What I Learned Treating the Mentally Ill on Rikers

"If they had no mental health issues before they entered solitary, they do now!" was our unofficial mantra.

During the 1990s, I worked as a clinical social worker at Rikers Island. Behind the bars and concrete, surrounded by the murky East River on all sides, I was part of a dedicated team whose mission was to bring emotional and psychiatric support to New York's jailed masses. Then, as now, over 80 percent of the Rikers population had been with a crime but not convicted, making life at the jail one of agonizing uncertainty as the incarcerated awaited their day in court, most unable to afford bail. Naturally, our mental health "referral basket" was overflowing. A typical batch of referrals would read: "threatening suicide," "weepy, depressed," "says he'll hang himself if he blows trial," "waiting for trial for two years—can't hold on much longer," "first incarceration—terrified," "hearing voices," "cutting himself..."charged

Amplifying the tension, we had 72 hours to meet with the person and determine a follow-up action, which usually meant some combination of medication and/or therapy.

The saddest referral of all was that of the severely mentally ill, people suffering from conditions like schizophrenia, dementia, and bi-polar disorder. Their jailhouse plight is at least partly the result of the well-intentioned shutdown of many big state psychiatric hospitals several decades ago, once deemed "snake pits," leaving municipal jails like Rikers in New York and Cook County in Chicago to fill the void of mental healthcare for the indigent. Without the necessary levels of supervised community housing to replace those hospitals, many of the mentally ill have fallen into police crosshairs for petty mischief, charged with offenses such as trespassing and loitering. When they were identified at Rikers, our response was to segregate them from the general population and place them in more protective housing.

Most of the jails on Rikers maintained a mental observation unit for mentally ill inmates, where they were provided with a higher level of psychiatric care. And I think we did a fine job of getting these fragile individuals stabilized—at least until the late 90s, when the Giuliani administration opted for a low-ball healthcare bidder to replace the relatively solid Montefiore Hospital, the city jail system's healthcare provider for the preceding 25 years. Suddenly, staff was reduced, necessary hospital-runs for the most seriously mentally ill were all but eliminated, and our mental observation units were transformed from rich therapeutic environments to depressing dens of neglect.

Photo courtesy the author

That was the state of affairs when I left the island in 2000, but 15 years later, Rikers was making more headlines than ever for violence, brutality, and mistreatment of the mentally ill. In response to all the scathing investigative journalism, public outcries, and a lawsuit brought by the Justice Department regarding treatment of adolescents, Mayor Bill de Blasio has pledged, and begun to enact, serious reforms, recently making good on one key promise by ending solitary confinement for all inmates 21 or younger. This focus on solitary confinement is heartening as this grueling punishment exacts a heavy toll, something I witnessed firsthand.

In my final post on Rikers, I was assistant mental health chief of the then-500-cell solitary confinement unit, referred to as the "Bing," supervising a team of eight psychiatrists and therapists. To manage the unit, we regularly doled out antidepressants, anti-psychotics, and mountains of sleeping pills. "If they had no mental health issues before they entered solitary, they do now!" was our unofficial mantra. Yet the pills had their limits, and we routinely entered these solitary cells and discovered slashed arms, blood-smeared walls, and agonized faces begging for relief from the torment of isolation.

While these Rikers reforms are encouraging, calls to close the place altogether are gathering steam. Although it is tempting to believe that a shutdown is the answer to all of Rikers's woes, we cannot overlook the possibility that a closure might simply relocate the suffering. Without addressing the issues that have driven the island's misery, I think this is a legitimate concern. Solitary confinement—a standard punishment in jails and prisons nationwide—would not vanish with a Rikers relocation. Nor would a proposed new jail be relieved of its role as caretaker of the severely mentally ill. And barring meaningful bail reform, low-level offenders who could easily report to court hearings from home if they could pay bail will continue to battle anxiety and depression. Without actual "speedy trials," there is also the possibility that those who insist on their constitutional right to trial could still languish for years awaiting their day in court, only now it would be inside a gleaming new facility.

Sheriff Tom Dart describes running a jail that happens to be one of America's largest mental health institutions in Chicago.

A Rikers shutdown is an incomplete solution to complex problems. Still, there are compelling benefits to doing so. The remote proximity of the forlorn island, in my experience, worsened the inmates' depression, anxiety, and fears about the future. The island is most easily accessed by car, and since the families of the incarcerated are often poor, cars are an unaffordable luxury; instead they must endure a nightmarish public transportation ordeal just to get out to Rikers. A switch to borough-based jails would inherently make it easier for family to visit loved ones, and the importance of maintaining those ties while incarcerated is crucial.

In October 2015, while testifying at a Board of Correction hearing, I described the calming effects of these visits on angry and distressed individuals. Family visits and stronger connections to the community that a borough-based jail could offer would help reduce violence and improve overall mental health. To bring these people back into the community fold as they await the outcome of their cases would represent a meaningful step forward in the crusade to reform criminal justice in America.

This article is part of the VICE series The Future of Incarceration. Read the rest of the package here.