NYC Jails Fail to Identify Prisoners With Cognitive Problems

The New York City Department of Correction and the city’s Correctional Health Services have almost no way of determining if an inmate on Rikers Island has an intellectual or developmental disability – something like a very low IQ or a disorder on the autism spectrum. Right now, there is no specific screening for these cognitive impairments during intake for people arriving at Rikers, no targeted services or care for these disabilities on the island, and no specialized units for them.

Because of the lack of screening, most people who come to Rikers with intellectual or development disabilities end up going unidentified by the Department of Correction and Correctional Health Services, the city partnership that provides health and mental health services on the island, say advocates and medical staff familiar with the Department’s process. As a result, these inmates typically end up housed among the general population of the jails, where they’re disproportionately susceptible to violence and abuse from other inmates and staff.

While inmates with psychiatric illnesses at Rikers have received considerable attention from the city’s administration in recent years and substantial resources have been developed for them, inmates with intellectual or developmental disabilities – a similarly large and vulnerable group – have gotten little of either. Often they’re simply treated as part of the mentally ill population; when inmates with cognitive disabilities aren’t housed in general population, they’re typically placed in Mental Observation Units designed for inmates with mental illnesses, units that are regarded as inadequate and inappropriate for people with intellectual or developmental disabilities.

“There’s so much mental illness, so I think this problem just gets overlooked,” says Dr. Daniel Selling, a psychologist who ran mental health care on Rikers from 2009 to 2014. “They just get lumped in with mental illness, which isn’t really providing the appropriate level of care.”

“It’s like saying that cancer is like heart disease,” says Mary Crowley, Vice President of the Vera Institute of Justice, a research and advocacy group based in Manhattan. “That’s just a profound misunderstanding of both issues.”

No one knows how many people are affected by this problem; the Department of Correction has been unable to estimate plausibly the size of the cognitively disabled population at Rikers. Research on other jails, however, suggests that the group may be sizable.

A 2010 study examining previous research found that 4-14 percent of the incarcerated population nationwide has a diagnosed intellectual disability – notably, that statistic would exclude people whose disabilities had not been diagnosed. A study last year by the federal Bureau of Justice Statistics found that among all jail inmates from 2011-2012, more than 30 percent reported having some kind of cognitive disability.

The report that comes closest to estimating the scale of the problem in New York is a 1991 study by the state’s now-defunct Commission on Quality of Care and Advocacy for Persons with Disabilities, which examined developmental disabilities among the state’s prison population. Unlike the city’s jail system, the state Department of Corrections and Community Supervision has long used a battery of tests, including an IQ test, to examine its incoming inmates for cognitive impairments.

The Commission’s study found that only one to three percent of New York’s state prison population had a developmental disability, but the Bureau of Justice Statistics report suggests that people with disabilities are typically a greater percentage of inmates in municipal jails than state prison systems. Since 1991, no study of New York’s prison system has updated the numbers found by the Commission on Quality of Care.

The city Department of Correction’s press office told City Limits that fewer than 20 people annually are identified as developmentally disabled out of more than 60,000 intakes per year, an improbable figure. If accurate, the Department’s number would indicate a significantly lower rate of disability among New York City’s incarcerated population than society as a whole, contrary to all research on the prevalence of disabilities in jail populations.

Alternately, if the true rate of disability among the Rikers population is on par with the 4-14 percent prevalence in jails across the country, DOC’s figure would suggest that the Department generally fails to identify more than 99 percent of all incoming inmates with such impairments.

Misplaced, and possibly endangered

The result of not identifying inmates with disabilities is cases like a Brooklyn man represented by Brooklyn Defender Services, a public defense agency, whose lawyers pseudonymously called him Mr. Spaulding for a testimony before the City Council last year. Spaulding suffered from moderate to severe mental retardation and a mental illness, but his intellectual disability was not identified during intake by Correctional Health Services.

While at Rikers, Spaulding was attacked repeatedly by other inmates until a beating left him needing facial surgery and with his arm in a sling. When he returned to general population after being released from the hospital, he was confused and scared, and he refused a strip search. For disobeying, he was placed in solitary confinement for several days, a move that—had Spaulding been properly assessed—would have run counter to the Board of Correction rule issued last year that categorically excluded people with serious cognitive disabilities or mental illnesses from solitary. One consequence of failing to identify these disabilities is that the Department of Correction still cannot effectively enact that rule.

In another case, a man in his mid-50s recently had to be placed in protective custody at the Manhattan Detention Complex because he was beaten so frequently at Rikers, says Mary Beth Anderson, head of the Mental Health Project of the Urban Justice Center, a legal services organization. Anderson says she’s convinced that the man is on the autism spectrum; she is a social worker as well as an attorney, and she evaluated the man and wrote a report for his case about her diagnostic impression of his disability. “He has a terrible inability to perceive social cues,” she says. “He has no sense of right or wrong in socialization.”

Three years ago, the man was arrested after a 14-year-old propositioned him for sex – Anderson says the he didn’t understand why it was bad. Other inmates found out that he was a sex offender and targeted him for attacks.

On December 9, 2014, Ambiorix Celedonio, an 18-year-old inmate with an IQ of 65 living in the Robert N. Davoren Complex on Rikers Island. which houses adolescents, was taken into a supply closet away from surveillance cameras and beaten by two guards after an officer named Medzid Kolenovic, one of the assailants, told Celedonio he was “speaking disrespectfully,” according to a lawsuit filed against the Department of Correction by Disability Rights New York, an advocacy group and federal watchdog. Celedonio had to be hospitalized for his injuries. (A criminal case against the officers was dismissed on Tuesday.)

“They get beat up,” says Anderson of people with cognitive disabilities in jail. “A lot of the time it’s because they’re being asked to do something and they don’t understand.”

A doctor who has worked on Rikers Island for nearly five years echoes Anderson’s view. “I’ve cared for many patients who’ve been the victims of violence who have intellectual disabilities and seem not to comprehend or be able to respond to the rules of the guards,” he says.

The doctor told City Limits that while passing by an intake cell in one of the island’s jails in 2012 or 2013, he noticed a man sitting naked in the cell. He later discovered that the man had “a tremendously low IQ” – in the 40s, indicating a moderate intellectual disability and an inability to communicate complex thoughts. The man had been left in the cell by officers after being involved in “a slew of fights and abuses,” said the doctor.

Diagnosis is not simple

This problem is not new. Tyreece Abney, an intellectually disabled man arrested for selling marijuana, was beaten to death in a general population unit on Rikers Island more than 12 years ago after calling a guard an obscene name when he couldn’t get his medication – he was taking both antipsychotics and anti-depressants.

“The entire time I was there, it was a problem,” says Selling. He says that experiences like the one described by the Rikers doctor who came across an intellectually disabled man left naked in an intake cell were “not uncommon.”

“I routinely saw people who weren’t getting good care,” says Selling. “People were only identified when it was pretty obvious.”

Incoming inmates do receive a physical and a psychological assessment to determine if they have a mental illness. But “it’s not easy” to identify people with intellectual or developmental disabilities even during a psychological evaluation, says Mark Murphy, an attorney with Disability Rights New York. “People don’t volunteer that information and may not even see themselves that way.”

“It’s not like someone takes a medication for an intellectual disability like they would for a mental illness,” he adds, so an inmate’s medical records may not help with the identification. Murphy says that Correctional Health Services would need specifically trained psychologists to do the screenings, which at the moment are done by medical staff.

“There are people who have these disabilities that don’t appear as this sort of caricature of developmentally disabled people,” says Riley Doyle Evans, an advocate with the Jails Action Coalition who has focused on this issue. “In many cases, they’ve been practicing their whole lives to hide their disability,” he says, so without a specialized screening process, the impairment can be very hard to diagnose.

If the system ran as it’s supposed to, says Selling, Correctional Health Services would identify an inmate who showed signs of a cognitive disability during an intake screening prior to arraignment, and then the state’s Office for People with Developmental Disabilities, or OPWDD, would come to do a full screening and determine if the person should be placed at a secure facility away from Rikers to get them out of the jail environment. “But it my years there,” says Selling, “I don’t ever remember that happening.”

Part of the problem is that for OPWDD to be willing to get involved in a case, the agency requires the person’s disability to have been diagnosed before they became an adult. But unless the disability is identified in school or the person’s family has the resources to approach OPWDD while they’re young, that rarely happens.

“So if someone basically stays out of trouble but then gets arrested at 25, OPWDD says, ‘Oh no, not eligible, not identified before age 22,'” says Anderson.

The agency “really doesn’t want to assume responsibility for this population,” says Jennifer Parish, who also works with the Urban Justice Center’s Mental Health Project. “Some people just slipped through the cracks when they were young and now they’ve just been subsumed by the justice system.”

OPWDD spokesperson Jennifer O’Sullivan told City Limits that the agency doesn’t have an age requirement for when someone must be found to be eligible for services, though she notes that the person’s disability must have occurred before they reached twenty-two. Without a diagnosis prior to that age, it can be difficult for people to demonstrate that their disability started before then. Regarding the possibility of placing inmates with disabilities in a secure OPWDD facility instead of Rikers, she said that “it is not under OPWDD’s purview to house individuals who have been ordered to serve time in a correctional setting.”

Perhaps most troubling, advocates and insiders say that people with cognitive impairments are likely still being placed in solitary confinement, violating that new Board of Correction rule. “If you’re not screening someone properly, then it’s very likely that they’ll end up in solitary anyway,” says Murphy.

Although inmates with disabilities may not face the same risks of violence in solitary confinement that they would in the general population, advocates and mental health professionals are united in the view that solitary is psychiatrically disastrous for people who already have significant mental health problems. A 2002 class-action lawsuit brought against New York’s state prison system by Disability Advocates, the predecessor to Disability Rights New York, resulted in massive restrictions on the state’s placement of people with mental illnesses or disabilities in solitary confinement. Dr. Terry Kupers, a psychiatrist and expert witness for the suit, noted the “pain and mental deterioration” caused by solitary and said that “the suffering and decompensation in isolated confinement…is not limited to prisoners with psychosis.”

Kelsey De Avila, a social worker with Brooklyn Defender Services, says that she recently met a client who was 10 days into a 20-day solitary confinement term and had significant cognitive delays. “He was having a difficult time understanding what was going on,” she says.

Aside from the few identified as cognitively disabled, the only way an inmate would be prevented from going into solitary is if they have a co-occurring mental illness that does get picked up during the screening process. Based on research in other jails, 25 percent of the population of inmates with intellectual disabilities is estimated also to suffer from a personality disorder, and about 7 percent from a serious mental illness. But otherwise, “if they’re not diagnosed,” says De Avila, “DOC can put them into solitary.”

The Mental Observation Units where inmates with cognitive impairments are often placed – either because they have a co-occurring mental illness, because their disability is misdiagnosed, or because they are among the few identified as disabled by DOC – may be better for them than general population. There’s a higher level of monitoring on those units and more clinical staff. But the treatment used on the units is focused on therapy and adherence to medication regimens, neither of which is very helpful for intellectual or developmental disabilities. “It’s for people who can be assisted by some kind of medication,” says Brenda Zubay, a social worker with Brooklyn Defender Services.

Furthermore, while an MOU is “theoretically a more protected unit, it really wasn’t,” says Mary Buser, a former assistant chief of mental health units in two jails on Rikers. Inmates are “not immune from brutality,” on MOUs, she says. But given the facilities available on Rikers, Buser adds, “there’s really no softer place for people with developmental disabilities.”

Reforms on tap

In recent months, there has finally started to be some movement on this issue. Officials from New York City Health + Hospitals, the city’s public health care network, have turned their attention to the ongoing problems with screening for cognitive disabilities on Rikers Island since taking over the Correctional Health Services contract last year from Corizon, the embattled private provider that ran the service for 15 years.

Health + Hospitals has started soliciting input from advocates and other city agencies about how to improve the jail’s screening system. The organization held its first meeting about the issue in mid-September with a large group of stakeholders, including clinicians from Correctional Health, representatives of the Office for People with Developmental Disabilities, lawyers from defense and prosecutors’ offices, and people involved in developing alternatives to incarceration.

According to people present at the meeting, which was closed to press, Dr. Elizabeth Ford, a psychiatrist who runs Correctional Health’s psychiatric services and oversees mental health care at Rikers, told the group that Correctional Health Services has the clinical staff to be able to care for inmates with intellectual or developmental disabilities and plans to create a screening tool to identify people with those disabilities as they arrive at Rikers.

A few simple additions to the current screening process could start to identify some of these people, says Anderson. Asking someone to read a short sentence or interpret a common figure of speech – “tell me what it means not to judge a book by its cover,” she offers – could be done by non-clinical staff and would help indicate people who need full screenings to determine diagnoses.

Ford also told the group that one of the eight new PACE units, plans for which were announced earlier this year, will be dedicated to serving the population of people on Rikers with intellectual and developmental disabilities. PACE units, short for Program to Accelerate Clinical Effectiveness, are a substantial investment; they provide the highest level of direct care of any housing environment at Rikers, with large clinical staffs serving only 30 inmates each, and they cost $2 million per year. Given the probable size of the cognitively disabled population at Rikers, a single PACE likely will not cover all inmates with these disabilities.

Many advocates and people familiar with the care available at Rikers believe that the jail complex is simply the wrong place for people with cognitive impairments, and that no changes to the treatment or facilities on the island will be able to make it an appropriate environment for people with intellectual or developmental disabilities. “I don’t think they should have been there to begin with,” says Buser.

The Rikers doctor agrees. “This is a group of people who by and large shouldn’t go to jail, and they certainly shouldn’t go to Rikers,” he says.

At the moment, however, there are few alternatives to Rikers for this population. Housing people with these disabilities away from the island would require secure facilities in the New York City area overseen by OPWDD, which has been opposed to opening new facilities, says Anderson. Others who attended the September stakeholders meeting say that OPWDD isn’t resistant to the changes discussed, but also that it’s not addressing its role. Right now, the only secure institution OPWDD maintains in New York City is the Bernard Fineson Developmental Center in Queens, which is scheduled to close next year.

“It’s a staffing and cost issue,” says Michael Neville, director of the second judicial department of the Mental Hygiene Legal Service, a state-funded defense agency that serves people with mental illnesses and intellectual disabilities. “OPWDD has been the sticking point.”

Peter Thorne, Deputy Commissioner of Public Information for the Department of Correction, told City Limits in an emailed statement that “Commissioner [Joseph] Ponte cares deeply about the health and well-being of all inmates and is working closely with the city’s new correctional health services provider to ensure our inmates are provided quality health care.”

“Upon intake, any patient with a suspected or confirmed neurodevelopment disorder is referred to the jail’s Mental Health team for evaluation and to determine appropriate housing and treatment,” wrote Levi Fishman, the Director of Public Affairs for Correctional Health Services, in an emailed response to questions. “We are actively working to develop additional screening and assessment tools to aid in our ability to identify these patients,” Fishman added.

Anderson and other advocates say they’re impressed with the new dedication of Correctional Health Services to fixing this problem now that Health + Hospitals has taken over, and that they’re optimistic after the September meeting. It will be slow going, however; the working group assembled in September won’t meet again for three months, and the new screening tool they develop may first be applied only to juveniles at Rikers.

In the meantime, people with significant cognitive disabilities will continue to be missed and end up in the dangerous environment of general population. “In many cases, we’re talking about someone with the intellectual capacity of a five- or six-year-old,” says Neville. “Imagine someone like that in an environment like Rikers.”