- Eighth Amendment
- cruel and unusual punishment
- serious mental illness
- solitary confinement
- deliberate indifference
Failure to Provide Mental Health Treatment and Inappropriate Use of Solitary Confinement for Seriously Mentally Ill Prisoners Violates Eighth Amendment
In Disability Rights Montana, Inc. v. Batista, 93 F.3d 1090 (9th Cir. 2019), the U.S. Court of Appeals for the Ninth Circuit reversed the district court's dismissal of a 42 U.S.C. § 1983 claim by Disability Rights Montana, Inc., that alleged the Montana Department of Corrections defendants violated the Eighth Amendment rights of all prisoners with serious mental illness incarcerated at the Montana State Prison. The court remanded the case for further proceedings and reassigned the case to a different district court judge.
Facts of the Case
Disability Rights Montana, Inc. (DRM), is a nonprofit organization authorized by the Protection and Advocacy for Individuals with Mental Illness Act to advocate for and protect the rights of mentally ill individuals in Montana. DRM filed a 42 U.S.C. § 1983 suit in the U.S. District Court for the District of Montana alleging that Mike Batista, the director of the Montana Department of Corrections, and Leroy Kirkegard, the warden of the Montana State Prison (known collectively as the Department of Corrections defendants) violated the Eighth Amendment rights of all inmates with serious mental illness who are incarcerated at the Montana State Prison. DRM alleged that policies and practices in place at the prison amounted to cruel and unusual punishment, and that the Department of Corrections defendants were aware of and deliberately indifferent to these practices.
DRM outlined nine specific policies and practices that they alleged violated prisoners' rights. These policies primarily involved the excessive and inappropriate use of solitary confinement with prisoners with serious mental illness, failure to properly diagnose and treat prisoners with serious mental illness, failure to consider prisoners' mental illness when deciding their housing and custody levels, and failure to review and evaluate prisoners' mental health care treatment plans adequately to identify and fix potential problems.
DRM supported their claim that the use of solitary confinement in seriously mentally ill inmates is cruel and unusual by citing statements from two national organizations and an amicus brief that inmates with serious mental illness should not be subjected to prolonged periods of extreme isolation. DRM went on to detail how placing a prisoner in solitary confinement limits their access to mental health treatment. They also alleged that the defendants failed to respond appropriately to reports of suicidal ideation from prisoners, which resulted in an increased risk of suicide among prisoners with serious mental illness.
To illustrate how the above policies and practices directly affected inmates, DRM described the care of nine prisoners who had at one point received a diagnosis of a serious mental illness. They alleged that these prisoners, all of whom spent time in various forms of solitary confinement, received inadequate mental health care. This led to a worsening of their mental illness, as well as an increase in self-harm. Three of the nine prisoners died from suicide while incarcerated.
Finally, DRM alleged that the Department of Corrections defendants were aware of the constitutionally suspect practices as they were involved in at least two previous lawsuits related to the prison's provision of mental health care to prisoners and the inappropriate use of solitary confinement with prisoners with serious mental illness. They also noted that prisoners frequently submitted requests for and grievances about their mental health care, and that DRM themselves sent a letter to Mr. Batista detailing many of these above complaints. Despite being aware of the concerns, the Department of Corrections defendants failed to remedy their practices.
In response to the suit, the Department of Corrections defendants filed a motion to dismiss for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6). The district court granted the motion to dismiss, and DRM appealed.
Ruling and Reasoning
The U.S. Court of Appeals for the Ninth Circuit reversed the district court's ruling and remanded the case to a different district court judge for further proceedings. The court of appeals noted that there is a well-established U.S. Supreme Court precedent that applies the Eighth Amendment's prohibition against cruel and unusual punishment to prisoners' right to receive mental health care that meets “minimum constitutional requirements.” In Brown v. Plata, 563 U.S. 493 (2011), the Court held that prisoners' Eighth Amendment rights are violated when they are exposed to a substantial risk of serious harm and prison officials are deliberately indifferent to this risk.
The court of appeals further relied on a two-prong test for cruel and unusual punishment described in Farmer v. Brennan, 511 U.S. 825 (1994). Under the first, objective prong, the plaintiff must show that prison conditions posed a “substantial risk of serious harm” to inmates. The court of appeals held that DRM's complaint contained sufficient factual allegations and, if true, that the policies and procedures of the prison may have posed a substantial risk of serious harm to inmates with serious mental illness. Specifically, DRM named nine system-wide practices that they allege were constitutionally deficient. They also described in detail the treatment of nine prisoners who were alleged to have serious mental illness. DRM's allegations of a substantial risk of serious harm were further supported by common sense and expert evidence presented in an amicus brief.
Next, the court of appeals discussed the second, subjective prong. Under the subjective prong, the plaintiff must show that the defendants were deliberately indifferent to the risk of harm. To demonstrate deliberate indifference, the plaintiff must show that the defendants were “aware of the facts from which the inference could be drawn that a substantial risk of serious harm exists” (Farmer, p 837), that the defendants drew the inference of risk, and that they were indifferent to the risk by failing to act. The court of appeals held that DRM satisfied this subjective prong by detailing the numerous complaints that the Department of Corrections defendants had received about harmful prison practices and deficient mental health treatment. This included two lawsuits against the prison, multiple grievances from prisoners, and letters to the Department of Corrections defendants from DRM itself. Despite being aware of the risks to prisoners, the Department of Corrections defendants failed to act and chose to maintain the damaging policies.
On remand, the court assigned the case to a different district court judge to “preserve the appearance of justice” (Batista, p 1100). The court concluded that the first judge acted without ill will but had confused the case with another case.
Discussion
This case outlines several matters that are relevant to mental health providers, particularly those working in a correctional setting. Citing Brown, the court of appeals stated that there are “clear connections between mental health treatment and the dignity and welfare of prisoners” (Brown, p 501). While this case focused on the harm that placing prisoners with serious mental illness in solitary confinement can cause, there were also allegations about inadequate mental health treatment. In particular, the plaintiffs described accounts of prisoners who at some point had a serious mental illness diagnosis. These prisoners were allegedly subjected to various forms of solitary confinement, often for punishment or control of behaviors that may be attributed to symptoms of a mental illness. Additionally, it was noted that prisoners rarely saw mental health providers while in solitary confinement, if at all. Most commonly they would meet with a mental health technician for a few minutes once a week at the door of their cell, without any accommodations for privacy.
There were allegations that mental health providers, including the prison psychiatrist, failed to diagnose serious mental illness in prisoners or to provide them with medications for their reported mental illness. These allegations were based on reports that prisoners who at one time had a diagnosis of a serious mental illness and were treated with psychotropic medications were later determined to not have a major mental illness or to be malingering their symptoms and were subsequently taken off of their psychotropic medications. Another common complaint was mental health providers' failures to respond to threats of suicide from prisoners. It was noted in the original suit that mental health providers often attributed threats of suicide, including self-injurious behaviors, to manipulation on the part of the prisoner. At times the staff responded to these threats by placing the prisoner in solitary confinement. The suit alleged that this dismissal of self-harm and suicidal thoughts led to an increase in deaths from suicide in prisoners with serious mental illness. Another main complaint was the lack of routine review of prisoners' mental health care treatment plans, leading to an inability to identify major concerns or inadequacies.
While this case did not address the actual factual nature of the specific allegations themselves, it is relevant that the claims about mental health practices, taken as factual for the purpose of this appeal, were found to be sufficiently plausible to constitute cruel and unusual punishment on the part of the prison administration. This case highlights potential caveats that psychiatrists should be aware of when working in the correctional system, particularly when diagnosing and treating mental illness and working with the correctional staff to determine how a prisoner's mental illness should affect their housing and custody status.
- © 2021 American Academy of Psychiatry and the Law