29-B-1. What to Do if the Psychiatric Medical Care You Receive Is Inadequate
You have a right to adequate medical care and treatment. Under the Eighth Amendment of the Constitution,31 the government has an obligation to provide medical care to people it is punishing by incarceration.32 This right includes the regular medical care that is necessary to maintain your health and safety. Many states also have state laws requiring prisons to provide medical care to prisoners.33 For more information about this general right, see Chapter 23 of the JLM, "Your Right to Adequate Medical Care."
(a) Your Right to Adequate Psychiatric Care
The provision of mental health care to prisoners is governed in the same way as the provision of physical health care. Most federal circuits have held the right to adequate medical care includes any psychiatric care that is necessary to maintain prisoners' health and safety.34 In Bowring v. Godwin, an important early decision, the Fourth Circuit Court of Appeals included treatment of mental illnesses as part of the right to medical care. The court noted that there is "no underlying distinction between the right [of a prisoner] to medical care for physical ills and its psychological or psychiatric counterpart."35
The Bowring court developed a three-part test to determine whether a prisoner has a right to psychiatric care. Under the test, a prisoner who suffers from a mental illness is likely to have a right to mental health treatment if a health care provider decides that:
(1) the prisoner has the symptoms of a serious disease or injury;
(2) that disease or injury is curable, or can be substantially improved; and
(3) the likelihood of harm to the prisoner (in terms of safety and health, including mental health) is substantial if treatment is delayed or denied.36
However, the right to psychiatric treatment is still limited to reasonable medical costs and a reasonable length of time for treatment.37 Therefore, psychiatric treatment will be given to the prisoner on the basis of what is necessary, not what is desirable.38
You should note that the Bowring test is the law only in the Fourth Circuit, which includes Maryland, North Carolina, South Carolina, Virginia, and West Virginia. The only courts that must apply the test are federal courts in these states. However, other courts are likely to consider using the standard in similar cases,39 especially because no court has issued a disagreeing opinion. You should still cite to Bowring even if you are not bringing a case in the Fourth Circuit, because the court in your circuit might find Bowring persuasive. For more information on what you may cite in your jurisdiction, see Chapter 2 of the JLM, "Introduction to Legal Research."
(b) Your Right to Treatment for Substance Abuse
The American Psychiatric Association incorporates in its definition of mental illness "substance-related disorders," which include illnesses like substance use, abuse, and withdrawal.40 The law, however, does not always consider such diseases as serious enough41 to require prison authorities to provide medical care to treat the diseases.42 However, many courts have found that prisoners have the right to treatment for substance abuse in certain circumstances. The sections below describe these situations.
(i) You Have No Right to Drug and Alcohol Rehabilitation in Prison
As a general rule, you have no right to rehabilitation while in prison.43 Individual states or corrections departments may decide that rehabilitation is an important goal and may implement programs to achieve that aim, but the Constitution does not require them to do so. One application of this rule is that there is no right to narcotics or alcohol treatment programs in prison.44 However, courts have at times ordered prisons to implement drug and alcohol treatment programs where the denial of these programs would otherwise lead to conditions that were so bad that they violated prisoners' rights to medical care. Prisoners often raise these issues successfully in the context of broader claims about unconstitutional conditions of confinement.45 Additionally, at least one court has found that prisoners should be "free to attempt rehabilitation...
