The treatment of inmates with special needs who also suffer from serious mental illnesses is a serious challenge to correctional facility administrators. One of the greatest tests to serving this prison population is the wide diversity of mental disorders that special needs inmates may exhibit. Following a discussion of bipolar disorders, mania, schizophrenia, and depression which typically affect a large number of special needs inmates, the article discusses inmate suicide as a serious problem among special needs inmates. It highlights the importance of medically managing those inmates with bipolar disorders, mania, schizophrenia, and depression, and notes that those special needs patients who fail to take their medications as prescribed are a problem not only in the corrections arena, but also for the health care industry in general. Working with mentally ill inmates requires a thorough understanding of the special needs population and a willingness to consistently assess various correctional situations for danger.