A recent ruling against Indiana prisons is the latest in a wave of federal court judgments finding that treatment of the mentally ill behind bars – in particular, subjecting those inmates to prolonged isolation – is unconstitutionally cruel and unusual.

Judge Tanya Walton Pratt of the District Court for the Southern District of Indiana on Dec. 31 ruled that a lack of basic treatment for mentally ill Indiana Department of Correction inmates held in isolation violates the U.S. Constitution’s Eighth Amendment. She concluded that, in accord with Brown v. Plata, 131 S. Ct. 1910, 1928 (2011), “[a] prison that deprives prisoners of . . . adequate medical care . . . is incompatible with the concept of human dignity.”

“Mentally ill prisoners within the IDOC segregation units are not receiving minimally adequate mental health care in terms of scope, intensity, and duration and the IDOC has been deliberately indifferent,” Walton Pratt wrote. “Based on the facts and law set forth in this Entry, therefore, it is the Court’s conclusion that the treatment of mentally ill prisoners housed in IDOC segregation units and the New Castle Psychiatric Unit, and the failure to provide adequate treatment for such prisoners, violates the Eighth Amendment’s proscription against the imposition of cruel and unusual punishment. The Plaintiffs have met their burden in that respect and are entitled to prevail.”

The case brought by the American Civil Liberties Union of Indiana asserted that about half of the 13 suicides at DOC over a recent five-year period were committed by mentally ill inmates held in isolation – a population that accounts for just 6 percent of prisoners.

“Now, unfortunately, the state is in the position of being told what to do” as a result of the court order, said Lindsay Hayes, project director for the Mansfield, Mass.-based National Center on Institutions and Alternatives, who monitored the Indiana case and has advised states facing similar litigation.

California, Massachusetts, New York, Pennsylvania and Wisconsin are among states in which federal courts have intervened after mentally ill inmates sued as a class over isolation in prison, Hayes said. NCIA has been involved in an advisory or advocacy role in several of those cases.

“The bottom line is, people with serious mental illness housed in isolation for a prolonged period of time, their mental illness only debilitates further, and there’s a higher incident of serious suicide attempts,” he said.

According to a 2006 National Institute of Corrections study, 41.1 percent of inmates nationwide in long-term detention were held in isolation or segregation at the time of their deaths.

The DOC has yet to determine whether it will appeal Walton Pratt’s ruling, in which the judge ordered a conference within 45 days “for the parties to discuss and establish the appropriate development of a remedy.” The case is Indiana Protection and Advocacy Services Commission on behalf of its clients and constituents v. Commissioner, Indiana Department of Correction, 1:08-CV-01317.

“We do what we think is all we can do” to prevent suicides, DOC spokesman Doug Garrison said. “We do have mechanisms in place to monitor those who have exhibited suicidal behavior.” He said it was important to note that mentally ill inmates held in isolation usually are “there for their behavior.” A common reason for placing inmates in isolation is violent behavior directed toward staff, he said.

DOC also is challenged by staff limitations, despite institutional safeguards to prevent suicides. “When you have to react to behavior that’s like that, sometimes it’s difficult in the best circumstance to frustrate someone who’s intent on ending their life,” Garrison said.

ACLU of Indiana Legal Director Ken Falk said during a news conference Jan. 2 that plaintiffs were sympathetic to the challenges DOC staff faces due to budget constraints, and both sides agree the problem is a societal one.

“These people are going to be released,” Falk said, estimating that 90 percent or more of the class of inmates covered by the ruling would be freed eventually. “The question you have to ask yourself as a Hoosier is, do you want someone released who is acutely psychotic?”

“There are a lot of good people at DOC and they like to provide more services than they can,” said Fran Watson, ACLU of Indiana vice president of litigation and a professor at the Indiana University Robert H. McKinney School of Law in Indianapolis.

Watson said she expects the state to appeal, but she said, “I also think what’s likely to happen is (the DOC will) take their obligation seriously under the federal court order.

“That said, it’s going to come down to resources,” she said.

Similar cases in New York and Massachusetts, for instance, have resulted in outcomes that required a commitment of resources, Hayes said. He said prison administrators in New York “agreed they need to do a better job of programming for seriously mentally ill,” and settled a federal case.

There, an agreement provided frameworks to identify the seriously mentally ill and to give inmates a level of due process that involves mental health staff when an inmate’s behavior rises to a level that isolation might be warranted.

New York and Massachusetts also have built alternative housing units for the seriously mentally ill or refurbished other facilities for that purpose, Hayes said. The units offer appropriate programming and require a much higher staff-to-inmate ratio, he said. “They’re used as an alternative to (inmate) placement into isolation.”

Hayes said such results, in part, represent an acknowledgement that there is a need to tailor specialized institutional care for the seriously mentally ill as had been common decades ago.

He said DOC can use the ruling to persuade lawmakers to fund appropriate care.

More than 1,600 segregation beds are spread among 14 correctional facilities around the state, including the psychiatric unit at New Castle. According to the ACLU of Indiana, about 450 mentally ill prisoners are being held in isolation, but the ruling will affect hundreds, if not thousands, of inmates across the state.

“It’s one of those problems society puts behind closed doors and you don’t want to look at it because it’s tough,” Watson said.•