NYC Jailers Hinder Patients’ Access to Mental Health Services

    People incarcerated in New York City jails are consistently obstructed from accessing mental health services. Sometimes they are rescheduled by the Correctional Health Services (CHS), the public agency providing such care, and other times they are missed because the patient is at court. But most of the time, it’s simply because Department of Corrections (DOC) staff fail to bring them to their appointments in the first place.

    In the first half of 2019, on average nearly one-fifth (18 percent) of all mental health appointments were missed because the DOC did not “produce” the incarcerated patient to the clinic, according to the latest reports on healthcare access published by the Board of Corrections (BOC), an independent oversight organization for the city’s jail system. Over those six months, 19,503 appointments were not completed for this reason. More broadly, the DOC’s “non-production” of patients caused the majority (64 percent) of missed appointments of all kinds.

    “I barely saw a psychiatrist when I was there,” Eileen Maher, a Brooklyn resident formerly incarcerated on Rikers Island for over a year, told Filter. When she was admitted, Maher was already on three psychiatric prescription medications. She said she had to “fight tooth and nail” to access them while jailed, only getting ahold of some of them after making use of The Legal Aid Society’s hotline.

    Maher was detained at Rikers between 2013 and 2014, before the BOC mandated the CHS to produce monthly access reports, which began in 2016. During her time in the jail, incarcerated people with scheduled appointments could sometimes “just go on up on your own” to the clinic, said Maher, while other times her ability to attend her appointments was hindered by the DOC’s staffing shortage. “If there wasn’t an escort, it was pretty much like, ‘Oh well, you guys aren’t going to [the medical unit],’ or ‘We don’t have anyone, so we can’t take you. You’ll have to wait.’” 

    The lack of an escort is one reason why a person may not be produced for their appointment, according to the DOC. Data on “No Escorts” is only publicly available for April and May of 2016. Of all the mental health appointments scheduled for the adult men and adolescent boys detained at the Robert N. Davoren Complex on Rikers Island, 1,906 of them were completed and marked as “Seen” during those two months—but 1,415 were not completed and instead marked as “No Escort.”

    This trend may contravene New York City’s mandatory minimum standards for mental healthcare, which require the DOC to “provide sufficient escort officers to ensure delivery of service in a manner that promotes the maximum efficiency of mental health services staff.” 

    The DOC was unable to comment at the time of publication.

    Additionally, the DOC attributes non-production to “tactical search operations,” alarms or lockdowns. A BOC report shows that the annual number of lockdowns in New York City jails increased by 88 percent from 2008 to 2017—though in 2018 they declined for the first time in four years. Data on searches and alarms were not publicly available at publication time—and this is part of the problem, said the BOC.

    Non-productions arise from “significant discrepancies” in documentation and communication between the DOC and CHS, according to the BOC’s May 2019 lockdown report. The coordination of patient care, which currently relies on interpersonal correspondence between DOC clinic captains and CHS staff, has major “gaps,” which “hinder understanding of the impact that emergency lockdowns have on health and mental health services for people in custody,” wrote the BOC. 

    Maher said she has seen how staff communication—or lack of it—can result in a person not getting the care they need. “Sometimes [corrections officers] wouldn’t tell people [when it was time for their appointment],” she claimed. “The medical [staff] would call the officer outside of our unit, and then the officer would lean in and tell the officer on duty in the unit. If you had a bad officer that day, sometimes they wouldn’t tell people. Especially when they didn’t like someone.”

    The DOC was unable to comment on this specific allegation at the time of publication. But they did suggest that some non-productions involve incarcerated people who choose to refuse to leave their housing areas for scheduled appointments, though data to support this claim is not available.

    The DOC is making changes to “ensure that everyone in need of care is seen by a medical professional in a timely manner,” Peter Thorne, the DOC’s deputy commissioner for public information, told Filter. The DOC has expanded capacity by opening a mini-clinic in the largest facility on Rikers, while also rolling out radio identification scanners and wristbands in all jail clinical settings, allowing for “real-time clinic production tracking.” The DOC has also added new escort officers. 

    Thorne said that the DOC holds “the safety and well-being of people in our custody” to be its “primary mission,” adding that they’re “committed to improving access to care.” But for Keith Brown, the director of health and harm reduction at the Katal Center for Health, Equity, and Justice, jails themselves are part of the problem.

    “We know that all health conditions can be exacerbated by incarceration,” Brown told Filter. This is especially true in the New York City jail system: Between 2015 and 2018, transgender women, for example, were forced to choose between substance use disorder treatment and being detained in areas not aligned with their gender, as Filter has reported

    “This is why people die in facilities. They die preventable deaths,” Brown said. Most recently, the DOC was rocked by the death of Layleen Polanco, who was being held in solitary confinement at Rikers when she had a fatal seizure related to her diagnosed epilepsy, for which she was taking medication.

    “The very condition of confinement—in the best scenario (and NYC jails are not that)—is in opposition to best practices for mental healthcare,” Nick Encalada-Malinowski, VOCAL-New York’s Civil Rights Campaign Director, told Filter.

    Similarly, Homer Venters, the former head of CHS and author of Life and Death on Rikers Island, has seen first-hand how the city’s jails can cause people’s mental health to spiral: You have patients with mental health problems who are decompensating [functionally deteriorating under the stress] or simply doing extreme things to try and get out of there [solitary confinement].” 

    Brown doesn’t think tweaking how the jails connect those they incarcerate with health services will be enough. Instead, “this is another example of why we need to close Rikers,” he said, alluding to the movement to shut down the jail. Encalada-Malinowski added that New York’s jails “do not fundamentally value the rights, safety, health and dignity of people who are incarcerated. If they did, these problems, which have been raised for years, would be addressed.”

    “It’s incredibly inhumane,” said Brown. “This is why we need to get people care outside these facilities.” 

    Photograph of a Rikers Island ‘Welcome’ Sign; by Carol Highsmith via Library of Congress 

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