Psychiatric Services (Program Statement 6340.04)

By Elizabeth Franklin-Best, Esq., and Christopher Zoukis, JD, MBA

Field	Value
Program Statement	6340.04
Subject	Psychiatric Services
Effective / current edition	01-15-2005
Change notices	None. BOP’s published policy list carries 6340.04 with no change notice.
Supersedes	The statement contains no Summary of Changes and no rescission line — unusual for a BOP program statement, and confirmed against the original PDF. It states only that it “does not cover forensic services” (p. 1).
Governing statute	18 U.S.C. §§ 4241–4248 (Chapter 313) for court-ordered examination, hospitalization and commitment — the PS cites “18 U.S.C. §§ 4241 – 4247” at pp. 6 and 9. The Bureau’s general care duty is 18 U.S.C. § 4042.
28 C.F.R. anchor	Part 549, subpart C, “Psychiatric Evaluation and Treatment,” §§ 549.40–549.46 — promulgated at 76 FR 40231 (July 8, 2011), six years after this Program Statement, and implemented by PS 6010.03, not by 6340.04. See Involuntary medication, below.
Related BP forms	BP-S801 Consent to Admission for Mental Health Treatment (current BOP numbering: BP-A0801) and the per-drug “Consent to Use (name of medication)” forms — PS 6340.04 at pp. 9, 11. The involuntary-hearing form set (BP-A0959, BP-A0960, BP-A0961, BP-A0962) comes from PS 6010.03, not from this statement.
Official PDF	bop.gov/policy/progstat/6340_004.pdf

Checked against the BOP policy set · 2026-09-06.

Program Statement 6340.04 is the Bureau of Prisons’ instruction to its own staff on how psychiatric care is organized and delivered inside federal prisons: which services every institution has to be able to provide, how fast a psychiatric evaluation happens after a referral, what informed consent to psychiatric medication has to include, and what may be done in a mental health emergency. It is the oldest health statement still on BOP’s published list, and large parts of it have been overtaken — most importantly the involuntary-medication procedure, which now lives in a regulation and a separate 2011 program statement, both described below.

For the plain-language walkthrough of what mental health care in a federal prison actually looks like day to day, start with Mental Health Programs for Inmates. This page is the rule.

The rule itself: psychiatric services

Everything in this section is transcribed from the Bureau’s own text at bop.gov/policy/progstat/6340_004.pdf, with the page anchor for each passage.

The services every institution has to provide

This is the artifact — the enumerated floor that applies at every federal prison, not only at the psychiatric referral centers. Transcribed in full from PS 6340.04 at p. 7:

8. SERVICES. … All institutions will provide the following services either through medical and mental health care staff at the institution or through consultation with community resources (the services may be delivered by clinicians and staff other than psychiatrists):

– Crisis intervention; – Emergency services; – Risk assessment for acts of self-harm or harm towards others; – Mental health screening of inmates suffering from symptoms or behavioral disturbances indicative of possible mental illnesses or disorders; – Detoxification from alcohol, benzodiazepines, and barbiturates; – Diagnosis and treatment of mild to moderate mental illnesses such as non-psychotic major depression, anxiety disorders, or sleep disorders; – Continuation of psychiatric treatment initiated at other institutions or prior to incarceration; and – Monitoring of inmates on psychiatric medications for side-effects and drug interactions.

PRCs provide all services necessary to meet their mission either on-site or through community resources. At a minimum, this includes:

– Complete diagnostic services; and – Inpatient and outpatient psychiatric treatment services for the severely mentally ill.

Two terms carry the weight of that list. A PRC is a Psychiatric Referral Center — “[a]n institution (usually a Medical Referral Center (MRC)) which has as part of its mission the provision of inpatient psychiatric services” (p. 4). Everywhere else is a “non-PRC,” and at a non-PRC “psychiatric services … will be under the Clinical Director’s direction,” with the policy recommending “that each institution not having a full-time psychiatrist or regular access to tele-psychiatry, contract for psychiatric services” (pp. 4–5). Read together: the list above is what any federal prison is expected to deliver; anything beyond mild-to-moderate illness is expected to move toward a facility built for it. The corresponding instruction at p. 5 is that people “with severe mental illness or who are severely developmentally disabled, will receive a mental health evaluation and, where appropriate, will be referred for placement in a facility or unit specifically designated for managing this type of individual.”

Forensic work is carved out. PS 6340.04 at p. 1: “This Program Statement does not cover forensic services which are covered under the Program Statement on Institution Management of Mentally Ill Inmates.” And at p. 6: “PRCs specified as forensic sites will provide forensic evaluations pursuant to 18 U.S.C. §§ 4241 – 4247.” Competency and sanity evaluations are a different track from clinical psychiatric care, and our explainer for that track is Forensic and Other Mental Health Evaluations (PS 5070.12).

The evaluation time frames

These are the numbers people come looking for. Each row is transcribed from the passage cited.

Situation	The Program Statement’s own words	Pin-cite
Referral for psychiatric evaluation, no mental-health evaluation in the last 30 days	“Inmates referred for psychiatric evaluation who have not received a psychological/mental health evaluation within the previous 30 days, will be seen within 14 days from the date of referral.”	PS 6340.04 at p. 8
Referral where an evaluation was done within the last 30 days	“Inmates who have received a psychological/mental health evaluation within the previous 30 days, will be seen in a timely manner consistent with the inmate’s clinical needs.”	PS 6340.04 at p. 8
Arrival with a Mental Health designation, not admitted inpatient	“Inmates with a Mental Health designation who do not need inpatient treatment or refuse admission to an inpatient unit, will undergo a complete psychiatric evaluation by either a psychiatrist or a licensed psychologist. … The psychiatric evaluation will occur within a clinically appropriate time frame, not to exceed 14 days from arrival.”	PS 6340.04 at p. 8
Admission to an inpatient psychiatric unit	“Inmates admitted to an inpatient unit will undergo a psychiatric evaluation within 24 hours of admission. Either a psychiatrist or licensed psychologist with admitting privileges may perform this evaluation.”	PS 6340.04 at p. 9
After emergency medication at a non-PRC	“At non-PRCs, the Clinical Director will consult with the office of the Medical Director within 24 hours of administering emergency medication (excluding weekends and holidays).”	PS 6340.04 at p. 14
How long emergency medication can run	“Ordinarily, emergency treatment with psychiatric medications at non-PRCs will not be continued for more than 72 hours without the Medical Director’s approval.”	PS 6340.04 at p. 14
Long-acting injectables in an emergency	“Ordinarily, long-acting psychiatric medications such as Haldol Decanoate and Prolixin Decanoate will not be used in emergencies except at PRCs.”	PS 6340.04 at p. 14
Fresh consent after a break in medication	An informed consent form will be obtained when “[a]n inmate has previously given informed consent, but has been off the medication for at least a year.”	PS 6340.04 at p. 11
Chief of Psychiatry oversight	“Each Chief of Psychiatry will have a documented external peer review at least every two years.”	PS 6340.04 at p. 4

The referral pathway itself is at p. 7: staff performing intake screening “will assess and make appropriate referrals to a mental health professional when an inmate: Has a mental health designation; Exhibits signs or symptoms consistent with a possible mental disorder; or Is on medication for treatment of a mental illness or disorder,” and that “[s]creening will be of sufficient detail to determine appropriate housing for the inmate until a thorough mental health evaluation can be completed.” At a non-PRC, the route into a psychiatrist “will generally be through Health Services or Psychology Services” (p. 8).

Continuity is directed both ways. PS 6340.04 at p. 10: “Inmates who have received psychiatric evaluation and treatment services at another Bureau institution will have that treatment continued at the new institution pending further evaluation.” And at p. 12: “All institutions will have a system(s) in place for assuring continuity of care for all inmates receiving psychiatric treatment even if such treatment was started before incarceration at the current institution. … Continuity of care is required from admission to transfer or discharge from the Bureau, including referral to community-based providers, when indicated.”

Informed consent to psychiatric medication

This is the second artifact, and it is the one most people never see in writing. PS 6340.04 at p. 11, transcribed:

a. Psychiatric Medication. Except in an emergency, informed consent will be obtained and documented prior to administering medication for psychiatric symptoms or conditions … Ordinarily, the prescribing physician will be responsible for obtaining the informed consent.

Patient education for obtaining informed consent includes the following information:

– Symptoms of the illness; – Potential benefits of treatment; – Potential risks and side-effects (especially serious ones); – Appropriate use of the medication; – When to notify staff of problems; – Consequences of noncompliance; and – Alternative treatments, including no treatment, and associated risks.

The inmate’s competency to give informed consent will be assessed and documented on the corresponding “Consent to Use (name of medication)” form. An informed consent form will be obtained when:

– A psychiatric medication is prescribed for which an informed consent has not previously been obtained; – An inmate has previously given informed consent, but has been off the medication for at least a year; – Clinical judgment deems that a new informed consent is appropriate because of a significant change in the inmate’s clinical status; or – An inmate on psychiatric medication is newly committed to the Bureau and does not have informed consent documented on any of the standard forms noted above.

The definition that gives that section its content is at p. 3: “Competence to Give Informed Consent. The inmate has an understanding of his/her diagnosis or condition, the treatment being offered, the potential risks, benefits and side-effects of treatment, especially serious ones, what to do in the event of such effects, the alternatives to the treatment being offered (including no treatment), and risks associated with the alternatives.”

Two things follow. First, consent is per-drug and it is documented on a form. “Consent to Use (name of medication)” is not a general treatment consent — it is drug-specific, which means a change of medication generates a fresh consent obligation. Second, noncompliance is not a ground for exclusion. PS 6340.04 at p. 12: “Inmates on psychiatric medication will be monitored regularly in Chronic Care Clinics. Noncompliance should not be the determining factor for exclusion from the Mental Health Chronic Care Clinic. … Inclusion in the Chronic Care Clinic should continue as long as the inmate has active symptoms of mental illness or is on psychiatric medication.” Being taken off the clinic roster for refusing medication is contrary to the Bureau’s own instruction.

When treatment can happen without consent

PS 6340.04 at p. 11 states the rule in two lines:

Psychiatric treatment, regardless of the unit in which the inmate resides, will be voluntary except when:

– Treatment has been ordered by the court; or – A mental health emergency exists.

“Mental health emergency” is defined twice, and the two definitions are not identical — a detail that matters. PS 6340.04 at p. 3:

d. Mental Health Emergency. For the purposes of the potential use of mental health seclusion or restraint, a mental health emergency is defined as a situation in which an inmate is suffering from a mental illness which creates an immediate threat of:

– Bodily harm toward self; – Bodily harm toward others; – Serious destruction of property which would immediately endanger self or others; or – Serious disruption of the therapeutic milieu that places the inmate at risk of harm by others.

For the purposes of emergency medication, a mental health emergency includes all of the above situations, as well as a situation in which there is an immediate risk of extreme deterioration of functioning secondary to a psychiatric illness.

The threshold for emergency medication is therefore broader than the threshold for seclusion or restraint. The same five-item list is repeated as the operative criteria at p. 13: “Psychiatric medication may be administered in a mental health emergency only by order of the physician, and if the inmate is at immediate risk of” bodily harm to self, bodily harm to others, serious destruction of property endangering self or others, serious disruption of the therapeutic milieu placing the inmate at risk of harm from others, or extreme deterioration of functioning secondary to a psychiatric illness.

The governing principle sits above all of it. PS 6340.04 at p. 13: “Interventions during a mental health emergency may include nonphysical interventions, voluntary medication, seclusion, involuntary medication, and/or restraint. The least restrictive method for controlling the situation will be employed and documented in the inmate health record.” And the definition at p. 3 puts the options in order: “Least Restrictive Clinical Interventions. The minimum intervention necessary to control the situation including the use of non-physical interventions, as well as voluntary medication, voluntary special housing, seclusion, involuntary medications, and restraints.”

The documentation obligation is specific and, in a dispute, it is the whole record. PS 6340.04 at p. 14 — documentation of emergency medication administration must include: “Type of emergency; Interventions attempted and the result(s); Reason that less restrictive interventions were not used or were ineffective; When, where and how the medication is to be administered; and Assessment and monitoring of the inmate for adverse reactions and side-effects.” The same three-item core is repeated for any emergency intervention at p. 15.

Two further limits are stated flatly. PS 6340.04 at p. 13: “Painful stimuli will not be used as a mental health intervention.” And on electroconvulsive therapy at p. 12: “ECT will only be considered for inmates at PRCs, except in an extreme emergency. Prior to administering any ECT, the Medical Director must approve the procedure in writing,” after which “ECT will be performed in the community by a qualified consultant psychiatrist privileged to administer the treatment.”

Involuntary medication: the rule that actually governs

This is the highest-stakes subject on the page, and PS 6340.04 is not where the answer lives. It is worth being exact about why.

The 2005 statement addresses involuntary hospitalization — moving someone to an inpatient psychiatric unit — and defers everything about involuntary medication to a companion directive. PS 6340.04 at pp. 8–9: “Inmates will only be admitted to an inpatient unit after giving informed consent for admission or under an appropriate court order (see the Program Statements on Administrative Safeguards for Psychiatric Treatment and Medication and Institution Management of Mentally Ill Inmates).” At p. 9 it sets out three propositions:

– Involuntary inpatient admission or treatment can occur only with a court order under 18 U.S.C. §§ 4241 – 4247. – 18 U.S.C. §§ 4241 – 4247 does not apply to un-sentenced Bureau of Immigration and Customs Enforcement (BICE), formerly the Immigration and Naturalization Service, detainees, un-sentenced prisoners in Bureau custody as a result of a court order, and state or territorial prisoners. – For those persons not covered by 18 U.S.C. §§ 4241 – 4247, the decision to admit or treat the person involuntarily must be made through an administrative hearing in accordance with Vitek v. Jones, 445 U.S. 480 (1980).

Both of the companion directives it points to are gone. “Administrative Safeguards for Psychiatric Treatment and Medication” was PS 6010.01 (9/21/1995); it was rescinded by PS 6010.03, Psychiatric Evaluation and Treatment, dated July 13, 2011 and effective August 12, 2011 (PS 6010.03 at p. 1). “Institution Management of Mentally Ill Inmates” was PS 5310.13 (3/31/1995); the current statement is PS 5310.16, Treatment and Care of Inmates with Mental Illness, with Change Notice CN-1 dated February 18, 2025.

What governs now is a regulation. 28 C.F.R. part 549, subpart C — §§ 549.40 through 549.46, “Psychiatric Evaluation and Treatment” — was promulgated at 76 FR 40231 on July 8, 2011. Unlike a Program Statement, it binds. PS 6010.03 is the Bureau’s implementing instruction for it and supplies the form set.

The hearing, verbatim

28 C.F.R. § 549.46(a), transcribed in full from the eCFR:

(a) Procedures. When an inmate is unwilling or unable to provide voluntary written informed consent for recommended psychiatric medication, the inmate will be scheduled for an administrative hearing. The hearing will provide the following procedural safeguards:

(1) Unless an exception exists as provided in paragraph (b) of this section, the inmate will not be involuntarily administered psychiatric medication before the hearing.

(2) The inmate must be provided 24-hours advance written notice of the date, time, place, and purpose, of the hearing, including an explanation of the reasons for the psychiatric medication proposal.

(3) The inmate must be informed of the right to appear at the hearing, to present evidence, to have a staff representative, to request witnesses, and to request that witnesses be questioned by the staff representative or by the person conducting the hearing. If the inmate does not request a staff representative, or requests a staff representative with insufficient experience or education, or one who is not reasonably available, the institution mental health division administrator must appoint a qualified staff representative.

(4) The hearing is to be conducted by a psychiatrist other than the attending psychiatrist, and who is not currently involved in the diagnosis or treatment of the inmate.

(5) Witnesses should be called if they are reasonably available and have information relevant to the inmate’s mental condition or need for psychiatric medication. Witnesses who will provide only repetitive information need not be called.

(6) A treating/evaluating psychiatrist/clinician, who has reviewed the case, must be present at the hearing and must present clinical data and background information relative to the inmate’s need for psychiatric medication. Members of the treating/evaluating team may also be called as witnesses at the hearing to provide relevant information.

(7) The psychiatrist conducting the hearing must determine whether involuntary administration of psychiatric medication is necessary because, as a result of the mental illness or disorder, the inmate is dangerous to self or others, poses a serious threat of damage to property affecting the security or orderly running of the institution, or is gravely disabled (manifested by extreme deterioration in personal functioning).

(8) The psychiatrist must prepare a written report regarding the initial decision. The inmate must be promptly provided a copy of the initial decision report, and informed that he/she may appeal it to the institution’s mental health division administrator. The inmate’s appeal, which may be handwritten, must be submitted within 24 hours after receipt of the hearing officer’s report. Upon request of the inmate, the staff representative will assist the inmate in preparing and submitting the appeal.

(9) If the inmate appeals the initial decision, psychiatric medication must not be administered before the administrator issues a decision on the appeal, unless an exception exists as provided in paragraph (b) of this section. The inmate’s appeal will ordinarily be reviewed by the administrator or his designee within 24 hours of its submission. The administrator will review the initial decision and ensure that the inmate received all necessary procedural protections, and that the justification for administering psychiatric medication is appropriate.

(10) If an inmate was afforded an administrative hearing which resulted in the involuntary administration of psychiatric medication, and the inmate subsequently consented to the administration of such medication, and then later revokes his consent, a follow-up hearing will be held before resuming the involuntary administration of psychiatric medication. All such follow-up hearings will fully comply with the procedures outlined in paragraphs (a)(1) through (10) of this section.

And the two exceptions, § 549.46(b):

(b) Exceptions. The Bureau may involuntarily administer psychiatric medication to inmates in the following circumstances without following the procedures outlined in paragraph (a) of this section:

(1) Psychiatric emergencies. (i) During a psychiatric emergency, psychiatric medication may be administered only when the medication constitutes an appropriate treatment for the mental illness or disorder and its symptoms, and alternatives (e.g., seclusion or physical restraint) are not available or indicated, or would not be effective. If psychiatric medication is still recommended after the psychiatric emergency, and the emergency criteria no longer exist, it may only be administered after following the procedures in §§ 549.44 or 549.46 of this subpart.

(ii) For purposes of this subpart, a psychiatric emergency exists when a person suffering from a mental illness or disorder creates an immediate threat of: (A) Bodily harm to self or others; (B) Serious destruction of property affecting the security or orderly running of the institution; or (C) Extreme deterioration in personal functioning secondary to the mental illness or disorder.

(2) Court orders for the purpose of restoring competency to stand trial. Absent a psychiatric emergency as defined above, § 549.46(a) of this subpart does not apply to the involuntary administration of psychiatric medication for the sole purpose of restoring a person’s competency to stand trial. Only a Federal court of competent jurisdiction may order the involuntary administration of psychiatric medication for the sole purpose of restoring a person’s competency to stand trial.

PS 6010.03 supplies four things the regulation does not. The notice at (a)(2) is given on BP-A0959, “Notice of Hearing and Advisement of Rights for Involuntary Hospitalization or Medication for Psychiatric Care or Treatment,” which “is filled out only by the referring psychiatrist currently involved in the diagnosis or treatment of the inmate” (PS 6010.03 at p. 9). The hearing report at (a)(8) is BP-A0961, “Hearing Report: Involuntary Medication for Psychiatric Care or Treatment” (p. 10); the hospitalization equivalent is BP-A0960. The appeal at (a)(8)–(9) is filed on BP-A0962 (p. 11). And PS 6010.03 at p. 8 states a point the regulation leaves implicit: “Administrative hearings for involuntary hospitalization and medication cannot be combined into a single hearing. If a particular inmate needs both involuntary hospitalization and medication, two separate hearings are conducted.”

Two procedural details from PS 6010.03 are worth knowing before a hearing. The person “is entitled to appear at the hearing; however, at the discretion of the hearing psychiatrist, the appearance requirement may be met by videoconference. Teleconference is not permissible, as it does not allow the hearing psychiatrist to visually evaluate the inmate” (p. 9). And the staff representative’s role is bounded: it “is limited to helping the inmate obtain copies of documents needed … or a written statement(s) from reasonably available inmates or staff,” plus assistance preparing and submitting the appeal (p. 9). A staff representative is not counsel.

Washington v. Harper and Sell v. United States — the distinction that decides everything

Two Supreme Court decisions govern forced psychiatric medication, and they answer different questions. Getting them confused is the most common and most costly error in this area.

Washington v. Harper, 494 U.S. 210 (1990) is the dangerousness case, and it is the source of the administrative hearing described above. The Court held: “given the requirements of the prison environment, the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate’s medical interest.” That is the substantive test — dangerousness plus medical interest, both.

On procedure, the Court was equally direct: “We hold that the administrative hearing procedures set by the SOC Policy do comport with procedural due process, and conclude that the Washington Supreme Court erred in requiring a judicial hearing as a prerequisite for the involuntary treatment of prison inmates.” It added that the Due Process Clause “‘has never been thought to require that the neutral and detached trier of fact be law trained or a judicial or administrative officer,'” and that “the Constitution does not prohibit the State from permitting medical personnel to make the decision under fair procedural mechanisms.” The Court also confirmed what is being weighed against that: an incarcerated person “possesses a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause.”

So: no judge is required where the Bureau proceeds on dangerousness grounds. A hearing before a non-treating psychiatrist, with notice, presence, evidence, witnesses and a staff representative, is what the Constitution demands — and 28 C.F.R. § 549.46(a) is BOP’s implementation of exactly that.

Sell v. United States, 539 U.S. 166 (2003) is the competency case, and it is judicial. It governs a different situation: the government wants to medicate a defendant solely to make them competent to stand trial, and there is no dangerousness justification. The Court held that “the Constitution permits the Government involuntarily to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests.” It added: “those instances may be rare.”

A court must make four findings: that important governmental interests are at stake; that involuntary medication will significantly further those interests; that involuntary medication is necessary to further them; and that administration of the drugs is medically appropriate. The Court also instructed courts on sequence: “A court need not consider whether to allow forced medication for that kind of purpose, if forced medication is warranted for a different purpose, such as the purposes set out in Harper related to the individual’s dangerousness … There are often strong reasons for a court to determine whether forced administration of drugs can be justified on these alternative grounds before turning to the trial competence question.” The reason given is practical: the dangerousness inquiry “is usually more ‘objective and manageable'” than the trial-competence inquiry.

The Bureau’s regulation reflects the split precisely. Section 549.46(b)(2) removes trial-competency medication from the administrative track entirely and says that “[o]nly a Federal court of competent jurisdiction may order” it. PS 6010.03 at p. 12 adds that “[a]ll court orders requiring the involuntary administration of medication for the sole purpose of restoring competency must be retained in the inmate health record.”

The practical distinction, stated plainly. If the Bureau’s stated reason is that the person is dangerous to self or others, gravely disabled, or a serious threat to property affecting institutional order, that is Harper territory and the forum is a BOP administrative hearing under § 549.46(a) with a 24-hour appeal. If the stated reason is restoring competency for trial and there is no emergency, that is Sell territory, the forum is the district court, and it belongs to trial counsel. A person facing the second should not be routed into the first, and a Sell order is not something a BOP hearing can supply.

A third case still does real work. Vitek v. Jones, 445 U.S. 480 (1980) — the decision PS 6340.04 itself cites at p. 9 — held that “[a] criminal conviction and sentence of imprisonment extinguish an individual’s right to freedom from confinement for the term of his sentence, but they do not authorize the State to classify him as mentally ill and to subject him to involuntary psychiatric treatment without affording him additional due process protections.” Vitek is about transfer to a mental hospital rather than medication, and it is the constitutional basis for the parallel hospitalization hearing at 28 C.F.R. § 549.45(b) — the track for people who are not covered by 18 U.S.C. Chapter 313, which PS 6010.03 at p. 5 identifies as including “alien detainees subject to an order of deportation, exclusion, or removal; material witnesses; contempt of court commitments; or other unsentenced inmates in Bureau custody.”

For people who are covered by Chapter 313, hospitalization runs through a court. 28 C.F.R. § 549.45(a): “A court determination is necessary for involuntary hospitalization or commitment of inmates pursuant to 18 U.S.C. Chapter 313.” The most common route for someone already serving a sentence is 18 U.S.C. § 4245: if a sentenced person “objects either in writing or through his attorney to being transferred to a suitable facility for care or treatment,” a government attorney may move for a hearing at the facility director’s request, and “[a] motion filed under this subsection shall stay the transfer of the person pending completion of procedures contained in this section.” The court commits only “if … the court finds by a preponderance of the evidence that the person is presently suffering from a mental disease or defect for the treatment of which he is in need of custody for care or treatment in a suitable facility,” and hospitalization runs “until he is no longer in need of such custody for care or treatment or until the expiration of the sentence of imprisonment, whichever occurs earlier.”

Applied Insight — Christopher Zoukis, JD, MBA, Managing Director: If a BP-A0959 notice is served, the clock is the emergency. The regulation gives 24 hours’ notice before the hearing and 24 hours after the written decision to appeal — and the appeal, which “may be handwritten,” is the only thing that stops medication from starting while it is pending. Three things should happen inside that window. Ask for a specific staff representative by name, in writing, before the hearing; if you do not, one is appointed for you. Ask that the treating psychiatrist’s clinical data be identified on the record, because § 549.46(a)(6) makes their presence and presentation mandatory and (a)(8) requires the hearing psychiatrist to state “the specific evidence relied upon” (PS 6010.03 at pp. 10–11). And get the notice to family or counsel the same day — this is the one BOP proceeding where a 24-hour delay is dispositive, and it is far easier to make a record before the hearing than to unwind one after.

What psychiatric services policy means for you

If you are the person inside: getting seen

Getting seen. Ask in writing, on a BP-A0148 Inmate Request to Staff — the form everyone calls a “cop-out” — and address it to Psychology Services or Health Services. If you have not had a mental health evaluation in the previous 30 days, the policy directs that you be seen within 14 days from the date of the referral (PS 6340.04 at p. 8). Date the request and keep a copy. If you arrived at the institution already carrying a mental health designation, the policy directs a complete psychiatric evaluation “not to exceed 14 days from arrival” (p. 8).

Medication continuity. If you were on psychiatric medication before you came in, or at a previous institution, say so at intake and say so again in writing. The policy directs that treatment “be continued at the new institution pending further evaluation” (p. 10) and that every institution have a system for continuity “even if such treatment was started before incarceration” (p. 12). Gaps at transfer are common; they are also contrary to the Bureau’s own instruction, which makes them worth naming precisely.

Consent is yours, and it is per drug. Except in an emergency, informed consent must be obtained and documented before psychiatric medication is administered, on the drug-specific “Consent to Use” form (p. 11). You are entitled to be told, before signing, the symptoms of the illness, the benefits, the risks and serious side effects, when to notify staff of problems, the consequences of stopping, and the alternatives including no treatment (p. 11). If you stop a medication, you are still supposed to stay in the Mental Health Chronic Care Clinic — “[n]oncompliance should not be the determining factor for exclusion” (p. 12).

If you are told medication will be given without your consent. Do not treat the BP-A0959 as paperwork. Read what the stated reason is: dangerousness, grave disability, or threat to property is the administrative track under 28 C.F.R. § 549.46(a); restoring competency for trial is a court’s decision and not the hearing psychiatrist’s. Appear if you can — appearance may be by videoconference but not by telephone. Ask for a staff representative. Appeal within 24 hours of getting the written decision, in your own handwriting if that is all you have; the appeal is what pauses the medication.

If you are the family member: why designation matters most

Three things are worth understanding.

Where someone is designated is most of the answer. Inpatient psychiatric care happens at a Psychiatric Referral Center, usually a Medical Referral Center; a regular institution is expected to handle crisis intervention, screening, detoxification, and mild-to-moderate illness, and to refer beyond that (PS 6340.04 at pp. 4–7). If a serious mental illness is not being managed where your loved one is, the real question is often designation, not clinic scheduling. See Medical Designations and Care Levels (PS 6270.02), the Federal Medical Centers overview, and the mental health care levels described in Treatment and Care of Inmates with Mental Illness (PS 5310.16).

You will not be told much, and there is a reason. Health information is protected, and staff will not discuss a diagnosis or a medication with you without a signed release. What you can do is give staff information rather than ask for it. A dated letter to the Chief of Psychology or the Clinical Director describing what you have observed — the content of calls, what has changed, prior diagnoses, past hospitalizations, what has worked before — becomes part of the picture the clinicians are working from. That is often the single most useful thing a family contributes.

If you learn about an involuntary medication hearing, act the same day. The notice period is 24 hours and the appeal window is 24 hours. If your loved one calls to say they were handed a hearing notice, that call is the whole opportunity. Ask for the form number (BP-A0959), the date and time of the hearing, and the stated reason. Then call counsel.

If dementia is in the picture, note that the policy itself points toward release: “Inmates with possible dementia will undergo a complete psychiatric and medical evaluation. Those with moderately severe or severe dementia should be considered for a reduction in sentence/compassionate release” (PS 6340.04 at p. 13). See Compassionate Release / Reduction in Sentence (PS 5050.51) and Compassionate Release for Serious Medical Conditions.

If you are counsel: psychiatric services

Know which forum you are in before you do anything else. The single most consequential question in a forced-medication matter is whether the Bureau is proceeding on Harper dangerousness grounds (BOP administrative hearing, § 549.46(a), 24-hour appeal to the institution mental health division administrator) or whether the government is seeking a Sell order to restore competency (district court, four findings, appealable as a collateral order — Sell itself so held). A client medicated under § 549.46 has an administrative record; a client medicated under a Sell order has a docket. They are not interchangeable, and § 549.46(b)(2) forbids the Bureau from using the administrative track for a pure competency-restoration purpose.

The administrative record is unusually rich and it is obtainable. BP-A0959 (notice), BP-A0960 or BP-A0961 (hearing report, which must record whether the hearing was in person or by videoconference and must state the specific evidence relied upon, the findings, and their justification), and BP-A0962 (appeal) are discrete documents, and the regulation requires a written report and a written appeal decision. Request them through the client and, where staff will not produce them, through a Freedom of Information Act or Privacy Act request. PS 6340.04 at p. 15 also directs that “[a]ll documentation related to psychiatric evaluations and treatment (inpatient, outpatient, and forensic) will be available in the inmate’s health record.”

Set expectations about what the Program Statement can carry. Under Reno v. Koray, 515 U.S. 50 (1995), a Program Statement is “an internal agency guideline” akin to an interpretive rule, “still entitled to some deference” but not a regulation. A departure from PS 6340.04’s fourteen-day evaluation window is not itself a cause of action. Section 549.46, by contrast, is a regulation, and the procedural protections in it are the ones with real teeth. Build on the regulation and on Harper‘s substantive standard — dangerousness and medical interest — rather than on the Program Statement’s timelines.

A note on scope. This firm defends. We do not bring prisoner damages actions, and this page is not written to support one. Where care has failed, the productive routes are the administrative-remedy ladder and, for injury, the Federal Tort Claims Act track — both described below — and, where the underlying issue is designation, care level, or release, a consult.

What has not changed since 2005

PS 6340.04 is dated January 15, 2005 and has never been reissued. It is, as of this writing, the oldest health-services statement on BOP’s published policy list. Unusually, it carries no Summary of Changes and no rescission line — confirmed by reading the original PDF’s header block — so what it replaced is not stated in the document.

What has changed is nearly everything around it. Four things now own subjects the 2005 statement addressed:

Subject	What 6340.04 says	What owns it now
Involuntary psychiatric medication and involuntary hospitalization	Defers to “Administrative Safeguards for Psychiatric Treatment and Medication” (PS 6010.01, 9/21/1995) and cites Vitek (p. 9)	28 C.F.R. §§ 549.40–549.46 (76 FR 40231, July 8, 2011) and PS 6010.03, Psychiatric Evaluation and Treatment (7/13/2011, effective 8/12/2011), which rescinded 6010.01
Identification, care levels, treatment programs and restrictive housing for people with mental illness	Defers to “Institution Management of Mentally Ill Inmates” (PS 5310.13, 3/31/1995)	PS 5310.16, Treatment and Care of Inmates with Mental Illness (5/1/2014, CN-1 2/18/2025), which created the CARE1-MH through CARE4-MH mental health care levels
Psychological assessment, intake evaluation and psychology programming	Defers to “Psychology Services Manual” (PS 5310.12, 8/13/1993)	PS 5310.17, Psychology Services Manual (8/25/2016)
Suicide prevention and suicide watch	Defers to “Suicide Prevention Program” (PS 5324.05, 3/1/2004)	PS 5332.01, Suicide Prevention Program (3/19/2026), which rescinded PS 5324.08 (4/5/2007)

What 6340.04 still governs. Strip out the four subjects above and a real core remains, and it is the core this page reproduces: the enumerated service floor at every institution (p. 7); the PRC/non-PRC division of labor and who supervises psychiatric services where (pp. 3–6); the referral triggers at intake screening (p. 7); the 14-day and 24-hour evaluation windows (pp. 8–9); the content of informed consent and when a fresh consent form is required (p. 11); the Chronic Care Clinic and the non-exclusion rule for noncompliance (p. 12); emergency medication criteria, the 72-hour limit, the 24-hour Medical Director consult, and the long-acting-injectable restriction (pp. 13–14); ECT approval (p. 12); the prohibition on painful stimuli (p. 13); dementia and compassionate-release referral (p. 13); and the documentation obligations (pp. 14–15).

Thirteen of its cross-references now point at editions that no longer exist. Verified against BOP’s current published policy list: P5050.46 Compassionate Release → PS 5050.51 (which replaced PS 5050.50 on September 3, 2026); P5070.11 Study and Observation Report → PS 5070.12, Forensic and Other Mental Health Evaluations; P5270.07 Inmate Discipline and Special Housing Units → split into PS 5270.09 (Inmate Discipline Program) and PS 5270.12 (Special Housing Units); P5310.12 → PS 5310.17; P5310.13 → PS 5310.16; P5324.05 → PS 5332.01; P5566.05 Use of Force → PS 5566.07, Use of Force, Application of Restraints, and Firearms (7/17/2024); P6010.01 → PS 6010.03; P6027.01 → PS 6027.03; P6090.01 → PS 6090.04; P6270.01 → PS 6270.02; P6360.01 → PS 6360.03; P7331.04 Pretrial Inmates → PS 7331.05. Only P5212.07, Control Unit Programs, remains current at the number cited.

Three additional divergences between the 2005 text and current law are set out below: the discipline regulation it cites no longer exists, the diagnostic manual it describes has been restructured, and the seclusion-and-restraint directive it relies on four times does not appear on BOP’s published policy list.

Where people get stuck getting psychiatric care

Four problems recur. Each has a route, and the route matters more than the complaint.

“I asked to see the psychiatrist months ago.” Start with a written BP-A0148 Inmate Request to Staff that says three things: the date of your original request, whether you have had any mental health evaluation in the last 30 days, and the fourteen-day figure from PS 6340.04 at p. 8. A cop-out that names the time frame and the date is a different document from one that says you have been waiting. Send it to Psychology Services and, separately, to the Health Services Administrator. If nothing comes back, the formal ladder is the Administrative Remedy Program: BP-9 to the Warden, BP-10 to the Regional Director, BP-11 to the Office of National Inmate Appeals, under 28 C.F.R. part 542, subpart B. The deadline is short — 28 C.F.R. § 542.14(a) sets “20 calendar days following the date on which the basis for the Request occurred,” subject to an extension “[w]here the inmate demonstrates a valid reason for delay.” BOP publishes BP-A0148 but does not publish the BP-9, BP-10 or BP-11 forms; you get those from your unit team. See Request to Staff, Administrative Remedy Program, and prison grievances.

“They stopped my medication when I transferred.” This is the most common psychiatric complaint in the federal system and the one with the clearest policy hook. PS 6340.04 at p. 10 directs that treatment received at another Bureau institution “will have that treatment continued at the new institution pending further evaluation,” and at p. 12 that every institution have a continuity system covering treatment “started before incarceration at the current institution.” Name the prior institution, the prescriber if you know it, the drug and dose, and the date the medication stopped. If a formulary substitution is the actual issue rather than discontinuation, say that instead — it is a different conversation and it belongs to the pharmacy statement. Related: Patient Care (PS 6031.06).

“I’m in the SHU and I’m getting worse.” PS 6340.04 at p. 10 directs that “[w]henever any inmate is transferred into a SHU, health care staff will be informed immediately and will provide assessment and review as indicated by local protocols,” recommends that PRCs establish separate Special Housing Units for people with mental illness “physically distinct from the SHUs used to house general population inmates,” and encourages non-PRCs to identify an area for people “suffering from active symptoms of a mental illness” because “[t]hese inmates are at increased risk of behaviors of self-harm or harm towards others.” Those are recommendations, not rules. What is stronger is PS 5310.16’s restrictive-housing framework, which builds mental health review into extended placement and ADX referral. Ask, in writing, for a mental health evaluation and for your mental health care level to be reviewed. See Special Housing Units, Solitary Confinement and Special Housing Units, and Treatment and Care of Inmates with Mental Illness.

“I got an incident report and I was psychotic at the time.” This is a real and underused avenue. PS 6340.04 at p. 10 directs that people “receiving an incident report and who are psychiatric inpatients, or whose mental status is questionable, will be referred to a psychiatrist or psychologist for an assessment regarding competency and responsibility.” The referral is supposed to be automatic where mental status is in question — but in practice it is triggered by someone raising it. Raise it in writing to the investigating lieutenant and to the Discipline Hearing Officer, and raise it before the hearing, not after. The competency-and-responsibility assessment is a distinct document from a routine clinical note. See Inmate Discipline Program and Inmate Discipline Proceedings.

Where the underlying problem is designation, mental health care level, or release, the administrative remedy path is necessary but rarely sufficient on its own. Those belong in a consult — see Federal Prison Consulting Services or contact us. Where the complaint is personal injury or property loss rather than a rule dispute, the track is different: a tort claim under the Federal Tort Claims Act on an SF-95, not a BP-9. And exhaustion matters if court is ever a possibility: under the Prison Litigation Reform Act, 42 U.S.C. § 1997e(a), no action may be brought about prison conditions until available administrative remedies are exhausted. “Exhaustion” means completing every level of the internal ladder, on time, before filing.

Related BOP policy on psychiatric services

The paired information page is Mental Health Programs for Inmates, which covers what mental health services look like from the inside and what programs are actually available. It links back here for the rule.

Policies that meet psychiatric services directly: Treatment and Care of Inmates with Mental Illness (PS 5310.16) is the statement that now owns mental health care levels, identification and placement, the team approach to care, and restrictive-housing review — the largest single piece of what a 2005 reader would have looked for here. Patient Care (PS 6031.06) is the parent health-services statement governing sick call, medical holds and continuity. Psychology Treatment Programs (PS 5330.11) covers the residential treatment programs, including RDAP. Forensic and Other Mental Health Evaluations (PS 5070.12) covers the competency and sanity evaluations that PS 6340.04 expressly carves out. Medical Designations and Care Levels (PS 6270.02) explains how someone is matched to an institution.

Where inpatient psychiatric care happens: the Federal Medical Centers overview, and the institution records for MCFP Springfield, FMC Butner, FMC Carswell, FMC Devens and FMC Rochester.

Subjects that intersect: Special Housing Units and Solitary Confinement and Special Housing Units for the SHU provisions at p. 10. Inmate Discipline Program and Inmate Discipline Proceedings for the competency-and-responsibility assessment. Management of Aging Offenders (PS 5241.01) and Compassionate Release / Reduction in Sentence (PS 5050.51) for the dementia provision at p. 13. Management of Inmates with Disabilities (PS 5200.06) for the developmental-disability referral at p. 5. Hunger Strikes (PS 5562.05) is the sibling subpart of the same medical-services regulation and turns on many of the same consent questions.

Routes and records: Request to Staff, Administrative Remedy Program, Federal Tort Claims Act, and FOIA and Privacy Act Requests for the hearing record and the health record. Background for families: What Families Should Know About Federal Prison and What Rights Do Prisoners Have?.

Frequently Asked Questions About BOP Psychiatric Services

Reviewed for legal accuracy by Elizabeth Franklin-Best, Esq., Principal Attorney·September 2026