Just a few years ago, when mentally ill prisoners finished serving their time at Rikers Island, they were dropped off at Queensboro Plaza in the wee hours of the morning with a $3 Metrocard and $1.50 in cash. They either made their way to relatives or shelters or came to compose a significant percentage of people living on the street.
This phenomenon did not escape the notice of mental health advocates at the Urban Justice Center. They filed suit against New York City in 1999, in a move that eventually led to the creation of “discharge planning.” An agreement was reached that required the city to take concrete steps to help mentally ill prisoners transition to life outside of jail. But according to a report issued last month by court-appointed compliance monitors, the vast majority of such prisoners still are not receiving the discharge planning they need.
The report says that as the city nears the end of its mandated five-year monitoring period, mentally ill inmates still face inappropriate referrals and a system that frequently does not begin to address their needs until they’ve left jail.
“People are coming out with nothing, just like they’ve always been coming out with nothing,” said Lisa Ortega, an organizer with the group Rights for Imprisoned People with Psychiatric Disabilities. About discharge planning, she said, “They’re doing some of it, but it’s a drop in the bucket.”
Under the agreement coming out of Brad H. v. City of New York, inmates who required psychiatric care while in prison were, upon their release, to be given a discharge summary explaining their diagnosis, their needs, and their post-release plans. These plans, which could include inpatient housing at a psychiatric care facility, outpatient treatment, and the provision of Medicaid, public assistance and food stamps, were supposed to be developed while the inmate was still in jail.
“The nature of jails is that people cycle in and out rather quickly and the reason the settlement is set up is so we can catch as many people as possible and provide services before they’re released,” said Jennifer Parish, director of criminal justice advocacy at the Urban Justice Center, the nonprofit group that represented the seven Rikers inmates in the Brad H. case.
According to Parish, however, either the planning never happens or, if it does take place, the referrals made don’t correspond to the inmates’ needs.
In the report, compliance monitors Henry Dlugacz, an attorney, and Dr. Erik Roskes write that 34 percent of the time, the discharge planning is “complete and on time.” Of that, 33 percent of the planning done is “appropriate.” Planning is done on time and appropriately only 11 percent of the time, Dlugacz and Roskes concluded. They declined comment on the report.
However, according to the Department of Health and Mental Hygiene (DOH) which is responsible for discharge planning, during a recent six-month period it created “comprehensive treatment plans within the timeframe” 93 percent of the time. The department doesn’t monitor whether these appointments are “appropriate.”
Jason Hershberger, DOH assistant commissioner of health care access and improvement, says the post-Brad H. system “prioritizes process over outcome” and is unduly restrictive. In testimony before the New York City Council committees on mental health and criminal justice this spring, Hershberger estimated that 85 percent “of the people to whom we provide discharge planning services are not seriously, persistently mentally ill.”
Because of the diversion of resources, “we are unable to provide optimal care to the 15 percent of patients with the most serious needs,” he said.
Observers outside the health department take issue with DOH figures. Dlugacz and Roskes, the two court-appointed monitors, have stopped including the city’s numbers in their reports because their findings are totally at odds with them. “I think the numbers show by themselves the incompetence that we’re talking about,” said Raymond Ortiz, a paralegal with the Urban Justice Center who visits Rikers twice a week to monitor inmates’ experience with discharge planning.
The Center’s report documents the cases of several people who received insufficient planning, among them Mr. B, a former inmate who was judged by mental health staff at the jail to require treatment for both mental illness and a cocaine addiction. However, when discharge planners referred him to an outpatient clinic, they gave him the incorrect number of a clinic that didn’t provide all of the services he needed.
The report also highlights the system’s rigidity. According to the UJC, 35 percent of mentally ill inmates refuse discharge services when they’re first offered – at a moment when they may not have the ability to evaluate them adequately – and then rarely get another chance. The report characterizes this as a “one strike and you’re out” approach.
The refusal problem is especially acute among inmates at the Rose M. Singer Center, the all-women jail on Rikers Island. Ortiz says that when he first began monitoring discharge services four years ago, RMSC discharge planners told inmates they didn’t offer many of the services they are legally required to provide, and many of the inmates Ortiz interviewed didn’t know what discharge services were. Although the system was eventually overhauled and improved, the refusal rate disparity remains.
The DOH disputes that it is to blame for the refusals. “Successful discharge planning requires a motivated and engaged patient,” DOH’s Hershberger said in his testimony April 30, which was called for by City Councilmember G. Oliver Koppell (D-Bronx), the chair of the committee on mental health. “Too many patients choose not to participate in the program, or choose not to attend their treatment appointments once they are released back into the community,” Hershberger said.
Maureen Fisher, the clinical director at the Fortune Society, a nonprofit organization that counsels former convicts, agrees that problems like inappropriate referrals and refusals of service are often the result of miscommunication by inmates.
“I don’t want to just blame it on the system,” Fisher said. “Part of the problem is that people will say, ‘Oh, don’t worry, I don’t need that service, I have a family I’m going back to,’ and that may not in fact be totally accurate.”
Councilmember Koppell sees it differently. According to Jamin Sewell, an aide to Koppell, it’s the Department of Corrections that’s responsible for poor information that discharge planners may have about inmates, not DOH. The corrections department did not respond to requests for comment.
“A lot of the problem is the subcontract with Prison Health Services and unfortunately the council has less oversight because the work is contracted,” Sewell said of the private firm the city pays to assess and care for inmates’ mental health. Sewell maintains that because the firm supplies incorrect information, discharge planners make incorrect decisions.
Another reason for refusals may stem from language barriers between inmates and discharge planners, according to Ortiz of the UJC.
“You have a discharge planner unit and in the whole thing, maybe three people speak Spanish,” he says. “Interpreters are needed and you can’t get an interpreter on Rikers Island, so you’re asking correction officers to interpret, and you can’t do that with inmates. There’s a trust factor, especially when your attorney is telling you not to speak with anyone.”
According to DOH spokeswoman Sara Markt, Rikers’ staff is both diverse and bilingual. When interpretation is needed, she said, there is a telephone language line with 170 languages.
The conflicting views of the system have made collaboration difficult. The UJC, for its part, says that, if necessary, it will go back to court to enforce the settlement.
“We really have the same interests,” said Parish. “We want to make sure that people get good services.”