After 10 days of isolation in his cell, an inmate at Stateville Correctional Center self-harmed for the first time in four years. The inmate (who will remain unnamed) suffers from a history of mental illness and self-harm. Until the COVID-19 outbreak locked down the Illinois correctional system, he had been stable.
The inmate’s experience is not an exception, said Amanda Antholt, who is in communication with the aforementioned inmate. Antholt is senior counsel at Equip for Equality in Chicago, Illinois, an organization that advocates for inmates with disabilities through legal services and monitoring.
“Most of the facilities are on some level of lockdown or quarantine. People are in their cells or in isolation in their cells up to 24 hours a day,” Antholt said. “And we have a lot of clients that have been pretty stable for a long time lately who are now deteriorating in those conditions.”
March 26, 2020, the Illinois Department of Corrections (IDOC) saw its first confirmed case of COVID-19 in Stateville Correctional Center, located in Crest Hill, IL. Uptown People’s Law Center (UPLC), an organization that advocates for prisoners’ rights, including mental health services, has been tracking the deteriorating conditions and growing number of cases in Illinois prisons. According to a report from the UPLC, COVID-19 has infected 9,616 prisoners in IDOC, and it killed 13 as of Jan. 13.
Stateville Correctional Center has one of the largest outbreaks in the entire IDOC system, according to the same report. The facility is home to 301 of the confirmed cases and 12 of the 13 deaths. Inmates across the country are at high risk of getting COVID-19 due to the dense nature of prisons and close proximity to others.
Nearly the entire IDOC system is in solitary confinement. Facilities are in lockdown to prevent spread of the virus, visitors have been prohibited for the past 10 months, staff are monitored for symptoms, and inmates spend 22 or more hours in their cells daily.
“There is a lot of literature about how horrific solitary confinement is, how it results in mental illness or symptoms and illness in people who are not mentally ill,” said Jennifer Soble, executive director of the Illinois Prison Project. “Then, you take somebody who is mentally ill and the world just explodes [inside solitary confinement]. It’s really horrific.”
Inmates’ mental health declines in COVID-induced medical isolation
Isolation is only one struggle inmates face. Nearly one year after the first case of COVID-19, routine mental health services remain halted or altered to comply with social distancing guidelines, said Alan Mills, the executive director of the UPLC.
Correctional facilities across the country work to balance public safety and mental health. In Illinois, a federal court mandate to improve mental health facilities, coupled with the Stateville outbreak, is pressuring IDOC prison operators to strike this balance.
The Bureau of Prisons, the federal agency that oversees IDOC, released a statement to modified prison operations in March 2020 to maximize social distancing and limit group gatherings.
“What we are seeing is that there are people who are being put in what is being called medical isolation. But what is in fact being experienced by them as solitary confinement,” said Sarah Grady, attorney and director of the Prisoners’ Rights Project at civil rights firm Loevy & Loevy.
When an individual is in solitary confinement, there are mental health standards that need to be maintained: routine checks on inmates, individual treatment plans for mental health care and mandatory out-of-cell time.
An annual May 2019 court-mandated report about mental health care in IDOC facilities shows that the department was not substantially complying with some standards because of staff limitations and a significant backlog of patients. Since inmates are facing 22 hours or more in their cells, Grady and others fear the situation is only deteriorating.
“It’s not just about keeping people safe or even keeping them stable. But when we put people in isolation, especially people with mental illness, we’re actually causing harm — physical and mental harm. And some of that harm is going to be very hard to heal from,” Antholt said.
The UPLC is negotiating with IDOC to address mental health care during the pandemic. The organization is advocating for services that provide inmates with proper mental health care and social interactions.
In March, IDOC reduced the size of group therapy — the main form of mental health counseling in prisons — in order to promote physical distance. As of January, 2021, prisoners has received virtually no group therapy, according to Mills. IDOC curtailed one-on-one therapy , and consultations must now occur at the cell front with a guard present. Telephone-health has been implemented for only some psychiatry appointments, Mills said.
IDOC vastly reduced yard time as well. Inmates’ confinement to cells with no outside time could be deadly to mental health, Mills said. Social interaction is a critical element to a healthy mindset, so isolation can be detrimental. Only a limited number of individuals are allowed in the yard during existing outdoor time
“It’s not enough, but at least it’s more than locking people up and never letting them leave their cells and talk to anybody, which is where we started,” Mills said.
IDOC did not respond to email requests for interview about the present conditions in its prisons.
Prisons are de facto psychiatric hospitals
Inmates in the U.S. prison system have a higher rate of serious psychological distress and mental health disorders than the general population, according to statistics from the Bureau of Justice.
“If people are not treated on the outside, they do things as a result of the mental illness, which constitutes criminal activity,” Mills said. “Rather than treating the mental illness, our default in society is to punish people for that. Therefore, the percentage of people in prisons that have a mental illness is significantly higher than it is on the outside.”
A Bureau of Justice study about mental health problems in prisons — released in 2017 with data from the 2011-2012 fiscal year — shows that 14% of state and federal inmates and 26% of jail inmates meet the threshold for serious psychological distress. Only 5% of the general population meets the same criteria, the study said.
Another 37% of all prisoners had been diagnosed by a medical professional with a mental health disorder, such as depression, bipolar disorder, or post-traumatic stress disorder.
Illinois prisons are almost equal to the national average, according to a 2020 report by IDOC; about 35% of inmates, or 13,000 individuals, in adult facilities are on the mental health caseload. According to the report, Stateville houses about 900 of inmates with mental health disorders — which accounts for about 80% of its entire population.
“Prisons are unavoidably toxic to mental health,” Mills said. “The basic premise of prisons is that you’re locked away from friends, family support systems, you’re constantly subjected to arbitrary enforcement of minutiae rules, and you could be punished at any time by being put into solitary.”
Inmates receive cookie-cutter care
An inmate suffering from hallucinations, another with depression and a third grieving the death of a loved one could all be in the same group therapy at an Illinois facility. Mental health care is uniform for all inmates, said Antholt.
“The thing we hear the most [from inmates] is just like a lack of individualized treatment,” Antholt said. “People are having issues that are specific to themselves … but the treatment they got is kind of cookie cutter.”
Rasho v. Jeffreys, a lawsuit filed in 2008 against IDOC for inadequate mental health care, set the precedent for mental health care guidelines across the state’s prisons. The suit was brought by the UPLC, Equip for Equality and other advocacy organizations in Chicago.
Since a settlement was reached in 2016, IDOC has been responsible for adhering to new mental health care guidelines for inmates. However, in 2017, a federal court-appointed monitor found that IDOC was failing to comply, with psychiatric care that was “grossly insufficient” and “extremely poor” in quality.
“The overwhelming issue with mental health treatment in Illinois prisons is the lack of the necessary staff to do the work that needs to be done to provide treatment. And that’s been a problem for many years. It’s the subject of the court’s order,” Antholt said.
Findings from the 2019 yearly monitoring report show some improvements in care, such as mental health screenings, psychotropic medications and group therapy. Monitoring and reporting on mental health care in prisons during the pandemic has been extremely difficult due to the no visitors policy and lack of communication.
These areas were found to still need improvement:
- Mental health evaluations and referrals
- Treatment plans and continuing review
- Additional mental health staff
- Medication practices
- Segregation practices
- Use of force and verbal abuse
- Discipline of seriously mentally ill offenders
Recently, Illinois filed a force majeure clause, a provision that relieves the state from performing its contractual duties. Due to the circumstances of the pandemic, IDOC does not have to comply with the terms of the settlement to improve mental health care during the pandemic.
The race to vaccinate inmates
While inmates suffer from reduced mental health services, they are also waiting for COVID-19 vaccinations. IDOC and Governor J.B. Pritzker have agreed that inmates will be vaccinated in group 1B, which means after health care workers and residents of long-term care facilities. Group 1B will begin vaccinations Jan. 25, according to Illinois Department of Public Health. However, a time frame for when inmates will be vaccinated has not been provided yet, Mills said. As of Jan. 20, the state had vaccinated a little over half a million people, according to IDPH.
“I’m a little bit filled with dread about the hole we’re getting into each day that this goes on,” Antholt said about the future of IDOC during the pandemic.
Grady predicts that the system will be “financially strapped” after the pandemic, which could have an effect on the improvement of mental health care services promised under the Rasho settlement.
Both Grady and Antholt hope that the correctional system will devise innovative solutions to address potential problems.
“On the positive side, I hope one long term effect is that we realize that we can significantly depopulate our jails and prisons, without adverse consequences to public safety,” Grady said.
Since March 2020, IDOC has halted admissions into county jails and has been releasing some prisoners on a case-to-case basis.