Sick and in solitary

Last summer, a 25-year-old robbery suspect at Rikers Island took a ball of concentrated soap meant to clean his jail cell and swallowed it. Jason Echeverria had been held for two months inside the Department of Correction’s Mental Health Assessment Unit for Infracted Inmates, where the confined typically spend 23 hours a day on lockdown. By swallowing the soap, Echeverria hoped to spring himself from his confinement; instead, for 20 minutes a corrections supervisor ignored his condition as he became violently sick and eventually died from the poisoning. The city’s medical examiner has found that the lack of immediate medical treatment constituted a homicide.

While Echeverria was being held in punitive segregation, New York City Department of Correction Commissioner Dora Schriro was assuring the city’s Board of Correction, which monitors her agency, that a long-awaited blueprint for dealing with the growing ranks of mentally ill at Rikers was nearing completion.

The study, undertaken by the well-respected Council on State Governments in conjunction with a special task force convened by the Mayor’s Office, set out to remedy one of the most disturbing trends facing the city’s jail system. Even as New York City’s jail population reaches historic lows, the number of mentally ill people in jails has ballooned, turning Rikers Island into a virtual psychiatric ward run by the Department of Correction. Today a record one in three residents at Rikers has some form of mental illness — more than 4,000 at a given time and a population up 26 percent since 2005.

A Department of Correction inmate transport bus arrives at the Manhattan Detention Complex at 100 Centre street from Rikers Island. Photo: William Farrington

The Department of Correction reports that the mentally ill at Rikers Island are involved in at least half of all jail incidents, including assaults on corrections officers. Its response has been to crack down hard on infractions and increase the number of punitive segregation beds. Since she became commissioner in 2009, Schriro has overseen the largest increases in punitive segregation units in the department’s history, spurring a rate of solitary confinement among the jail population that is projected to reach five times the national average this year. Punitive segregation for the mentally ill is also increasing. Rikers now has hundreds of designated cells, including the one where Echevarria died. In 1990, the jail had just a dozen.

Conditions are so severe that even the medical director at Rikers for Department of Health and Mental Hygiene has felt compelled to speak out. During a Board of Correction meeting last year, Dr. Homer Venters called the segregation units “parking lots for people with mental illness” and described the Rikers mental health segregation unit as “a complete failure in meeting the needs of patients and the needs of DOC.”

“Rikers Island is one of the top three mental health facilities in the country,” said Bonnie Sultan, a sociologist and criminal justice expert who has monitored treatment of mentally ill inmates in New York City jails. While the Department of Correction has experimented with a pilot program that offers cognitive-behavioral therapy for inmates, and assigns mental health clinicians for the punitive segregation unit, most of what it can offer is punishment. “What we’re seeing,” said Sultan, “is the system is further debilitating these people.”


Justice Delayed

For the mentally ill at Rikers, trials and justice are frequently delayed as inmates pile up criminal charges through incidents with corrections officers or because they can’t conform their conduct to jail disciplinary codes. Once they’re placed in segregation, their mental health troubles can become even more pronounced. A body of research in recent years has shown that the mentally ill are particularly at risk for severe psychological reactions to the isolation of solitary confinement. The United Nations Rapporteur on Torture has said the mentally ill should not be subjected to such punishment.

In an emailed statement, Department of Correction Commissioner Dora Schriro pointed to recently announced measures to divert mentally ill offenders before they get to jail and described them as part of a signficant transformation in care.

“With City agencies, the courts and community-based providers working together to keep low-to moderate-risk defendants with mental health needs out of jail whenever possible but supported by services and supervision, and high-risk defendants who go to jail getting the services they need, New York City is leading the way nationally towards safer and smarter correctional systems. The mentally ill will be able to receive appropriate care in the least restrictive setting sooner, and should have far fewer re-arrests after their release.” The agency did not respond to a request for comment on Jason Echeverria; last year, it told the Daily News that officials were “saddened” by his death and were investigating.

Prisoner rights advocates in New York City have long criticized the Department of Correction’s steady increase in segregation as a way to maintain order in the jail environment, saying it reveals deep, systemic failures in the city’s criminal justice and mental health agencies.

“There really is no internal mechanism for bridging the gap between civilian hospitalization and jail confinement,” explained John Boston of Legal Aid’s Prisoners’ Rights Project. According to Boston, the courts and jails are sorely unequipped to move mentally ill people quickly into treatment or community-based alternatives to incarceration. Instead, the jails absorb mentally ill people by the thousands, with a focus on punishment more than treatment. “No one seems to be able to do anything about it,” said Boston.


The Mayor Steps In

If there was hope for progress, it lay in the study from the Council on State Governments. After Schriro joined the study and the project secured funding from the Department of Justice and the Jacob and Valeria Langeloth Foundation, City Hall insisted that other city agencies be consulted. The result was the launch in September 2011 of the mayor’s Citywide Justice and Mental Health Initiative Steering Committee, which brought together a vast, all-star cast that included Chief Policy Advisor to the Mayor John Feinblatt, Council Speaker Christine Quinn, Police Commissioner Raymond Kelly and Manhattan District Attorney Cyrus Vance. The purpose of the unusual summit, explained Bloomberg later, was for everyone to roll up their sleeves and dedicate their collective energy to solving the mental illness problem in the city’s jails.

In its quest for solutions, the Council on State Governments Justice Center conducted more than 20 focus group meetings and analyzed thousands of records from the Department of Correction, Criminal Justice Agency, and Department of Health and Mental Hygiene in order to try and understand why the mentally ill were spending so long in jail and returning again and again. The Council promised an unprecedented, wide-ranging analysis important not just for New York City, but for local governments across the country confronting similar trends.

For months, criminal justice organizations that had participated in the focus groups remained in the dark about what the report would find or recommend. When the Council finally released the much-delayed study in December, many participants were dismayed that the brief paper said almost nothing about the role of the corrections system itself — including punitive segregation — on inmates’ mental health.

“We would have expected that would be a part of the dialogue coming out of this research, because it’s what we see,” said Glenn Martin, executive director of the Fortune Society, which currently runs the only state-licensed mental health clinic that gives treatment and therapy tailored for recently released inmates from Rikers Island. “It’s noticeably absent from the research — the impact of jail conditions and the system of punitive segregation.”

At 15 pages, the final report is undeniably slim and repeats many already established facts about the lengthier incarcerations of those with mental illness. Martin said his first response was, “I’m glad someone put it in writing, but this can’t be news to people.”

The Council on State Governments reported that mentally ill inmates spend an average 112 days in jail, versus 61 days for the general population. The Council’s analysis also shows that mentally ill inmates are likelier than others to be in jail on misdemeanor charges rather than felonies, and that the release of mentally ill inmates is often delayed because they cannot post bail or assist in their own defense.

Most tellingly, the data revealed that the largest disparities for lengths of stay in jail were among the pretrial population — inmates like Echeverria who have not been found guilty of crimes yet. According to the Council, they will spend twice as long in jail as non-ill inmates, which suggests the city’s courts are unequipped to move the mentally ill through the judicial process quickly.

Part of the problem, the study found, is that the courts send many mentally ill people to jail who shouldn’t be there in the first place, because judges, prosecutors and defense counselors have extremely limited knowledge of alternatives to incarceration when it comes to their mentally ill charges.

The Council on State Governments addressed this finding with a recommendation that the  courts help mentally ill defendants get into community-based alternatives to imprisonment where appropriate.


New Promises, Following Broken Ones

City Hall’s response was to announce in December the creation of Court-Based Intervention and Resource Teams. The mayor’s newly proposed budget plans for eight staff positions, to be fully in place by the summer of 2014. These teams will assess mentally ill inmates, and recommend to judges that those who do not pose a flight risk or are likely to reoffend be released to the supervision of the community-based programs while they await trial.

It’s an expansion of an idea that has already seen success in the state’s Mental Health Courts, where judges frequently refers mentally ill defendants to community-based treatment, instead of jail, while they await trial.

“The crime is not the mental illness,” notes Judge Matthew D’Emic, who presides at the Brooklyn Mental Health Court and says the new mental health teams could have an impact on how his colleagues decide to arraign mentally ill defendants. “This might give the judge more of an inclination to release [a defendant] on their own recognizance or set no bail, because he feels more sanguine about them being in treatment and returning to court.” D’Emic pointed out, however, that the initiative had never been tried before. “The devil is in the details,” he said.

Indeed, defense attorneys said they are ambivalent at best about the new teams because so few details are known yet. What tools will be used to measure a client’s risk of reoffending? Can district attorneys subpoena their clients’ assessments? Who is going to do the assessments?

It also remains unclear how widely community supervision will in fact be available to mentally ill defendants. The Council report noted that existing supervision programs “currently do not have the capacity to serve all the referrals they could potentially receive.”

Another reason for skepticism has been the uneven performance by the Department of Correction in ensuring mentally ill defendants get care once they leave jail, under the decade-old settlement in the lawsuit Brad H. v City of New York. Monitors in that case have found, for example, that inmates too often receive referrals to inappropriate programs after they are released.

Jennifer Parish, director of criminal justice advocacy at the Urban Justice Center’s Mental Health Project, applauded any efforts by the city to address the needs of mentally ill inmates, but notes that promises have been broken before. “Ten years ago they agreed to provide services to this very population and some of those obligations are things that they are identifying now,” said Parish. “If the city had embraced its obligations, it could have done a lot to contribute to alternatives to incarceration.”

The court-based teams may divert some defendants away from Rikers or prevent others from returning. But without reforms to the way Rikers incarcerates them, it’s not clear how much the fate of most mentally ill inmates will really improve.

Martin said he fears the study became a smokescreen for a corrections system wildly out of step with the rest of the country in its reliance on punitive segregation. “We’ve allowed our jails to serve as a surrogate for mental health institutions,” said Martin. “There’s no more expensive way to treat mental illness, but it’s what we do.”

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