For most of past two decades, California's prison population has exceeded 200% of capacity. Images of gymnasia converted to dormitories filled with triple-bunk beds have been featured in media stories. Since 1995 the prison mental health system in California has been monitored by a special master, appointed after a federal court found that the state was “deliberately indifferent” to prisoners' psychiatric needs. In 2007 the special master reported that any system improvements had “succumbed to the inexorably rising tide of population.” In 2008, concluding that overcrowding was the primary cause of the failure to provide adequate treatment, the court ordered California to reduce its prison population to no more than 137.5% of capacity within two years. In the fall of 2010 California appealed this order to the U.S. Supreme Court. In this month's Law and Psychiatry column, Paul S. Appelbaum, M.D., reviews the Supreme Court case, which has implications for other states with overcrowded prisons (page 1121). In a Taking Issue commentary, Henry J. Steadman, Ph.D, notes that the issue of prison overcrowding will intersect in 2014 with full implementation of health care reform, creating opportunities to prevent unnecessary incarceration of people with mental health needs (page 1117).