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DEVELOPMENTS IN THE LAW THE LAW OF MENTAL ILLNESS “[D]oing time in prison is particularly difficult for prisoners with men- tal illness that impairs their thinking, emotional responses, and ability to cope. They have unique needs for special programs, facilities, and extensive and varied health services. Compared to other prisoners, moreover, prisoners with mental illness also are more likely to be ex- ploited and victimized by other inmates.” HUMAN RIGHTS WATCH, ILL-EQUIPPED: U.S. PRISONS AND OFFENDERS WITH MENTAL ILLNESS 2 (2003), available at http://www.hrw.org/reports/2003/usa1003/usa1003.pdf. “[I]ndividuals with disabilities are a discrete and insular minority who have been faced with restrictions and limitations, subjected to a history of purposeful unequal treatment, and relegated to a position of political powerlessness in our society, based on characteristics that are beyond the control of such individuals and resulting from stereotypic assumptions not truly indicative of the individual ability of such indi- viduals to participate in, and contribute to, society . .” Americans with Disabilities Act of 1990, Pub. L. No. 101-336, § 2(a)(7), 104 Stat. 327, 329 (codified at 42 U.S.C. § 12101 (2000)). “We as a Nation have long neglected the mentally ill . .” Remarks [of President John F. Kennedy] on Proposed Measures To Combat Mental Illness and Mental Retardation, PUB. PAPERS 137, 138 (Feb. 5, 1963). “[H]umans are composed of more than flesh and bone . [M]ental health, just as much as physical health, is a mainstay of life.” Madrid v. Gomez, 889 F. Supp. 1146, 1261 (N.D. Cal. 1995). 1114 2008] DEVELOPMENTS — MENTAL ILLNESS 1115 TABLE OF CONTENTS I. INTRODUCTION......................................................................................................................1117 II. SELL V. UNITED STATES: FORCIBLY MEDICATING THE MENTALLY ILL TO STAND TRIAL ...........................................................................1121 A. The Sell Decision...............................................................................................................1122 B. An “Important” Government Interest.............................................................................1124 C. “Medically Appropriate”...................................................................................................1128 D. “Effective” and “Necessary” ............................................................................................1131 E. Conclusion..........................................................................................................................1132 III. BOOKER, THE FEDERAL SENTENCING GUIDELINES, AND VIOLENT MENTALLY ILL OFFENDERS ...............................................................1133 A. The Federal Sentencing Guidelines and Mentally Ill Offenders.................................1134 B. The Potential Impact of Booker on Sentences for the Mentally Ill ...........................1137 C. Above-Guidelines Sentences for Violent Mentally Ill Offenders .................................1141 D. Civil Commitment and Its Challenges ...........................................................................1142 E. Going Forward ..................................................................................................................1144 IV. THE IMPACT OF THE PRISON LITIGATION REFORM ACT ON CORRECTIONAL MENTAL HEALTH LITIGATION .................................................1145 A. The “Availability” of Administrative Remedies to Acutely Mentally Ill Inmates ....1147 1. The Exhaustion Requirement and the Mentally Ill ................................................1147 2. Exceptions to Exhaustion............................................................................................1148 3. The Case for Personal Availability ............................................................................1149 B. Mental Illness as a “Physical Injury”............................................................................1151 C. Volume Reduction and the Elaboration of Constitutional Standards........................1152 1. The Importance of Clear Precedent to Correctional Litigation.............................1152 2. DOJ Investigations as an Entrenchment of Precedent ...........................................1154 D. Conclusion .........................................................................................................................1155 V. THE SUPREME COURT’S PURSUIT OF PROCEDURAL MAXIMA OVER SUBSTANTIVE MINIMA IN MENTAL CAPACITY DETERMINATIONS ...........1156 A. The Three Instances of Capacity Defined ......................................................................1157 B. The Court’s Proceduralism...............................................................................................1158 C. The Problem with a Primarily Procedural Approach...................................................1161 D. Toward Increased Substantive Engagement ..................................................................1163 E. Conclusion..........................................................................................................................1167 VI. MENTAL HEALTH COURTS AND THE TREND TOWARD A REHABILITATIVE JUSTICE SYSTEM .........................................................1168 A. Mental Health Courts: An Overview ..............................................................................1169 1. The Rise of the Mental Health Court .........................................................................1170 2. The Expansion of the MHC System ...........................................................................1171 3. The Long-Term Benefits of MHCs Outweigh Their Startup Costs........................1172 B. The Criminal Justice System: Retribution or Rehabilitation? ...................................1174 C. Mental Health Courts: The Herald of a Fundamental Shift in the Criminal Justice System?......................................................................................1176 1116 HARVARD LAW REVIEW [Vol. 121:1114 VII. VOTING RIGHTS AND THE MENTALLY INCAPACITATED........................................1179 A. The State of States’ Laws .................................................................................................1181 B. Judgments Facilitating Advocacy ...................................................................................1185 C. What’s Next? ......................................................................................................................1189 2008] DEVELOPMENTS — MENTAL ILLNESS 1117 I. INTRODUCTION Three traditions have dominated mental health law scholarship: “doctrinal constitutional scholarship focusing on rights, therapeutic ju- risprudence scholarship focusing on the therapeutic implications of dif- ferent laws, and theoretical scholarship focusing on philosophical is- sues underpinning mental health law.”1 These strands are well repre- sented in the six Parts of this Development, which focus on the interaction between mental illness and the law in its many forms. The separate Parts address the doctrines created by the Supreme Court and implemented by lower courts, federal and state legislation that enables or hinders the participation of the mentally ill in society, new institu- tional forms and their effects on the mentally ill, and underlying con- ceptual constructs about the nature of criminal punishment, compe- tency, and active participation in society. However, this Development does not take for granted the construc- tions of mental illness present in legal scholarship. The Parts delve into and recognize the law’s impact on and therapeutic potential for the mentally ill, a nontrivial portion of the general population. An es- timated 26.2% of Americans aged eighteen years and older suffer from a diagnosable mental disorder in a given year.2 Because the criminal justice system has become home to many mentally ill individuals,3 sev- eral of the Parts focus on this area. This Development notes that soci- ety has often failed to craft and interpret the law in ways that are cog- nizant of mental illness and sympathetic to mentally ill individuals. One might assume that the situation of the mentally ill in the legal sys- tem is continually improving as advocates demand more rights, but some Parts note that such a meliorative trend has not been present in recent years, especially in the criminal justice setting. However, the various Parts also note bright spots or opportunities ripe for legal solutions. Part II discusses how lower courts have interpreted the Supreme Court’s decision in Sell v. United States,4 a case that discussed the standard for involuntarily medicating defendants in order to render them competent to stand trial. This Part finds that lower courts have on the whole misapplied Sell, leading to decreased protections for ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Elyn R. Saks, Mental Health Law: Three Scholarly Traditions, 74 S. CAL. L. REV. 295, 296 (2000). 2 Ronald C. Kessler et al., Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Dis- orders in the National Comorbidity Survey Replication, 62 ARCHIVES OF GEN. PSYCHIATRY 617, 617 (2005). 3 See Fox Butterfield, Prisons Replace Hospitals for the Nation’s Mentally Ill, N.Y. TIMES, Mar. 5, 1998, at A1. 4 539 U.S. 166 (2003). 1118 HARVARD LAW REVIEW [Vol. 121:1114 mentally ill defendants. Sell set out four factors that must be met be- fore a trial court can balance the state’s interest in

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