Nearly 44 percent of the people in Illinois Department of Corrections (IDOC) custody are on the mental health caseload. About a third of those individuals have a serious mental illness. In a system housing roughly 30,000 people, that means well over 4,000 prisoners with serious mental illness are in IDOC's care.
As of December 2024, only 67 of IDOC's 175 state-budgeted mental health provider positions were filled.
This is not a new problem. Illinois prisons have been the subject of federal mental health litigation since 2007. The Rasho v. Walker case resulted in a consent decree and court-appointed monitor. The monitor declared psychiatric care in IDOC prisons a "state of emergency." A court found IDOC in deliberate indifference to prisoners with mental illness. A special treatment center -- the Joliet Treatment Center -- was built and opened in 2017. Then, in July 2022, federal court oversight ended. According to attorneys who had spent 15 years litigating the case, "whatever semblance of mental health care that IDOC had started to implement fell off a cliff."
In April 2025, a new federal class action was filed: Hilliard v. Hughes. It alleges that IDOC now responds to mental illness with punishment rather than treatment -- including the use of pepper spray and mace-ball guns on prisoners in self-harm crises, at a rate nearly three times higher in 2025 than in 2023.
What Illinois Prisoners Are Entitled To
Under Estelle v. Gamble (1976) and the Eighth Amendment, IDOC is constitutionally required to provide adequate mental health care. Under the ADA and Rehabilitation Act (alleged in Hilliard v. Hughes), IDOC may not subject prisoners to isolative confinement that disparately impacts them due to their mental illness.
These rights exist on paper. Whether they are being met in practice is the central dispute in the active 2025 litigation.
Mental Health Screening at Intake
All IDOC prisoners are screened at intake, including at the Northern Reception Center (NRC) in Crest Hill, which is the primary point of entry for most prisoners entering the IDOC system. The intake screening identifies mental health needs and establishes an initial mental health classification.
The 2025 Hilliard lawsuit raises concerns about intake specifically: medication continuation upon entering prison has historically been a documented failure in IDOC, with psychiatric medications being interrupted during the intake period.
If your person has a psychiatric history, provide documentation at intake -- prior hospitalizations, diagnoses, and active medications. Given IDOC's history of medication interruption at intake (documented in the Rasho case and its successor), this documentation may be essential.
The Rasho v. Walker Litigation (2007-2022)
Rasho v. Walker (C.D. Ill., Case No. 1:07-cv-01298-MMM) was filed in 2007 by prisoner Ashoor Rasho and became a class action on behalf of all IDOC prisoners on the mental health caseload. Key events:
- 2007: Case filed.
- August 2015: Class certified.
- May 2016: Parties enter a settlement agreement with a court-appointed monitor.
- 2017: IDOC found in violation of settlement (insufficient psychiatrists, non-individualized treatment plans, medication without follow-ups, unstructured out-of-cell time, inadequate crisis care). Court declares IDOC's failure to provide care an "emergency situation."
- October 2017: Court grants preliminary injunction ordering IDOC to provide crisis care, medication management, and mental health evaluations.
- 2017: Joliet Treatment Center opens as part of the consent decree remedy.
- 2022: Court oversight ends and IDOC is released from monitoring.
- July 2022: Oversight ends. Attorneys note IDOC's care "fell off a cliff" after oversight ended.
The primary counsel for the class in Rasho were Equip for Equality, Uptown People's Law Center, Dentons, and Mayer Brown.
Hilliard v. Hughes (Filed April 2025)
Hilliard v. Hughes is the successor to the Rasho litigation. Filed in April 2025 by Uptown People's Law Center, Equip for Equality, and DLA Piper, it alleges:
Mental illness met with punishment. IDOC regularly responds to mental health crises and self-harm with punishment rather than treatment: segregation, restraints, pepper spray, and mace-ball guns. In 2025, IDOC used chemical agents an average of 37 times per month when responding to self-harm -- up from 16 times per month in 2023. Overall chemical agent use increased from 75 times per month (2023) to 137 times per month (2025).
Severe staffing shortage. As of December 2024, only 67 of 175 budgeted mental health provider positions were filled. Requests for care go unanswered. One plaintiff made six requests over a year to see a mental health professional and received no response. Another received no individual therapy since approximately 2020 despite a required treatment plan for PTSD.
One-size-fits-all approach. IDOC allegedly uses a uniform treatment plan regardless of diagnosis -- a person with grief and mild depression has the same plan as someone with severe schizophrenia.
Lockdowns as de facto solitary. Administrative lockdowns at IDOC facilities increased approximately 650% from 2019 to 2024, often due to staff shortages. These lockdowns function as de facto solitary confinement and disproportionately harm prisoners with mental illness.
ADA violations. The complaint alleges IDOC violates the ADA and Rehabilitation Act by subjecting prisoners with mental illness to isolative confinement that disproportionately impacts them.
Inadequate discharge planning. Mental health and disability needs are not considered in discharge care. Medication continuity is not adequately arranged at release.
The suit specifically notes that the Joliet Treatment Center -- opened in 2017 as a therapeutic facility under the Rasho consent decree -- is "no longer a place for recovery and stabilization" since leadership changed after oversight ended.
The Joliet Treatment Center
The Joliet Treatment Center (also referred to as the Joliet Treatment Facility) was built and opened in 2017 as part of IDOC's Rasho consent decree obligations, in partnership with the Illinois Department of Human Services (IDHS). It was designed to provide meaningful mental health treatment in a therapeutic setting for seriously mentally ill IDOC prisoners.
Under the Rasho oversight period, the Joliet Treatment Center was a flagship reform. Since oversight ended and leadership changed, the April 2025 Hilliard complaint describes it as having fallen from that purpose. Verify current conditions at publish.
HB 4828 (2025): Restrictive Housing Transparency
In March 2025, Illinois passed HB 4828 into law. The bill aims to enhance transparency, accountability, and public awareness regarding restrictive housing practices in IDOC -- requiring reporting on the use of restrictive housing and conditions. This is the Illinois legislation identified by the Unlock the Box Campaign as the relevant 2024-2025 reform.
HB 4828 does not address the Hilliard v. Hughes allegations directly, but it establishes a transparency and reporting framework that advocates can use to document and publicize conditions.
The Lockdown Problem
Administrative lockdowns at IDOC have increased approximately 650% from 2019 to 2024, according to a John Howard Association report. These lockdowns -- often driven by staff shortages -- restrict movement, recreation, programming, and mental health access. For prisoners with mental illness, extended lockdowns are effectively solitary confinement.
The Hilliard lawsuit specifically alleges that lockdown conditions, combined with the use of chemical agents in response to self-harm, have created a prison environment where mental illness is criminalized rather than treated.
Illinois's Partnership with IDHS
IDOC partners with the Illinois Department of Human Services (IDHS) for higher-level mental health services. The IDHS operates forensic psychiatric facilities through its Division of Mental Health, including the Elgin Mental Health Center (EMHC) -- the forensic hospital that serves people found not guilty by reason of insanity or unfit to stand trial. IDOC-IDHS collaboration created the Joliet Treatment Center. For prisoners who need inpatient psychiatric hospital care beyond what IDOC can provide in-house, IDHS is the referral pathway.
What Families Can Do
If your person is in IDOC custody and has a mental illness:
Provide psychiatric history at intake. Supply documentation of prior hospitalizations, diagnoses, and active medications. Medication interruption at intake is a documented historical IDOC failure. Getting prior records to the receiving facility can help maintain continuity.
Document every request for care. Given that the 2025 Hilliard complaint documents plaintiffs who made six requests over a year without response, documentation of requests -- with dates and methods -- is essential for any future grievance or legal action.
Know the staffing reality. With 67 of 175 budgeted positions filled, wait times and service gaps are structural. Document any denial of services with specific dates, times, and what was requested.
Know the lockdown impact. If your person is in a facility under a lockdown or modified movement order, ask specifically whether mental health contacts are still occurring during the lockdown. If programming and mental health services are suspended, document this.
Know the Joliet Treatment Center situation. If your person has been referred to or is at the Joliet Treatment Center, ask what the current therapeutic programming looks like. The 2025 Hilliard complaint describes it as no longer functioning as a therapeutic facility.
Know the discharge planning failure. The Hilliard complaint alleges that discharge planning does not adequately address mental health and medication continuity. If your person is approaching release, proactively ask IDOC what community mental health providers have been identified and whether medication has been arranged to bridge the gap to a first community appointment.
File a grievance. IDOC has an administrative grievance process. File formal grievances for: failure to respond to mental health requests, medication interruption at intake, failure to provide individualized treatment, lockdown conditions that prevent mental health access, and discharge planning failures.
Contact Equip for Equality. Equip for Equality (equipforequality.org) is the federally mandated Protection and Advocacy organization for Illinois and was co-counsel in both Rasho v. Walker and Hilliard v. Hughes. They accept complaints from prisoners and families.
Contact the Uptown People's Law Center. UPLC (uplcchicago.org) is co-counsel in both cases and accepts prisoner rights inquiries.
Contact the John Howard Association. JHA (thejha.org) is a prison watchdog organization that monitors Illinois prison conditions and may be able to document specific facility concerns.
Seek legal help. If your person has a serious mental illness and is not receiving care, is being subjected to chemical agents in self-harm crises, is in extended lockdown with no mental health contact, or has had psychiatric medication interrupted at intake, consult a prisoner rights attorney with experience in Illinois's federal courts (Central and Northern Districts of Illinois).
Frequently asked questions
How does Illinois screen prisoners for mental illness?
All IDOC prisoners are screened at intake, primarily at the Northern Reception Center (NRC) in Crest Hill for men. The screening identifies mental health needs and establishes a mental health classification. Medication continuation upon entering prison has been a documented failure in IDOC history -- psychiatric medications have been interrupted during the intake period. Provide documentation of psychiatric history, diagnoses, and active medications at intake to support medication continuity.
What percentage of Illinois prisoners have mental illness?
Nearly 44% of people in IDOC custody are on the mental health caseload -- meaning they have been identified as having mental health needs. About a third of those individuals have a serious mental illness. In a system of roughly 30,000 people, this means over 4,000 prisoners with serious mental illness are in IDOC custody.
What was the Rasho v. Walker lawsuit about?
Rasho v. Walker (C.D. Ill., filed 2007) was a class action challenging inadequate mental health care in IDOC. It settled in 2016 with a consent decree and court-appointed monitor. The monitor declared psychiatric care a "state of emergency." Courts found IDOC in deliberate indifference. The Joliet Treatment Center was built as part of the remedy. Oversight ended July 2022 -- and by 2025 attorneys described IDOC care as having "fell off a cliff" after oversight ended.
Why did Illinois mental health care collapse after 2022?
Court oversight of the Rasho consent decree ended in July 2022. Without the accountability structure of the consent decree and court monitor, IDOC did not maintain the improvements it had begun implementing. By 2024, only 67 of 175 budgeted mental health positions were filled, lockdowns had increased 650%, chemical agent use against prisoners in self-harm crises tripled, and requests for care were going unanswered for months.
What is the Hilliard v. Hughes lawsuit about?
Hilliard v. Hughes was filed in April 2025 by Uptown People's Law Center, Equip for Equality, and DLA Piper as a successor to the Rasho litigation. It alleges: IDOC responds to mental illness with punishment (segregation, restraints, pepper spray, mace-ball guns); only 67 of 175 provider positions are filled; care requests go unanswered; treatment plans are not individualized; lockdowns function as de facto solitary confinement; chemical agent use in response to self-harm has tripled since 2023; the ADA is violated by isolative conditions that disproportionately harm people with mental illness; and discharge planning does not address mental health needs. The suit seeks injunctive relief, not money damages.
What is the Joliet Treatment Center?
The Joliet Treatment Center opened in 2017 as a flagship reform under the Rasho consent decree, built in partnership between IDOC and IDHS to provide meaningful mental health treatment in a therapeutic setting. After court oversight ended and leadership changed, the April 2025 Hilliard complaint alleges it is "no longer a place for recovery and stabilization," with frequent lockdowns and non-individualized care. Current conditions should be verified at publish.
Does Illinois use force against mentally ill prisoners?
Yes, documented in the state's own data. In 2023, IDOC used chemical agents (pepper spray, mace-ball guns) an average of 16 times per month when responding to self-harm and 75 times per month overall. By 2025, those numbers increased to 37 times per month in response to self-harm and 137 times per month overall. The Hilliard complaint specifically alleges that the use of chemical agents against prisoners in self-harm crises is not a treatment response -- it is punishment.
What are Illinois lockdowns and how do they affect SMI?
Administrative lockdowns at IDOC facilities have increased approximately 650% from 2019 to 2024, primarily due to insufficient staffing levels. During lockdowns, movement, recreation, and programming are restricted -- and in practice, so is mental health contact. The Hilliard complaint characterizes lockdown conditions as "effectively solitary confinement" that disproportionately harms prisoners with mental illness, who need consistent therapeutic contact and structured time out of cell.
What can families do if mental health care is denied in IL?
Provide psychiatric history and medication documentation at intake. Document every request for mental health care with dates and methods. Know the lockdown situation at your person's facility. If your person is in crisis and being responded to with chemical agents rather than treatment, document it. File IDOC grievances for care denial, medication interruption, lockdown conditions preventing MH access, and discharge planning failures. Contact Equip for Equality (equipforequality.org) or Uptown People's Law Center (uplcchicago.org) -- both are co-counsel in Hilliard v. Hughes and accept complaints.
Who oversees mental health care in Illinois prisons?
No federal court currently exercises active oversight of IDOC mental health care -- Rasho oversight ended July 2022. Equip for Equality (equipforequality.org) serves as the federally mandated Protection and Advocacy organization for Illinois and is co-counsel in Hilliard v. Hughes. Uptown People's Law Center (uplcchicago.org) is co-counsel in both Rasho and Hilliard. The John Howard Association (thejha.org) is an independent prison watchdog that monitors IDOC conditions. The Hilliard v. Hughes federal lawsuit (filed April 2025) is the primary current accountability mechanism. ---