The Mentally Disordered Inmate and the Law ========================================== * Gregory B. Leong By Fred Cohen, Esq. Second Edition. Kingston, NJ: Civil Research Institute, 2008. Two volumes. 1,114 pp. $237.50. Professor Fred Cohen comes from a law background and is professor emeritus in the Graduate School of Criminal Justice at the State University of New York at Albany. Perhaps more significantly, he has been a federal court monitor for correctional medical and dental care in the Ohio state prison system and has acquired first-hand knowledge of incarcerated individuals and the institutions housing them. From this perspective, his two-volume work explores a wide array of topics affecting the mentally disordered incarcerated population. Cohen presents court decisions, many in considerable detail, to illustrate the various topical areas. Forensic psychiatrists would be familiar with the cases, as they are many of the landmark cases of forensic psychiatry selected by the American Academy of Psychiatry and the Law (AAPL). They include such familiar litigations as *Youngberg v. Romeo*, *Rouse v. Cameron*, *Wyatt v. Stickney*, *Robinson v. California*, *Powell v. Texas*, *Tarasoff v. Regents of the University of California*, and *Jaffee v. Redmond*, to name a few. These cases readily facilitate the forensic psychiatrist's comprehension of the legal underpinnings of Cohen's work. Nonetheless, correctional mental health litigation has been dominated by whether the threshold of deliberate indifference, as promulgated by *Farmer v. Brennan*, has been breached. Overall, the reader is exposed in considerable detail to the debate and complexities of deliberate indifference and other legal constructs, which would be expected, since this book is intended for an audience knowledgeable in the law. Beyond the familiar AAPL landmark cases, Cohen explores others such as *Madrid v. Gomez*, which details the situation at the California Department of Corrections facility at Pelican Bay and provides a chilling description of a maximum security facility and its impact on mental health. *Madrid v. Gomez* and other litigations presented capture the plight of the mentally disordered inmate, and the overall tone of the book indicates that Cohen is writing from an advocacy perspective. He praises highly those psychiatrists and other experts whose work supports his apparent position, while reserving scant praise for representatives of state and institutional interests. For example, in Chapter 21 (section 3[2]), he describes a plaintiff expert in a case as “the country's premier correctional psychiatrist” while describing an expert for the defendant State of Illinois as “the utility infielder in all areas of correctional mental health.” Cohen's work contains 21 chapters and a large Appendix. He offers that a prison or jail administrator need only read the second chapter, which provides an overview of the law and the mentally disordered inmate. The forensic or clinical psychiatrist should read much more than the second chapter, to appreciate the mental health and associated clinical practice topics and concerns in the correctional setting, although many of the chapters would be likely to prove laborious and tedious because of the predominant focus on legal matters. The chapters dealing with clinically relevant topics, such as those covering the treatment relationship (Chapter 9), the effect of isolation on mental disability (Chapter 11), and suicide (Chapter 14), would probably command the greatest interest from the forensic or clinical psychiatrist. From a lawyer's standpoint in analyzing case law, the decision itself is of the utmost significance, with any subsequent adverse outcomes that befall any of the case's parties being generally ignored. However, if there is a third edition to this work, Cohen might consider revising the chapter on the treatment relationship to mention what transpired subsequent to the case of *In re Kanuri Sugury Qawi*. Qawi's case involved his successful refusal of antipsychotic medication. Upon returning to the community, he continued to forgo needed psychiatric treatment and ended up accused of killing his roommate and being found incompetent to stand trial.1,2 Also in a third edition, Cohen might discuss *Panetti v. Quarterman* (decided on the day Cohen completed his preface to this edition), as the case regarding competence to be executed. (The current edition discusses *Singleton v. Norris*.) Although this two-volume work covers a gamut of topics concerning mental health in the correctional world, the overall length of the two books may be excessive for forensic or clinical psychiatrists. The work contains a relative dearth of pragmatic, clinically relevant material. Some of the length is attributable to the Appendix, which contains excerpts from 10 of the cases explored in the book, a description of the Residential Treatment Unit at the Ohio Department of Rehabilitation and Corrections, and the *Dunn v. Voinovich* consent decree from Ohio. Not only does the material found in the Appendix seem extraneous, it occupies about one-half the space in one of the volumes. Therefore, unless a forensic or clinical psychiatrist has an extreme interest in the tedious legal underpinnings surrounding correctional mental health, this lengthy work, while appearing to be a solid contribution to the legal world, would be best kept on the shelves of libraries and institutions for psychiatrists to consult on an as-needed basis. ## Footnotes * Disclosures of financial or other potential conflicts of interest: None. * American Academy of Psychiatry and the Law ## References 1. Romney L, Gold S: Tragedy follows landmark court win. Los Angeles Times. March 16, 2007. Available at [http://www.latimes.com](http://www.latimes.com). Accessed March 16, 2007 2. Romney L: Proceedings against ex-mental patient suspended. Los Angeles Times. May 12, 2007. Available at [http://www.latimes.com](http://www.latimes.com). Accessed May 12, 2007