The Illinois Department of Corrections continues to flounder in its efforts to care for inmates with mental illness, according to a new report authored by Dr. Pablo Stewart, a psychiatrist and court-appointed monitor on a 2016 settlement agreement on a class-action lawsuit.
The report says Illinois prisons have made improvements in some areas. For example, inmates are now screened for mental illness upon arrival, and prisons have implemented training protocols for all mental health staff.
But staffing levels remain “grossly inadequate” to provide adequate mental health treatment to all inmates who need it. The lack of staff "is the main contributing factor to the poor quality of the mental heath care provided to the mentally ill offenders within IDOC,” Dr. Stewart wrote.
"I have even encountered mentally ill offenders with newly missing teeth and physical exam evidence of recent trauma to their faces. If I had encountered these types of injuries with my own patients, I would be obligated to report them to the police.”Dr. Pablo Stewart, court monitor's report
Court monitor: Pontiac prison staff assault mentally ill inmates
The report singles out Pontiac Correctional Center for having a “culture of abuse and retaliation” against mentally ill inmates.
The monitoring team found both an “informal use of force and retaliation system” and “evidence of intimidation of the mental health staff at Pontiac by the custody staff”—problems that have persisted since the lawsuit was settled 30 months ago.
“It is my opinion as Monitor that the Department has not done anything to effectively address this ongoing problem at Pontiac,” wrote Dr. Stewart, adding that he is “absolutely convinced” that staff are physically assaulting mentally ill inmates there.
Dr. Stewart said in the report that his assessment is based on hundreds of corroborating interviews with both inmates and mental health staff. Those accounts are further corroborated by inmates' medical records, hundreds of filings to the Court regarding alleged incidents of physical abuse, and Dr. Stewart’s own observation of injuries to inmates’ heads and faces.
“I have even encountered mentally ill offenders with newly missing teeth and physical exam evidence of recent trauma to their faces,” Dr. Stewart wrote. “If I had encountered these types of injuries with my own patients, I would be obligated to report them to the police.”
Dr. Stewart also described an “elaborate system of retaliation perpetrated by the custody staff against the mentally ill offenders at Pontiac,” which include withholding food, visits, phone calls, restricting them from participating in required activities, setting up inmates for assault by labeling them “snitches,” providing them the means (staples, paper clips, other sharp objects) to perform self-injurious behaviors, and placing incriminating evidence in their cells, including weapons or other forms of contraband.
The reports states IDOC officials' response has been: “the Department takes allegations of abuse seriously.”
In response to a request for comment on the new court monitor report and allegations of abuse at Pontiac, IDOC spokesperson Lindsey Hess wrote via email: "The Department is reviewing the report. Anytime the monitor makes the Department aware of allegations of excessive force, those allegations are taken seriously and investigated."
"We take swift action to refer (any reports) we get to the state police or the state's attorney. We will not tolerate that."John Baldwin, IDOC Director
In an interview last month, Director John Baldwin said he would "be surprised" if mistreatment of mentally ill inmates in the form of physical abuse or retaliation were happening today.
"And whenever we get notification about something like that, we take swift action to investigate," Baldwin said. "We take swift action to refer (any reports) we get to the state police or the state's attorney. We will not tolerate that."
But in the new report, Dr. Stewart said he has been relaying information about abuse of mentally ill inmates at Pontiac "to parties informally and in writing throughout my tenure as Monitor,” Dr. Stewart wrote. “Nothing has come of my reports. In fact, the staff at Pontiac are more strident in their actions and dealings with me since I have been formally reporting their abuse.”
According to the report, Dr. Stewart will be seeking outside legal consultation, at his own expense, “to determine what professional and ethical obligations I have to report this abuse to outside police agencies."
"As Monitor, I do not make these allegations frivolously," he wrote.
Inadequate treatment has ‘ripple effects’ throughout IDOC
Inadequate treatment caused primarily by IDOC’s issues with understaffing have “ripple effects” throughout the agency, according to the report, contributing to “self-injurious behaviors, staff assaults, use of force incidents, administration of involuntary medication, restraint use,” as well as excessively long stays in “Crisis Watch,” where inmates do not receive adequate emergency care.
"If you look at the misconduct as a symptom of an illness, the first reaction should be, ‘How do we up the amount of treatment that somebody is getting?’ Because clearly they’re not getting either enough or the right kind of treatment."Alan Mills, attorney, Uptown People's Law Center
Attorney Alan Mills, executive director of the Uptown People's Law Center, represents Illinois inmates with mental illness in the class-action lawsuit that was initially filed in 2007.
He said when inmates with mental illness “act out” or have behavior issues related to lack of mental health treatment, it’s too often considered a “disciplinary problem” and may result in the use of force or the removal of certain privileges, including participation in therapy or out-of-cell activities.
But “if you look at the misconduct as a symptom of an illness, the first reaction should be, ‘How do we up the amount of treatment that somebody is getting?’ Because clearly they’re not getting either enough or the right kind of treatment,” Mills said, likening the behavior to withholding aspirin from a person who has a fever until their temperature goes away.
Dr. Stewart echoed this notion in his report by writing: “If a mentally ill offender, due to the mental illness, has a behavioral problem that results in a disciplinary infraction, this offender should receive a greater amount of mental health care and not be placed in segregation.”
The report notes that inmates with mental illness who get placed in segregation or “restrictive housing” do continue to receive treatment according to the treatment plan they had before receiving this disciplinary infraction.
However, the treatment most non-segregation offenders receive is limited to one 15- to 30-minute individual session per month “and timely medication followup if they are lucky.”
And at Pontiac, Dr. Stewart reports severe staffing shortages prevent inmates in segregation from receiving individual sessions at all.
The report states IDOC prisons are currently able to provide only a small number of seriously mentally ill inmates with the care they require, at facilities like the Joliet Treatment Center, which was housing 106 inmates as of November 24, 2018.
“They simply have not hired enough people yet in order to do the job. Therefore it’s not fair to blame the people who are there,” Mills said. “They’re being asked to do the impossible. They’re being asked to do two people’s jobs.”
In an interview last month, Director Baldwin said the agency is working to recruit on college campuses for corrections jobs, bring in medical residents from the University of Illinois at Chicago and Southern Illinois University to provide treatment, and is making “every effort” to comply with the terms of the settlement.
"I can understand the court’s frustration with us... This case was hanging on for a long time, and it was only in the last three-and-a-half years that Illinois decided we needed a response."John Baldwin, IDOC Director
IDOC has created new facilities for mentally ill inmates, and has also trained and hired more mental health staff.
Late October, a federal judge issued a permanent injunction in the IDOC mental health lawsuit, which is now 11 years old, saying the agency has been “deliberately indifferent” to inmates’ medical needs.
Baldwin said that assessment is not fair.
“But I can understand the court’s frustration with us, as well," he said. "This case was hanging on for a long time, and it was only in the last three-and-a-half years that Illinois decided we needed a response.”
Because of that, Baldwin said, there’s a lot of ground to make up.
Shortcomings persist with regard to segregation, backlogs & crisis beds
Among the areas of compliance highlighted in the report, the monitoring teams notes that IDOC has formed review committees—comprised of attorneys, security professionals and mental health staff—to recommend reducing or eliminating mentally ill inmates’ remaining time in segregation, in compliance with the lawsuit settlement.
IDOC facilities also appear to be compliant with the requirement that prison staff keep progress notes following contact with seriously mentally ill inmates and consult with mental health staff regarding housing recommendations for inmates transitioning out of segregation.
Despite progress in a few areas, IDOC facilities remain “very far from meeting its responsibilities regarding providing mental health care to offenders in segregation” and is “clinging to outdated custody notions regarding mentally ill offenders and segregation,” according to the report.
The monitoring team also found inmates are not consistently evaluated within 48 hours of being placed in segregation or provided with an update of their treatment plan. Neither are they receiving the required minimum hours of structured and unstructured out-of-cell time.
Some increased mental health staffing has led to a decrease in the backlog of psychiatric evaluations to 231, down from 500 at the time of the second annual report. The psychiatric appointment backlog stands at 734, as of November 16, 2018, down from 3,397 at the time of the second annual report, but up from 265 on October 26, 2018.
(T)he Department remains very far from meeting its responsibilities regarding providing mental health care to the offenders in segregation." Dr. Pablo Stewart, court monitor's report
Increased use of telepsychiatry may be cause for some of that backlog reduction. The monitoring team found telepsych services are being provided to inmates in the stable, outpatient population as recommended.
However, IDOC is also using telepsychiatry in a “non-evidence-based manner,” for all levels of care, including crisis, which Dr. Stewart notes in the report was never authorized. Furthermore, telepsychiatry providers are “not operating under a protocol or an Administrative Directive.”
There also remains an inadequate number of hospital beds for inmates. Twenty beds for male inmates and 20 for female inmates are required, but as of November 1, 2018, IDOC had only 10 beds for males and 12 for females, according to the report.
IDOC has also created “Crisis Intervention Teams” to intervene when an inmate shows a change in behavior signaling that they may endanger themselves or others if not treated immediately.
But the monitoring team found “very credible evidence” that custody staff “continue to insert themselves between the mentally ill offenders at the crisis intervention teams.”
The monitor wrote IDOC will not be rated in compliance on the requirement for crisis intervention until the agency can demonstrate these “potentially deadly” interferences are no longer occurring.
Read the full 105-page report from Dr. Pablo Stewart here
Source document contributed to DocumentCloud by Christine Herman (Christine Herman).
This story was produced by Side Effects Public Media, a news collaborative covering public health.
Christine Herman is a recipient of the 2018-2019 Rosalynn Carter Fellowships for Mental Health Journalism. Follow her on Twitter: @CTHerman