A federal judge ruled earlier this week the Indiana Department of Corrections (IDOC) has violated the Eighth Amendment rights of prisoners by not providing adequate mental health care. It had violated mentally ill prisoners by subjecting them to conditions that amounted to solitary confinement and only worsened their illness.
The American Civil Liberties Union (ACLU) chapter in Indiana brought the lawsuit on behalf of the Indiana Protection and Advocacy Services Commission and a class of inmates with serious mental illnesses.
Judge Tanya Walton Pratt of the US District Court of the Southern District of Indiana applied the following constitutional standard:
Deliberate indifference to serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain, proscribed by the Eighth Amendment. This is true whether the indifference is manifested by . . . prison guards in intentionally denying or delaying access to medical care or intentionally interfering with the treatment once prescribed.
The judge found “mentally ill prisoners prisoners within the IDOC segregation units”—in solitary confinement—were not receiving “minimally adequate mental health care” and the IDOC had been “deliberately indifferent” to prisoners in IDOC segregation units and the New Castle Psychiatric Unit.
She cited, “A prison that deprives prisoners of basic sustenance, including adequate medical care, is incompatible with the concept of human dignity and has no place in civilized society.”
The judge concluded based on evidence presented that there were “three ways” segregation (solitary confinement) was harmful to prisoners with serious mental illness. First, “The lack of social interaction, such that the isolation itself creates problems. The second is that the isolation involves significant sensory deprivation. The third is the enforced idleness, permitting no activities or distractions. These factors can exacerbate the prisoners’ symptoms of serious mental illness. This condition is known as decompensation, an exacerbation or worsening of symptoms and illness.”
Decompensation, the judge added, can result as a prisoner experiences auditory or visual hallucinations, sleep disturbance, memory problems, anxiety, paranoia, depression, eating problems, or engaging in self-injury or suicide.” Symptoms can lead to behavior that poses a risk to the safety of staff or the prisoner himself. The symptoms can also induce paranoia and lead to prisoners refusing to leave their cell.
Evidence showed there were a “disproportionately high number of mentally ill prisoners within the segregation units within the IDOC.”
Prisoners in solitary confinement commit a “disproportionately high percentage of suicides.”
…Within the IDOC, since the beginning of 2007, 11 of 23 suicides were committed by mentally ill offenders in a segregated setting. Thus, nearly one-half of the prisoner suicides during this period of time were committed by 22% of the total IDOC prisoner population. Stated otherwise, the rate of prisoner suicides in segregation was nearly three times that of prisoner suicides in other housing units… [emphasis added]
As the USA Today noted, in one case a doctor at an Indiana prison ”determined a suicidal prisoner was experiencing ‘severe difficulty coping with segregation.’” However, IDOC had the inmate put back into solitary confinement. The prisoner was isolated for 23 hours a day “in a cell not much larger than a closet at the New Castle Correctional Facility.” The inmate’s mental health deteriorated, and, two weeks later, he committed suicide.
IDOC staff are well aware of the “pernicious effects on prisoners with serious mental health illness,” the judge stated. For example, in a private settlement to an earlier lawsuit, Mast v. Donahue, the IDOC Commissioner stated:
…These offenders may have been diagnosed with a mental disorder that is worsened by confinement in a Secure Confinement Unit [SCU]. In these cases, it is in the best interests of the Department to attempt to obtain mental health treatment for these offenders rather than simply placing them in a long-term disciplinary segregation or Department-wide administrative segregation unit…
Prisoner medical records, suicide and self-harm reports and use of force incident reports all show the “deterioration and injury caused to mentally ill prisoners.” Dr. Robert Walsh, an expert witness, explained:
…The fact is that mentally ill people often have difficulty conforming to prison rules and regulations, and are more likely than other prisoners to be cited for disciplinary infractions. In the isolation of these segregation units, there is a very high risk that mentally ill prisoners will decompensate and become more dysfunctional and harder to manage…
“The goal of mental health care in the correctional setting is to prevent harm from occurring to prisoners and to prevent prisoners from causing harm as a consequence of a mental condition that significantly influences their behavior,” the judge stated. “The consensus of opinion in a professional body of literature on the subject presented in this case is that segregation [solitary confinement] is detrimental for people with serious mental illness because it makes their symptoms worse or because, at best, they do not get any better.”
The judge highlighted Dr. Kathryn A. Burns, another expert witness, who offered a description of a site-visit to the New Castle Psychiatric Unit inside the state-owned but privately run correctional facility (run by the GEO Group):
…Inmates in all phases of treatment displayed remarkably high levels of psychiatric symptoms; some were frankly psychotic with disorganized and delusional thinking; some displayed mood symptoms—manic as well as depressive symptoms. This degree of pathology was not unexpected given that the MHU is identified as the place providing the highest or most intensive level of care. However, what was surprising was the lack of intensive treatment provided: treatment plans are not adjusted or revised to address on-going or worsening symptoms; medication adjustments are infrequent and some inmates who had inappropriately been taken off of medications by one psychiatrist hadn’t yet been seen by the new doctor even though they had been identified as priority cases; some inmates were receiving no treatment whatsoever; some were held in the program with no improvement or access to property, recreation or out-of-cell time for extended periods of time (years in some instances) without treatment…
The judge did not know how to remedy the violations to prevent future illegal deprivations of civil rights. She said she planned to hold further proceedings to determine what the prisoners would be entitled.
As of January 4, no appeal had been filed by IDOC.
The Fort Wayne News-Sentinel in Indiana ran a strong editorial in support of the decision:
…Most of the inmates with mental illness will be released eventually. It’s far better for them to be treated while they’re incarcerated instead of letting their problems mount until they’re released back into society.
This isn’t just an Indiana problem; it’s being faced in other states as the number of mentally ill inmates increases and the easy solution of segregating them in isolation grows in popularity. Indiana has a chance to get ahead of the curve on this issue, and it should jump at the chance…
In conclusion, though it remains to be seen what the judge will instruct IDOC to do, this should be considered an important victory. It shows not having proper staff or resources is no excuse for failing to provide prisoners with adequate health care. Individuals in US prisons should not be subjected to conditions of solitary confinement while serving their sentences if they are mentally ill.