Claims of Inadequate Mental Health Treatment and Prolonged Solitary Confinement

Facts of the Case

In February 2007, Mr. Johnson was incarcerated in the Illinois state penitentiary system. During his nine-year incarceration, he exhibited frequent conduct problems and a failure to comply with prison rules, which resulted in his transfer between multiple facilities. Because of his many conduct violations, he received extended periods of disciplinary segregation, more commonly known as solitary confinement. In 2013, he was transferred to Pontiac Correctional Center (PCC), a maximum-security prison. While at PCC, he accumulated additional conduct violations resulting in a total of over three years served in disciplinary segregation. He was further penalized with yard privilege restrictions for poor conduct, which included throwing feces, fighting, and assault.

Mr. Johnson had a history of serious mental health conditions that predated his incarceration. When transferred to PCC, he was evaluated for mental health concerns by medical staff. They determined a treatment plan and evaluated him on a monthly basis. He was diagnosed with a number of mood and anxiety disorders and antisocial personality disorder, and treated with numerous mood stabilizing, antipsychotic, and antidepressant medications, though he never achieved stability. While in disciplinary segregation, he was placed on crisis watch on nine occasions when reporting suicidal or homicidal thoughts. He also reported auditory hallucinations, he excoriated his flesh, and exhibited bizarre behaviors, including smearing himself with feces. During the three years, he frequently requested a transfer to a mental health unit, though his treating psychiatrists determined this was “not warranted” (Johnson, p 901). In August 2016, he was transferred to Joliet Treatment Center after he was evaluated to have “achieved a measure of compliance with his treatment plan,” two months after filing the lawsuit (Johnson, p 901).

In June 2016, Mr. Johnson filed a pro se complaint under 42 U.S.C. § 1983 (2012), alleging that the inadequate mental health treatment and inhumane conditions of confinement were a violation of his Eighth Amendment rights. This matter was brought before the U.S. District Court for the Central District of Illinois, Peoria Division. In summary judgment, Judge Bruce found that Mr. Johnson's Eighth Amendment rights were not violated because he did not demonstrate that he suffered adverse health consequences from his time in segregation, his transgressions were assessed to be dangerous, and staff's actions did not constitute negligence. Mr. Johnson appealed, and the matter was brought before the U.S. Court of Appeals for the Seventh Circuit.

Ruling and Reasoning

In his appeal, Mr. Johnson was represented by counsel, and two amicus briefs were submitted. Counsel expanded his case on appeal and expounded on the topics of the constitutionality of solitary confinement in general and the damages Mr. Johnson endured for his prolonged detention. Citing Soo Line R.R. Co. v. Consolidated Rail Corp., 965 F.3d 596 (7th Cir. 2020), the court waived the latter topic as it was never raised in the district court. The court upheld the district court's decision by addressing the three original claims brought forth by Mr. Johnson (the loss of yard privileges, certain cell conditions, and the adequacy of his mental health treatment).

Concerning the cell conditions, the court articulated the deliberate indifference liability standard, contending that Mr. Johnson must show that prison officials knowingly ignored an undue risk to his health or safety. The court stated that Mr. Johnson provided insufficient evidence of deprivation of a single human need and therefore did not meet the standard to prove cruel and unusual punishment.

Regarding the loss of yard privileges, the court primarily referred to Pearson v. Ramos, 237 F.3d 881 (7th Cir. 2001). In this case, they held that 90 days of no yard privileges as punishment for misconduct or implementing multiple successive 90-day sanctions for nontrivial behavior did not qualify as cruel and unusual punishment. The court conceded that his time in segregation was much longer than that experienced in Pearson, though the level of misconduct exhibited by Mr. Johnson was not trivial, and he did not argue that it was trivial.

Last, the court addressed the concern of inadequate mental health treatment. The court explained that Mr. Johnson needed to demonstrate that clinicians had known of and deliberately disregarded his mental health needs, in accordance with Howell v. Wexford Health Sources, Inc., 987 F.3d 647 (7th Cir. 2021), or to show that their judgment was a “substantial departure from accepted professional judgment” (Johnson, p 905, citing Eagan v. Dempsey, 987 F.3d 667 (7th Cir. 2021)). The court agreed that it was clear Mr. Johnson experienced mental illness, although it determined that the evidence he provided was insufficient to substantiate a departure from accepted professional standards or deliberate negligence.

Dissent

Judge Rovner entered a dissenting opinion. She joined the majority in part, and dissented in part, focusing her dissent on the constitutionality of the yard restrictions.

First, she asserted that exercise is an essential human need, as stated in Delaney v. DeTella, 256 F.3d 679 (7th Cir. 2001), and Davenport v. DeRobertis, 844 F.2d 1310 (7th Cir. 1988). She also cited Pearson, stating that, while solitary confinement can negatively affect one's health and mental well-being, it could also constitute cruel and unusual punishment if one is simultaneously deprived of a basic human need, like exercise.

Second, Judge Rovner said that a complete deprivation of basic human need would be warranted only to protect the person's safety, or the safety of others, or to prevent a serious security threat. She cited Bass, Martin, and LeMaire, which justified use of yard restrictions, based on inmates' past escapes and danger to others (Bass v. Perrin, 170 F.3d 1312 (11th Cir. 1999); Martin v. Tyson, 845 F.2d 1451 (7th Cir. 1988); LeMaire v. Maass, 12 F.3d 1444 (9th Cir. 1993)).

Judge Rovner detailed Mr. Johnson's resultant behavior changes and asserted that his deteriorating mental state perpetuated further conduct violations, which she argued was worsened by a lack of exercise.