It was with a renewed sense of spirit that I arrived at the Mental Health Center, home to the city jail system’s most severely mentally ill inmates. This facility was based in a large wing of the Anna M. Kross Center (AMKC), Rikers’ largest jail. Though it was only across the road from GMDC, as I sat in my new boss’s office I already felt like I was in another world. Unit Chief George Davis was a balding, serious man. Joining us was the chipper Karen Doyle, one of two clinical supervisors. An oversized bulletin board listed the staff, over two dozen psychiatrists and clinicians. The place was huge! Karen smiled and pointed to my name, which she had inked in underneath George’s. I felt a flush of pride at the words: “Assistant Unit Chief.”
“We’re something of a MASH unit,” George explained. “We treat the sickest of the sick—that’s all we do, Mary. Buses pull up at all hours of the day and night from the other jails, and they come across the bridge from the borough houses. It’s our job to get them stabilized and returned to their own Mental Observation Units.”
“And as quickly as possible,” added Karen. “A big part of our job is to make space for incoming patients. We have 350 beds, which may seem like a lot, but it’s never enough.”
George suggested a tour, and as Karen resumed her paperwork, we stepped out into the wing that housed most of the Mental Health Center’s patients. “We operate a total of seven houses,” George explained. “Three dorms, four cellblocks. Five houses are in this wing; the other two are in the main jail. We even have our own clinic here, just for our patients.”
The clinic, known as Hart’s Island, was our first stop. “Believe it or not,” said George, “it was named for Hart Island.” Located a little farther up the river from Rikers, the mile-long Hart Island serves as New York City’s potter’s field. “There’s a lot of folklore on Rikers, but no one knows who named our little clinic and why it stuck, but it has.”
Inside the curiously named clinic was a battered and clouded Plexiglas “waiting room” where a huddle of raggedy patients coughed and shivered. Since it was count time, a CO stood in front of the window, ticking them off on her fingers. “I got nine bodies in here!” Even though the Mental Health Center was home to the “sickest of the sick,” it was still jail, and with misery etched on their faces, these patients sat passively, seemingly inured to the indignity of being counted like cattle.
A second, smaller pen served as the psychiatric waiting room, with three patients inside. “They were just bused in,” George explained. One man was singing and rapping his hand against the window, while a rumpled older man paced back and forth. The third was curled up on the floor.
Next to the pen was the “on call” office, which was staffed twenty-four hours a day by a psychiatrist. The presiding doctor that morning was Dr. John Toussant. “Welcome aboard,” Toussant smiled when George introduced me. “Three new arrivals,” he said, pointing to the pen. “The older guy who’s pacing, I just gave him a shot of Haldol. He should start calming down pretty soon, and then we’ll get him over to the new admissions dorm.”
“Sounds good,” said George.
“Aaagghh, nothing wrong with that guy!” said a dour officer seated at a nearby desk.
“Putney!” George smiled. “Mary, I’d like you to meet Officer Putney. Not much happens around here without Putney!”
I extended my hand to a squat officer with a whiskered chin. But Putney simply glared at me. “There’s a lot of knuckleheads in here, nothing wrong with ’em!”
“Oh, come on, Putney,” George chided. “A lot of these guys are very sick, and you know it.”
“Yeah—and a lot of ’em ain’t.”
George didn’t have to explain this scenario to me. It was an all-too-familiar example of the tension between the Mental Health staff and the Department of Correction when it came to the mentally ill. For the most part, DOC was of the view that the mentally ill were faking it. They made their own frank assessments, which they were only too happy to share. To us, the mentally ill are patients; to them, they are inmates. To us, they are sick and often misunderstood; to DOC they are manipulators who are always trying to “get over.”
With a wink from Toussant and a grunt from Putney, George and I departed Hart’s Island. Across the hall was the new admissions dorm, which George explained was a temporary way station for the newly admitted. “Treatment begins here, and we also do a more in-depth evaluation before we move them into one of the other houses.”
Inside the dorm, most of the patients were still dozing in their cots; others milled around in various states of dress, toothbrushes and soap in hand. A scruffy older man looked around with wide-eyed newness, awakening not just to the day but to lucidity. It was a familiar scene, complete with the morning cigarette haze, not at all unlike the Mental Observation Units at GMDC. In a little while, food wagons would arrive with lunch trays, and nurses would push in pharmacy carts laden with medication. The patients would line up for meals, and line up again for their Dixie cup full of pills. After that, there would be group therapy and maybe a staff-supervised game of bingo.
Off to the side were two small offices where Mental Health workers were meeting with the earlier arrivals. “We have a clinical meeting at eleven o’clock every morning, and they’ll report on the newcomers,” said George.
We then checked in on four more houses, which were more of the same—the jail system’s sickest inmates rousing to another day of life and treatment behind bars.
Our only remaining business was a visit to Lower 1 and 3, the two houses not contained in our wing. “Hope you’re up for a walk!” George said.
At the end of the wing, an officer unlocked the barred gate that separated our unit from the main jail. We stepped into AMKC’s wide hallways, which were buzzing with morning activity. Navy blue–uniformed COs, two and three abreast, strode confidently down the corridor while a smattering of inmates, passes in hand, hurried along in a more subdued manner. The “beep-beep” of a motorized golf cart alerted us to step aside as an intent-looking CO with two captains aboard maneuvered through pedestrian traffic and zipped down the hall. A parade of linen wagons rumbled by, powered by white-uniformed inmate workers. Another crew swabbed the floors using string mops overly saturated with the jailhouse standard: pine-scented disinfectant.
We walked through seemingly endless corridors that narrowed down to thin passageways. Over the years, in order to accommodate a growing inmate population, the jails were enlarged using prefabricated extensions that resulted in mazelike structures, and this trip to Lower 1 and 3 revealed this haphazard design. We kept going until we reached a remote section of the jail. Finally, big black lettering spelled out “Lower 1 and 3.” Its old oak doors reminded me of an elementary school classroom, except the panes of glass were cracked or missing altogether. With no electronic buzzers here, George pounded the door and a bored CO meandered over with his big key. When he pulled the door open and we stepped in, I was stunned by the deplorable condition of the house. The damp cinder-block walls were mottled with mildew, and wide swaths of peeling paint hung perilously over our heads. Two dreary dayrooms sat empty.
Tentatively, I followed George down a dimly lit tier. Upon peering into the cell windows, it was immediately obvious that these patients were much sicker than the men back in the main wing. Some were pacing and muttering; others, clothes in tatters, lay still on their narrow cots. A few yelled out to us, trying to get our attention, but it was hard to discern real concerns from psychotic rants. One man with a matted beard stared straight ahead through the window of his door, chanting, “My wife’s a millionaire, but my hat doesn’t fit!”
“Shouldn’t they be sent to the hospital?” I asked George.
George shook his head. “Things are different now. Hospital runs are expensive.”
“So what do we do? How do we treat them?”
“We wait. Even without meds, they often cycle in and out of psychosis, and when they straighten out a little, we try to persuade them to take the meds. A lot of times it works.”
“Seems kind of primitive.”
George shrugged.
I felt a terrible sadness for these tormented souls who’ve so long been misunderstood. Centuries ago, their odd behavior was attributed to possession by demons, and the afflicted were treated accordingly. Other horrible myths took hold, such as the belief that the mentally ill are impervious to temperature extremes and therefore were denied heat during the winter and chained to the walls of cold, dark asylums.
More recently, large state psychiatric hospitals took over the age-old problem of caring for the mentally ill. But over time, even these hospitals deteriorated and needed to be shuttered. With the advancement of powerful antipsychotic medications, the new hope was that mental illness could be managed with medication and supervised community housing. But that second, vital component—the supervised housing that the mentally ill needed and their families yearned for—never materialized, and medication alone often is not enough to support an independent life. Instead, massive numbers of mentally ill remain in a chronic state of psychosis, rendering them unable to attend to the simplest demands of daily living. In the absence of some kind of intermediary supervised care, they live on the streets, shuffle between family members, get into petty mischief, and wind up in jails and prisons, the new caretakers of the mentally ill.
While we waited for the CO to let us out, I couldn’t help but think that despite all the recent breakthroughs in the treatment of mental illness, this dungeon-like facility of Lower 1 and 3 made it seem like we hadn’t come very far at all.