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Inmates with mental illness pose unique challenges for correctional facilities. Facilities often lack appropriate services to treat these disorders and are unfamiliar with how to help inmates who have difficulty adjusting to the prison environment. The overrepresentation of inmates with some form of mental illness exacerbates these challenges for corrections agencies. Of particular concern is whether or not inmates who suffer from mental illness receive individualized misconduct punishments that accommodate their mental health status. Most correctional facilities have formal procedures to handle inmate misconduct incidents; official reports of misconduct often lead to charging, pleas, verdicts, and sentencing similar to sentencing practices in a criminal court. Little is known about this discretionary sentencing process within prisons and whether this process is influenced by inmate characteristics. Utilizing three years of data from a large state correctional system, the current study examines the role of inmate characteristics in the misconduct sentencing process within prisons, focusing specifically on the role of mental health status.