Commentary: The role of mental health in the inmate disciplinary process.

The article by Michael S. Krelstein, MD, which presents the results of a nationwide survey examining the role of mental health professionals in the inmate disciplinary process, is a significant contribution to the correctional mental health literature. Dr. Krelstein succinctly summarizes the case law that has provided the framework for the prison disciplinary process. The Supreme Court’s current conservative posture concerning the rights of prisoners is exemplified in Sandin v. Conner, which views placement in an administrative segregation unit for less than one year as not representative of a significant and atypical hardship in the context of ordinary incidents of prison life. As a result, due process is not ordinarily required for such placements, because liberty interests are generally not violated under this standard. Despite this invitation to forego due process hearings, it has been my experience that prison systems have continued to provide such hearings for a variety of reasons, some of which may be related to the integrity of the disciplinary process. In addition to establishing a structure that can provide a clear and consistent message to inmates who are violating prison rules and regulations, these hearings can also serve to decrease abuse of the disciplinary system by correctional officers (i.e., writing up inmates for rule violations that are unfounded). Segregation units, especially disciplinary segregation, are usually designed to be experienced by the inmate as an atypical hardship in the context of ordinary prison life, despite the Supreme Court’s perception. This recognition by prison administrators probably also contributes to the continuation of these due process hearings. The impetus for prison mental health care professionals to have an increasing role in the inmate disciplinary process is described by Dr. Krelstein as arising from recent class action litigation challenging the quality of mental health care services in prisons. This statement is accurate, but it may be helpful to provide more history to understand better the subsequent evolution of mental health input into the disciplinary process. An overview of class action litigation in correctional psychiatry has been summarized recently in this Journal. In prison systems with constitutionally inadequate mental health services, it is not difficult to find inmates in segregation units who have serious mental illnesses and were placed in these units because of a rule infraction that often was related to their mental illness. Some of these inmates were obviously psychotic at the time of their rule infractions. Inmates housed in these segregation units (the jailwithin-a-prison usually referred to in correctional systems as administrative, disciplinary, or punitive segregation) are usually locked down in their cell 22 to 23 hours a day for weeks, months, or, less commonly, years. The clinical condition of an inmate with a serious mental illness placed in a segregation unit often deteriorates or does not improve because of lack of adequate psychiatric treatment. Such a finding is often a crucial issue that contributes to plaintiffs’ prevailing in class action litigation relevant to mental health services and often is the initial imDr. Metzner is Clinical Professor of Psychiatry, University of Colorado Health Sciences Center, Denver CO. Address correspondence to: Jeffrey L. Metzner, MD, Clinical Professor of Psychiatry, University of Colorado Health Sciences Center, 3300 East First Avenue, Suite 590, Denver, CO 80206.