For thousands of mentally ill inmates in Illinois prisons, the suffering never ends.

A new lawsuit filed on behalf of 19 named inmates and an additional 12,800 mentally ill prisoners, outlines allegations of widespread constitutional violations.  The 50-page filing describes prisons with large mental health caseloads as “aggressively stressful, hostile environments in often physically unsafe conditions.”

Left locked in their cells day after day “regardless of the deleterious effects on their mental health,” prisoners are subject to what amounts to cruel and unusual punishment under constitutional standards, says lawyers for the inmates.

The details of the living conditions of the men and women identified in the lawsuit are difficult to read. Reports of self-harm, years without access to phone calls or visits, months long waiting lists for care and disciplinary action for those who request help in a crisis.

“He is not allowed soap to wash his hands or utensils to eat with, and showers are contingent on agreeing to speak to mental health staff through the cell door in front of officers,” the lawsuit says of inmate Bryon Porter’s lack of care.

Many of the cases highlighted in the lawsuit involve people who went to prison as early adults, many of them with mental health issues going back to their childhoods.

The lawsuit, Hilliard v Hughes, outlines the downward spiral that has taken place at the Department of Corrections since 2022, when the state was released from its obligation to complete a major overhaul of the prison mental health system.  The end of judicial oversight required as part of a settlement agreement in the Rasho lawsuit marked the end of efforts to significantly and systematically improve mental health treatment.

“Whatever semblance of mental health care that IDOC had started to implement fell off a cliff,” lawyers note in the new litigation.

Increases in violent responses by IDOC staff to self-harm incidents can be found in the state’s own data, according to the lawsuit:

“In 2023, IDOC used chemical agents on average 16 times per month when responding to self-harm and 75 times a month overall. In 2025, those numbers have jumped significantly to an average 37 times per month when responding to self-harm and 137 times a month overall. This means that currently, more than once each day someone in IDOC who is suffering with serious mental illness and engaging in self-harm is met with pepper spray or other chemical substances.”

The crisis of care has resulted in fire-setting incidents that have claimed at least two lives as individuals in several prisons have “set fire inside their locked cells and even to their own bodies while IDOC staff stand by and allow it to happen,” said a lawyer’s media statement on the lawsuit.

I spent years covering the Rasho litigation, a lawsuit filed by Ashoor Rasho, a seriously mentally ill man whose name became synonymous with mental health treatment in Illinois prisons. The legal tug of war between attorneys for the state and inmates took place in the U.S. District Court for the Central District. During more than a decade of hearings, the well of the Peoria courtroom was crowded with lawyers for both sides, their briefcases bulging with documents to help make their case.

The final agreement was a framework of improvements costing tens of millions of dollars. And a mandate for future oversight by a court-appointed monitor to ensure compliance with the plan.

According to the new lawsuit, the staffing levels have declined, with only 67 full-time mental health positions filled out of 175 budgeted positions for the care of nearly 13,000 people.

Representing the inmates this time are lawyers with DLA Piper, Equip for Equality and Uptown People’s Law Center. Several of the lawyers worked on Rasho.

When the men and women incarcerated in Illinois prisons lack sufficient mental health treatment, their 8th Amendment rights are in jeopardy.  While many incarcerated people living with severe mental illness have spent most of their years behind bars and will never be released, others will come home.  Their return to our communities, without treatment, is a costly consequence of a flawed system that has impacts on their lives and those who live with and near them.

The Illinois Department of Corrections declined my offer to include their comment on the lawsuit.