SPRINGFIELD — At 19, Ashoor Rasho had already served a prison term for robbery and was heading back for eight years for a Cook County burglary.
Recently, he marked his 40th birthday in the state's penal system, most of it locked up in segregation, where he is serving 26 more years for six assaults on Department of Corrections staff. Since 2006, Rasho has been in the segregation unit at Pontiac Correctional Center.
Rasho is one of 4,662 Illinois inmates diagnosed as severely mentally ill. The mental health care he and nearly 11,000 other prisoners are getting is the basis of a 2007 federal lawsuit that looks to overhaul behavioral health services in the massive prison network that houses about 48,000 inmates in facilities designed to hold 32,000.
In 2011, both sides in the lawsuit agreed to an assessment of the prison mental health system. Fred Cohen, a New York law professor and national expert on corrections, led a team that spent nine months visiting eight of the state's 27 lock-ups, studying case files and interviewing staff and inmates.
The result was a 180-page report that remains confidential based on an agreement by the state and attorneys for Rasho that its contents be sealed and not be used in the litigation.
Cohen does not agree with the order keeping his report out of public view, but he's abided by the mandate. But in an interview with The Pantagraph, Cohen described some of the more compelling details of what he saw during the tours.
"What I saw, beginning at reception, was about one of the worst prison mental health systems I ever saw. The system breaks down at the front door and never recovers," he said.
And, the lack of a resolution to the lawsuit eight years after its filing does not speak well for Illinois, once considered a leader in prison mental health care, according to Cohen.
"We're not just talking about feelings here. You have people who are dying in there," he said, adding the numbers and housing conditions of inmates held in solitary confinement was shocking.
Rasho, whose history of hallucinations, suicide attempts and self-mutilation is well-documented, was one of the inmates Cohen met. The inmate's condition became more dire in solitary, said Cohen.
"He ate part of his own shoulder. I will never forget that," said Cohen, professor emeritus in the Graduate School of Criminal Justice at the State University of New Work at Albany.
Outdated physical facilities, mental health staff shortages and lack of access to hospital-level care reportedly are the main criticisms in the Cohen report.
At Menard Correctional Center, built in southern Illinois in the 1850s, Cohen talked with two seriously mentally ill inmates — both weighing about 300 pounds, who shared a 6-by-9 foot cell. At Stateville near Joliet, Cohen's team dodged raindrops inside the facility as staff tried to find a dry spot for him to meet with prisoners.
The need is obvious, he said, for more and better qualified staff to be hired by Wexford Health Sources, the Pennsylvania-based firm awarded a 10-year, $1.3 billion contract to provide health care and mental health services.
A supervisor who asked Cohen to explain what his team meant by a treatment plan — a term understood by entry-level professionals — defined the problem, he said.
Before settlement talks in the lawsuit broke off in July, in part because of the ongoing state budget crisis, the state and inmates' lawyers had negotiated a proposed settlement that called for about $100 million for four new treatment units and more than 600 new clinical and security staff.
The state has moved forward with parts of the agreement, hiring staff and beginning the $17 million renovation of a former Joliet youth home into a treatment facility.
"Over the past few years, the Illinois Department of Corrections has implemented significant initiatives to enhance the delivery of mental health services statewide, including changes in policy and procedures, hiring of additional staffing and creating a level of care system that enhances special/residential treatment services for all offenders" within IDOC, agency spokeswoman Nicole Wilson said recently.
She added the state's budget impasse has not lessened the state's commitment to efforts "to provide quality treatment and a standardized approach to mental health services through research, innovation and consultation."
Lawyers for the state argue IDOC faces special challenges when it comes to hiring staff qualified to work in prison mental health programs. Competition for higher-paying jobs in the private sector is a perennial issue, lawyers say.
Still, the state reported in a recent court filing, progress has been made to fill identified vacancies.
But left unresolved after eight years of litigation is the issue of hospital care for the most severely mentally ill inmates. The need for such care was confirmed in an April report from IDOC to Dr. Raymond Patterson, the most recent federal monitor for the lawsuit.
The lack of hospital facilities is the focus of a motion filed in July by inmates asking that a third party be named to arrange inpatient care.
Inmates "have exhausted all less extreme measures" to secure necessary care, said the motion, and appointment of a receiver "is the only remedy with a chance to remedy the grave and immediate threat" to the prisoners.
In support of the request, inmates' lawyers attached state data showing that two seriously mentally ill inmates died in June and two others, not categorized as severely impaired, committed suicide during the same month.
The state declined comment on the deaths.