The story was first mentioned to Helena Bonham Carter 13 years ago, with Helena playing the role of Collette and Susan Sarandon playing Eleanor.

55 Steps is based on the life of Eleanor Riese, a patient who sued for her right to refuse antipsychotic medication. Eleanor Riese was diagnosed with schizophrenia when she was 25. At the time of the trial in 1989, she was 44 and had been in and out of psychiatric hospitals for several years preceding her case. During her stay at St. Mary's Hospital in San Fransisco, she developed physical symptoms caused by antipsychotic medication to which she did not consent.

Morton Cohen continued teaching law until two months before his death on April 12, 2018, at the age of 82. While he was in the hospital, in his last weeks, he was still working on a case advocating for better treatment for elder patients in nursing homes.

Collette Hughes continued advocating for clients with disabilities. Following Eleanor's wishes, she increased her focus on protecting the rights of patients being restrained in isolation.

Vera Farmiga was originally cast as Colette Hughes before dropping out. Hilary Swank replaced her.

The Rise decision was a major step toward reforming America's mental health system by empowering patients and improving communication between patients and their doctors about individual treatment needs.

Eleanor Riese died on April 6, 1991, of a kidney infection resulting from the side effects of antipsychotic medication. She was 47 years old.