“Mentally ill people should not have to seek help in a cage, surrounded by feces, within a storage closet. This is the state of the Illinois Prison System.”

The dire assessment of conditions in the Illinois Department of Corrections was recently offered by Harold Hirshman, a Chicago lawyer who has spent nearly two decades litigating the inadequate mental health care in the state’s prison system. In his most recent report (see attached document for his full remarks) Hirshman compares the current challenges facing Alabama prisons with the longstanding deficiencies in Illinois.

Both states have been forced into the courtroom to answer allegations of mistreatment of mentally ill inmates. In Illinois, the complaints include a host of problems, among them a serious lack of medication management, counseling services, and confidentiality for the 12,000 mentally ill inmates included in a class action federal lawsuit.

“Imagine finally gathering the courage to tell someone you’re suicidal and then being shoved in a tiny box while all your possessions are taken away. This is the reality for inmates in the Illinois Department of Corrections,” said Hirshman. Counseling sessions lasting mere minutes take place at the cell door within easy listening range of others.  Those conversations include details of the suicidal ideations that lead to serious mental health crises. A report authored by a court-appointed monitor described the cell door counseling: “It’s not even poor psychiatric care. It’s non-psychiatric care.”

The monitor’s comment is reminiscent of a remark made to me in 2017 by Dr. Melvin Hinton, former chief of mental health services at IDOC.  “We’re not rebuilding a system. We’re building one,” Hinton told me as we toured a new residential treatment center in Joliet. Nearly a decade later, staff shortages have kept the center from being fully utilized.

In Alabama, a judge ordered quarterly monitoring reports to determine if inadequate staffing numbers have improved. According to Hirshman, “the same should be done in Illinois. Otherwise, we will continue to have patients incapable of receiving mental health care.” After years of work on a plan to overhaul mental healthcare in Illinois prisons, a federal judicial ruling derailed the progress. Mental health advocates report a return to the dreadful conditions outlined in years of federal proceedings.

Calls for improvements to prison mental health care must come from outside the courtroom, said Hirshman. Citizens have a right, an obligation, to know about the conditions that impact the lives of mentally ill inmates. After all, the prison systems in both states are funded by taxpayers.

“The suffering of fellow citizens of Illinois, of the families and friends of these patients who cannot get the care necessary for them to live a full, peaceful lives cannot stay in the dark.”

From Harold Hirshman, Chicago attorney for Illinois inmates fighting for adequate mental health care:

 

Mentally ill people should not have to seek help in a cage, surrounded by feces, within a storage closet. This is the state of the Illinois Prison System (IDOC). Dr. Barboza found these conditions when she visited the Pontiac Correctional Center. In addition to the feces, the patients lacked basic necessities like drinking water and natural light. The results of these conditions are clear. Patients are reduced to primitive behavior.[1] The Illinois Prison System takes people who need help and makes them worse. They encourage self-harm and other forms of destructive behavior that harms the patient and those around them. No matter your feelings on prisons, prison reform, or punishment, we must be able to find common ground on the fact that people should not be killing themselves mere feet from lifesaving help. It’s deplorable no matter the space. It must be stopped. In Alabama, similar conditions existed within prisons, and the Alabama Department of Corrections was successfully sued. This led to a Judicial Order mandating certain changes. Similar changes would greatly impact the lives and conditions of mentally ill prisoners in IDOC. Here, the prisons lack timely care, confidentiality, adequate assessments and access to therapy, and living conditions that uphold the human dignity of the prisoners. These factors combined create a system of deliberate indifference that has rendered the mental health services of IDOC ineffective at best, and abusive at worst.

Imagine finally gathering the courage to tell someone you’re suicidal and then being shoved in a tiny box while all of your possessions are taken away. This is the reality for inmates in the Illinois Department of Corrections. Prisoners within IDOC often have limited, or no access to mental health care. When this care is provided, it is delayed and inadequate. Many prisoners are not given the mental health services they need because they lack preexisting conditions when they enter the system. Even those who manage to access mental health services receive the bare minimum or less. Many receive only 15-30 minutes of mental health services per month, often administered through their cell door[2]. Understaffing of key positions has led to unanswered requests for mental health services.[3] Multiple prisoners have reported filing multiple requests over multiple months for help before being seen.[4] When they get an appointment, they are often seen by unqualified mental health staff for the services they require. Prisoners have been given their medications hours after they are scheduled to. Additionally, they have been given prescriptions for 6 months or more, a dangerous practice for the health and safety of the prisoners. They are randomly taken off needed medications if they ask about what they are taking.[5] Sometimes, they receive no medication

These conditions are exacerbated by a lack of confidentiality when patients eventually receive care. In one complaint from a prisoner in Hill Correctional Center, the main mental health provider at that facility was the daughter of a warden, the wife of a C/O, and multiple family members of hers worked at the prison as well. Testimonies from that prison, and across IDOC, reported that they did not feel safe telling staff about their mental health issues, and that nurses at their facilities violated HIPAA[6]Prison is a dangerous place to show weakness, especially if the guards and prisoners on their tier have harmed their mental health. Without confidentiality, prisoners will be hesitant to share their deepest issues that require healing  Their fears are corroborated by reports from both the former Monitor of Mental Health at IDOC and an expert witness who visited institutions such as Pontiac. Both experts expressed concern over the lack of confidentiality, and the unwillingness of staff to attempt to protect confidentiality.[7] No matter how quietly health officials speak, they are still speaking through an iron door. The mere fact that a mental health official is approaching your cell can be harmful. “It’s not even poor psychiatric care. It’s non–psychiatric care.”[8]

Sometimes the conversations themselves are dangerous. In one instance, when a prisoner expressed suicidal ideations, the mental health professional on duty told him to “draw when he felt that way.”[9] Even when patients can speak privately with mental health staff, the current assessments and access to therapy are lacking.  Assessments for mental illness are often conducted by unqualified staff such as CRNPs, leading to misdiagnoses or missed diagnoses.[10] Therapy sessions are often canceled or shortened. Even when patients are able to meet therapy, they have reported that the efforts undertaken by the mental health staff show a lack of care—for example, worksheets or homework given out are not checked or discussed after assignment. The care is also overly generalized. The Expert, Ms. Barboza has reported that both their medical and therapeutic regimens are copy pasted, general forms for staff members to fill out.[11] In one instance, no matter the illness of the patient, the only form filled out by the staff was a suicide risk assessment.[12] Without proper assessment or access to therapy, these patients cannot receive the help necessary to overcome their mental illnesses.

The living conditions provided by IDOC do not uphold the human dignity of prisoners, especially in mental health wings. One testimony from Logan Correctional Center reads: “This is [REDACTED] wing now [REDACTED] wing way way worse it’s a punishment – naked in a smock. When your on your period you have no panties you have to hold the pad in between your legs prayin it stays you only get a shower NO matter what goes wrong Mon, Wed, Thurs. So pray hard your pad don’t move in your sleep.”[13] Many prisoners who struggle with serious mental illness report being placed into restrictive housing because of actions that are caused by their mental illness.[14] Restrictive housing greatly limits the amount of time these patients get out of their cells, often an hour or less per day.[15]

If you do disclose your suicidal ideations to prison officials, you will be stripped naked, placed in a dark, dirty cell, and left there for days.[16] IDOC has used these conditions as a mechanism for preventing suicides.[17] However, being stripped of all of your possessions, including clothing, and thrown into a dark, filthy room for an indefinite amount of time does not comport with this objective. Treatment of this kind worsens mental health, risks physical health, and disregards the dignity of the human person due to these prisoners.

Taken together, IDOC’s treatment of mental health patients within their care render IDOC’s care ineffective and in some extreme cases, abusive. Prisoners cannot improve their mental health under these conditions. The lack of improvement and care leads mental health patients to act out. They are subsequently sent to restrictive housing, worsening their outlook. Then the cycle repeats. . Furthermore, when mentally ill prisoners act out, it can be dangerous to those around them, a sentiment echoed by multiple testimonies from within IDOC.

To that end, in 2007 prisoners sued The Illinois Department of Corrections (IDOC), but the system is dragging its feet on change. Prisoners are being encouraged to kill themselves, handed the tools to do so, and laughed at when they express their pain. When they consider revealing their struggles to mental health workers they discover that some of them are related by marriage or blood to the guards outside their cell (Hill Correctional Center). More often, they only receive 5-15 minutes once a month and sometimes they speak to no one at all. Experts testify that people should be getting at least an hour weekly.[18] Patients are “genuinely afraid to bring [their] issues up to staff / healthcare.”[19] Why? Because if a prisoner admits to being suicidal, they are stuck in a tiny box and all of their things are taken away. In their most vulnerable moment, they have nothing except a voice that floats into their cell to only ask “are you still suicidal?”

Illinois is not the only state with a prison system in desperate need of an overhaul. Alabama has similar issues. In 2014, inmates there filed a suit against the Alabama Department of Corrections (ADOC). They claimed that Alabama officials displayed “deliberate indifference” to their prisoners. In June 2024, the 11th Circuit Court of Appeals agreed.

Deliberate indifference relates to mistreatment under the 8th Constitutional Amendment. The term “deliberate indifference” was first coined in 1976 in the Supreme Court decision Estelle v. Gamble. However, an actual definition of “deliberate indifference” came two decades later in Farmer v. Brennan.[20] The Court set up a two part test with an objective and subjective standard. In order to properly sue a prison official, the inmate must show that 1. They faced or are at substantial risk of facing great harm and 2. That the prison official knows this and is choosing to do nothing. Different courts have interpreted these two standards differently over time, so for the purposes of this article we’ll cover why Alabama found “deliberate indifference” in their prison system and how Illinois compares.

In Alabama, the district court judge in 2017 found that patients were being denied the right to have confidential meetings with mental health providers. When the meetings did occur, they took place in full view of the guards and other prisoners.[21] Confidentiality is necessary for inmates for several reasons. First, because the people causing the harm could be the ones listening in—whether that’s prisoners or the guards themselves. If a patient has a problem with one of the guards, they should not be forced to discuss it in front of them. Second, mental health is a personal and sensitive topic. In Illinois prisons, the nurses simply ask questions through the cell door. In order to have these conversations they must be loud enough for the entire cell block to hear. Prisoners should not have to expose their secrets to everyone around them just to potentially get some relief.

To help with this problem, the district judge ordered more staffing for mental health positions.[22] The reason for this decision being that more staff means a single psychiatrist will have enough time to actually meet with patients instead of jumping from cell to cell. An increase in staffing was an essential part of the ruling. When prisons are severely understaffed, it becomes increasingly more difficult to serve the needs of the patients. As previously mentioned, Illinois has similar issues. Patients are forced to disclose their problems to mental health professionals through their cell doors.

This leads us to the second issue, understaffing. In Alabama, mental health staff simply had too large of a case load to effectively and timely give care.[23] They did not hire a sufficient number of psychiatrists for the growing population of inmates.[24]  Despite an agreement from a different case, the ADOC continued to reduce the number of psychiatrists and replace them with less qualified CRNPs. These workers are supposed to work under and be supervised by a psychiatrist[25]. As Plaintiff’s expert Burns puts it: “Unlicensed staff could not provide mental health care to people outside of prison independent of supervision by a licensed provider and are unqualified to do so in prison”.[26] Prisoners should not have grossly inadequate mental health care.

From 2000 to 2016, the ADOC cut the average number of psychiatrists in the prison system from 8 to 5 despite the actual prison population growing.[27] The cutting means that patients simply could not be seen in any meaningful way. 5 or 10 minutes a month is not enough time to help. It’s barely enough time to check-in and ask if the medicine they are on is working. If part of the point of mental health is to actually help patients, they need more time. This same problem has been reported by prisoners in the IDOC[28]. Patients report seeing their psychiatrist for the sole purpose of asking about medication. For the most severely mentally ill, they are supposed to have hourly meetings weekly, but instead even they barely get to see a psychiatrist. What this means is that you have a growing prison population and no way to treat them. The mental health professionals become stuck in crisis mode meaning they can barely handle the emergency cases let alone the weekly checkups.[29] In the district ruling and again in the 11th Circuit, judges ruled that this level of insufficient staff was irresponsible.[30] The Court ordered a quarterly monitoring report to ensure that staffing levels increased sufficiently.[31] The same should be done in Illinois. Otherwise, we will continue to have patients incapable of receiving mental health care.

Suicide prevention and restrictive housing are also two interlaced problems in both ADOC and the IDOC. In Alabama, patients with mental illnesses were placed in restrictive housing instead of in mental health facilities. Restrictive housing is another term for solitary confinement. Patients are locked in their cell for more than 22 hours a day. Mentally ill patients sometimes act up. Sometimes their reality is not shared. Alabama would take these patients at their lowest and shove them into a place corrosive to their mental wellbeing. They are punished for things they cannot do or do not know to do because of their disabilities.

In addition, ADOC did not do nearly enough to prevent suicide. Their patients report being given razors to shave even though they had just used them to cut themselves.[32] One Alabama plaintiff remembers cutting himself repeatedly with the razor. He would be transported to receive medical help, and when he returned, the razor would still be in his cell. One time, his blood was still drying on the floor (ADOC Amended Complaint 91). Patients are medicated against their will[33]. Many patients don’t know what medication they are on. When they ask what they are on, they don’t receive an answer and sometimes are simply taken off of it. If they refuse to be medicated, they can be placed in restrictive housing. Patients cannot be medicated against their will unless it can be shown that they are severely mentally ill and dangerous to themselves or those around them.[34]

Illinois and Alabama both have mental health crisis. Their prisons are understaffed and underserving their populations. The practices within these prisons worsen the outlook of their mentally ill patients.  In Alabama, that mistreatment was deemed so severe as to require a remedy provided by the court. They have been required by two separate courts to clean up their act. Illinois should be no different. The treatment of mentally ill prisoners in Alabama has both the same root causes and effects as the treatment of prisoners in IDOC. There, courts required remedy. Here, courts should do the same.

Despite the conditions in these prisons, the public has minimal knowledge of what has happened. Both States have kept their treatment of mentally ill prisoners hidden from their citizens. It must come to light. The suffering of fellow citizens of Illinois, of the families and friends of these patients who cannot get the care necessary for them to live full, peaceful lives cannot stay in the dark. The citizens of Illinois, just like the citizens of Alabama, have a right to know what goes on in the prisons funded by their taxes. Atrocities such as these continue, unpunished, because the state covers up the mortalities, the abuse, the suffering of these people. The people of Illinois have a right to know what is going on in their state prisons.

 

 

 

 

[1]Barboza, Sharon. “Report on Harm Being Done to Individuals Incarcerated Within the Illinois Department of Corrections Secondary to Lack of Mental Health Services” Dec, 29, 2023.

[2]Pablo Stewart Deposition 44,82.

[3] Stewart 44.

[4] JHA Muddy River Correctional Center Testimony 27.

[5] JHA Logan Correctional Center Testimony 14.

[6] JHA Hill Correctional Center Testimony 96, 123; Logan Correctional Center 277

[7] Barboza 9; Stewart 79-80

[8]Stewart 80.

[9] JHA Hill Correctional Center Testimony Q15t.

[10] Barboza, 3.

[11] Barboza, 6.

[12] Barboza, 7.

[13] JHA Logan Report Testimony 155.

[14] Stewart 57.

[15] Stewart 59; Barboza 5.

[16] Stewart 57-58.

[17] Id.

[18] Stewart 44.

[19] JHA Reports Hill testimony 123.

[20] Farmer v. Brennan, 511 U.S. 825, 829 (1994).

[21] Braggs PSOF at 179.

[22] Braggs v. Dunn, 562 F. Supp. 3d 1178 at 1186 (M.D. Ala. 2021).

[23] Burns Expert Report at 5.

[24] Id. at 11.

[25] Id. at 15.

[26] Id. at 16.

[27] Id. at 12.

[28] JHA Reports Logan Testimony 14, 155; Pinckneyville 72; Danville 199, 242, 310; Muddy River 261, 505.

[29] Stewart at 20

[30] Braggs, 562 F. Supp. 3d at 1183

[31] Id. at 1186

[32] Supra note 18 at 188

[33] Id. at 92

[34] Alabama Code 22-52-1.1