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Minorities and Mental Health Care in Prisons
Annotated Bibliography

Cassandra S. Gerhardt
The University of Dayton School of Law
Spring 1997



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).


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).


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).


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).


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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