A
possible explanation is the ethnic difference in
pharmacokinetics. The author suggested this can be remedied
by running clinical trials that have a higher representation
of African-American. [Back]
W.B. Lawson, THE
ART AND SCIENCE OF PSYCHO PHARMACOTHERAPY OF AFRICAN
AMERICANS, 63 Mount Sinai Journal of Medicine 301, 305
(1996).
This second article by Lawson has many
of the same premises as the one above. However, it is worth
including this article as well because the author has made a
few more interesting findings regarding the disparate mental
health treatment of African-American. First, in addition to
the factors described above, the author asserted that
African-Americans are more susceptible to involuntary
treatment. While, psychotic disorders are over diagnosed in
this population, anxiety related disorders are under
diagnosed. It naturally follows that anti-anxiety
medications are then under used when treating an
African-American. The author concludes by advocating for a
paradigm shift change of sorts. He presents the notion that
marketing and research policies must include the issues
facing African-Americans. [Back]
Estelle
v. Gamble, 97 S.Ct. 285, 297 (1976).
This Supreme Court, in a decision
written by Justice Marshall, J., addressed the question of;
"what must a plaintiff prove for a prison's medical
action/inaction to constitute a violation of their 8th
Amendment right to be free from cruel or unusual
punishment?" This is the first case in which the Court
addressed the issue directly. The Court introduced a
standard that has been coined "deliberate
indifference" burden. In applying the new proposed
test, the Court made it clear that this was to be a heavier
burden than mere medical malpractice. The Court's
explanation was that a plaintiff can seek remedy in tort law
for mere negligence. Further, for the medical treatment to
raise to a constitutional question, the burden must be more
than a negligence standard. However, the Court did recognize
that this "deliberate indifference" could be
evidenced in a number of ways. It could be evidenced by a
prison guard's intentional denial of medical care or by the
prison's doctor's response to an inmate. In his harsh, but
on point dissent, Justice Stevens asserted that the
majority's terms are used ambiguously. The burden of showing
a "deliberate indifference" a subjective one.
Justice Stevens suggests that, a plaintiff should not have
to show that a defendant had the "intent" to do
anything. Rather, the focus should be on the resulting
condition, whether it be from "design, negligence, or
mere poverty." As evidenced by the cases to follow,
Justice Stevens' concerns were well placed. As litigation
has continued to rise in this area, so too has the burden of
potential plaintiffs. [Back]
Doty
v. County of Lassen, 37 F.3d. 540, 548 (9th Cir.
1994).
Interestingly, this appeal's court
decision implemented a relatively high standard of review in
considering the orders of the lower court. The appeals court
did not agree with the ease at which the district court
implicated constitutional requirements under the 8th
Amendment. By using a less deferential standard here the
appeals court affectively limited the situations where a
plaintiff could allege an 8th Amendment claim regarding
improper health care. The court announced that, "[i]n
accordance with the other courts of appeals that have
examined this issue, we now hold that the requirements for
mental health care are the same as those for physical health
care needs." The court relied on other circuit courts
when it announced that for a claim to come under 8th
Amendment scrutiny, the "deliberate indifference"
must be regarding a "serious" medical need. It
went on to say that the regular discomfort or stress that
results from incarceration is a part of the inmates' penalty
and cannot rise to the level of a "serious"
medical condition. [Back]
Smith
v. Jenkins, 919 F.2d 90, 94 (8th Cir. 1990).
The court conducted a de novo review
of the district court's grant of summary judgment to the
defendant herein. After considering the facts per
defendant's testimony and affidavit, the court concluded
that the findings of fact had yet to be determined in the
case, thus summary judgment should have been precluded. The
court reversed the district court's grant of summary
judgment and remanded for a review of the plaintiff's
medical records. The court reasoned that, a standard of care
must be presented for a court to assess if the doctor's
responses were "deliberately indifferent." The
court noted that once a prison inmate has received medical
care for a specific condition it is difficult to find and
8th Amendment violation. Although the doctor saw Smith on
four occasions, the record is not sufficient to assess the
physician's treatment, because a disagreement exists
regarding the plaintiff's previous mental health care
treatment. [Back]
Vaughan
v. Lacey, 49 F.3d 1344, 1346 (8th Cir. 1995).
This decision was a result of an
appeal from a summary judgment granted to defendants. The
plaintiff filed a § 1983 action against claiming that
prison officials violated his 8th Amendment rights by being
"deliberately indifferent" to his serious medical
needs. The circuit court affirmed the summary judgment
granted below. The plaintiff was diagnosed as having
clinical depression and psychomotor retardation. Between
April 1990 and January 1992 the plaintiff was taking three
medications for his disorders. The medications were
prescribed by a Dr. Roy Barnes. In January 1992 the
plaintiff herein was transferred to a federal prison camp.
Upon his arrival a prison psychiatrist and doctor reduced
his prescribed medications. The plaintiff submitted a
written request to the defendant herein (Captain Lacey) to
be put on the medications he was taking per Dr. Barnes
order. Lacey responded promptly, and had a Dr. Parkerson, a
private physician, examine him. This doctor prescribed only
one of the medications he had been on prior to 1992. Given
the facts herein, this case centered around a disagreement
regarding the best treatment for the inmate. The court found
that disagreement regarding treatment is not sufficient
evidence to find a prison "deliberately
indifferent" to an inmate's serious medical needs. [Back]
Coleman
v. Wilson, 912 F.Supp. 1282 (E.D.Cal. 1995).
This federal district court has
gravely departed from the original doctrine of
"deliberate indifference" announced first in the
Supreme Court's Estelle decision above. The
court here makes it relatively easy to implicate the 8th
Amendment's cruel and unusual punishment clause. The court
uses the 8th Amendment to advocate proactive measures to
ensure proper mental health care to inmates. This court has
clearly rejected the notion that a plaintiff must show more
than negligence for the 8th Amendment to be implicated. The
court effectively abandons any inquiry into the subjective
intent of the defendants. This opinion resembles Justice
Steven's dissent in Estelle rather than its
progeny. Incredibly, the court takes a final note worthy
leap away from the original "deliberate
indifference" notion. The court made a frontal attack
on the mental health services as a whole. The court
concluded that these system wide deficiencies evidenced the
prison's "deliberate indifference to inmates. The court
concluded its findings of fact and law by recommending that
the California Department of Corrections implement various;
forms, protocols, standards, consulting experts, procedures
and regulations to improve the situation. [Back]
Madrid
v. Gomez, 889 F.Supp 1146, 1283 (N.D. Cal. 1995).
Gomez is a 1995 United States
Federal Court decision from the Northern District of
California. Gomez et. al., plaintiffs herein, brought action
alleging improper confinement and care while inmates at
Pelican Bay correctional facility. Among the many
allegations, the inmates charged the state with 8th
Amendment violations. The court said that medical and mental
health care are conditions that are subject to an 8th
Amendment analysis. Although inmates are entitled to
sufficient medical/mental health care under the 8th
Amendment, the treatment does not have to be "the best
medical care available. Rather, to establish 8th Amendment
liability, plaintiffs must demonstrate that prison officials
are 'deliberately indifferent' to 'serious' medical needs of
inmates." This appears to be a very difficult standard
to meet. First, the plaintiffs must demonstrate that either
a "pattern of negligent conduct" or "systemic
deficiencies" exist and that the defendants (1) knew
the risk to inmate health, and (2) acted with disregard for
this risk. "In short, plaintiffs must show that
defendant consciously disregarded a substantial risk of
serious harm to plaintiff's health or safety. (Court
quoting, Farmer, 114 S.Ct. at 1980). This case is a very
long fact intensive decision. The court raises and discusses
many issues regarding the inmates rights to adequate
medical/mental health care. More important, this case is
interesting as it concludes that while punishing inmates
prison official must consider the possible mental health
effects that such punishment could have. The Court also
alluded to the fact that prison officials need to carefully
consider its actions when punishing a known mentally ill
patient. [Back]
Molesky
v. Walter, 931 F.Supp. 1506, 1514 (E.D. Wash. 1996).
This federal district court case
invokes an inmate's 8th Amendment rights as well. However,
the plaintiff herein alleged that forcing him to submit to a
psychological evaluation amounted to cruel or unusual
punishment. This is the antithesis of plaintiff's arguments
in the Gomez case. However, here the court granted
the defendant's motion for summary judgment. The court
found, inter alia, that (1) a psychological evaluation was
not a hardship that could result in cruel or unusual
punishment, (2) his equal protection rights were not
violated, and (3) prison officials justifiably infringed
upon the inmates right to privacy. Interestingly enough, the
plaintiff here was a sex offender as well. The Department of
Corrections in Washington, according to state statute, is
required to implement a physical, dental and mental health
screening immediately upon an inmate's arrival to the
facility. The purpose of this requirement is to provide any
medically necessary treatment to the inmate as soon as
possible. It is interesting that this type of procedure was
absent in the Gomez case, above, and sought after in the
name of their 8th Amendment rights. Conversely, the state
here as implemented policies to care for inmates' medical
and emotional needs. These very things are used herein to
assert that plaintiff's rights are being violated. What a
flexible instrument we Americans have in our Constitution. [Back]
California
v. Washington, 51 Cal. Rptr. 2d 618 (Cal. Ct. App.
1996).
California, seemingly always in the
foreground regarding law and mental health enacted a law
that provides for renewable one-year commitments for
severely mentally ill prisoners completing their terms, when
their disorders are recurrent and not in remission. The
original California statute is broad in its reach, because
the law applied retroactively to those criminals convicted
of a crime three years ago. The state government attempted
to gloss over the application of the state and federal
constitutions. Also, in its original form, the statute
allowed for involuntary commitments of mentally ill parolees
absent a showing of dangerousness. This is peculiar because
all other commitment statutes in the state required a
showing of dangerousness. This clearly violates the equal
protection clause of the United States Constitution. This
form of the statute was struck down on constitutional
grounds. This case demonstrates the grave struggle that a
jurisdiction may experience, when it attempts to address the
issues of the mentally ill who commit crime. It leads to
much confusion. On one hand, the mentally ill should be
treated differently because they do not always have the
requisite "criminal intent." However,
jurisdictions have confused the issue. While they are
subjecting the defendant to the same amount of punishment as
a "normal" defendant, they are simultaneously
involuntarily committing parolees without affording them the
proper due process. [Back]
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