Hearing on mental health crisis at Rikers spurs debate over solutions

More than half of people held in New York City jails receive mental health services during their incarceration, testimony heard in a City Council hearing last week revealed. The reliance of incarcerated individuals on mental health services shows the role Rikers Island plays as a major site of psychiatric care — and raises questions about whether jail can provide the long-term treatment many people need.

At the Council oversight hearing on Sept. 23, officials and advocates debated the mental health needs of people in city custody and whether the Department of Correction and Correctional Health Services can adequately meet them.

The hearing came amid continued scrutiny of conditions at Rikers, including two deaths in custody within a week in March. A Sept. 25 report found that Barry Cozart died at Rikers from acute intoxication involving mixing drugs such as methadone and gabapentin.

CHS officials said roughly 61 percent of people in the city jail system received mental health services while incarcerated, while about 22 percent had been diagnosed with serious mental illness. Among women in custody, 85 percent received or were enrolled in mental health services and 49 percent had a serious mental illness.

“Many of New York City's most clinically complex individuals receive mental health care on Riker's Island that they may not have had access to in the community,” said Dr. Joseph Otanakar, chief of mental health for CHS.

'The symptom is just the surface of what else has brought them'

But Raji Edayathumangalam, a senior policy social worker at New York County Defender Services who testified at the hearing, said providing treatment inside jail is only part of the problem.

CHS can serve as a “crisis stabilization point” for people experiencing acute psychiatric or substance-use problems, she said. But stabilization is different from recovery.

“Recovery is not just about symptom reduction. And it’s not just about symptom remission,” Edayathumangalam told The Chief in an interview a week after the hearing. “People come in with various problems of living that have to be addressed. And the symptom is just the surface of what else has brought them.”

CHS operates 17 mental-observation units and 10 Programs to Accelerate Clinical Effectiveness, or PACE, units. It also operates a 20-bed PACE unit at Bellevue Hospital for people with particularly complex psychiatric and medical needs.

Earlier this year, CHS launched STEP, an intermediate level of care between mental-observation units and general population. Most people receiving mental health treatment, however, remain in general population and receive their care through jail clinics.

Edayathumangalam described CHS as a critical partner but said the jail environment itself can undermine therapeutic care.

“It’s a security function, but healing is a therapeutic function. And those are competing priorities,” she said.

People entering jail with serious mental illness may already have histories of trauma, hypervigilance or post-traumatic stress. The conditions of incarceration — including constant surveillance, bright lights, slamming doors, overcrowding and the need to remain continually alert — can further activate those responses, she said.

“Many of our patients enter our care with tremendous sociomedical and mental health needs, and their involvement in the criminal legal system, up to and including jail detention, often exacerbates those challenges,” Otanakar said at the hearing.

Marc Bullaro, who spent more than 28 years with the NYC Correction Department, including as executive officer of the training academy and commanding officer of the intelligence bureau, offered a different perspective. Bullaro said people who need mental health treatment were put in jail because they caused harm to others and society, even if jail is not the ideal setting to receive it.

“Is it the best place for them to receive that treatment? No. But I think it has to be done in jail,” he said.

Bullaro also argued that mental health treatment and correctional officers’ responsibilities should be treated as separate issues. He said officers should receive specialized training in mental health and that DOC should do more to ensure people in custody are escorted to scheduled treatment and follow-up appointments.

Edayathumangalam said the broader challenge comes when people leave jail. She described a “revolving door” in which people move between jails, hospitals, courts and community systems without enough coordination.

CHS provides some reentry support, including connections to Medicaid and community providers. People with serious mental illness can also receive supportive-housing applications, transitional case management and, in some cases, a smartphone with a year of service.

“Treatment alone is not enough,” Edayathumangalam said. “You need all the social services that keep people stable and integrated in the community.”

Bullaro also pointed to drugs entering Rikers – which he described as “rampant” – as another factor that he said can worsen mental health problems and contribute to suicidal behavior.

“Preventing the drug introduction will also help in this issue,” he said.

Edayathumangalam argued that the city ultimately needs to strengthen the community infrastructure available before and after incarceration.

“The time to invest in community infrastructure is now,” she said.