Despite Central Office’s insistences to the contrary, health-care services on Rikers Island were deteriorating, and nowhere faster than at the Mental Health Center. My initial hopes of supporting the staff in a meaningful way fell by the wayside as my job was reduced to a scramble to plug empty shifts. My interaction with the overworked staff amounted to settling squabbles and serving as a sounding board for tearful outbursts. Most were already doing double shifts, yet we were forced to borrow staff from other jails. But our biggest problem was a shrinking psychiatrist pool. As doctors resigned through normal attrition, there was a long lag in replacing them. St. Barnabas was trying to replace these physicians—most of whom had limited licenses—with fully licensed doctors. The limited license doctors, the medical backbone of Rikers Island, were mostly foreigners. Like Alex, my former beau, they needed to pass stringent exams to become fully credentialed here. While they studied, they practiced medicine under provisional state licenses. This arrangement had worked well for years, providing the jails with a steady stream of physicians. But in their zeal to snare the contract, St. Barnabas had naively agreed to utilize only fully licensed doctors. For fully licensed doctors, with a wide array of employment options, jail is simply not an appealing workplace.
Undaunted, Central Office was having some recruiting success with moonlighters, fully credentialed psychiatrists looking to make extra money working overnight shifts. While their presence provided badly needed coverage, the presence of these anonymous late-night doctors only added to an overall sense of fragmentation. But worse, their arrival had unexpectedly dangerous consequences.
One morning, I got a call from a housing officer, reporting that a schizophrenic named Josiah Parker wasn’t bathing and was behaving erratically. “I’m afraid he’s going to get jumped,” the officer warned.
When I arrived at the dorm to investigate, the patients were up and about, having just finished lunch. The remains of the meal still lay on the plastic trays. Somehow, the food never managed to resemble the mouth-watering fare depicted on the menu taped to the bubble window. Although standard and kosher meals are offered, both managed to look exactly the same: brownish glop, seasoned with packets of ketchup, washed down with the standard jailhouse beverage—Kool-Aid.
Wearing an array of hats, caps, and do-rags, the patients were returning trays to the food wagon, lighting up cigarettes, and milling around. A few talked on the phones, others waited their turn. In the dayroom the TV was blaring, and wet clothes were spread out on plastic chairs to dry (clothes were washed in buckets of water). A few of the more health conscious were doing push-ups. Contrary to popular jail folklore, I never saw a weight room or extravagant recreational facility at Rikers. In terms of outdoor recreation, some of the newer jails maintained spacious, evenly cemented yards with basketball hoops, but the older jails offered nothing more than small patches of grass and broken cement set aside for “recreating.” Although entitled to one hour of outside “rec,” not every house goes out at an optimal time of day. The rec time slot for this dorm was 7 a.m. Due to the early hour, most never made it outside at all, especially during the winter.
With lunch just finished, one of the highlights of the day was over and the patients were already curling back up in their cots. A common strategy for surviving jail was to try to sleep away the months between court appearances.
I was disheartened to see that nothing therapeutic was going on. The interview rooms were empty, and the scene throughout the day would differ little from this. Ordinarily, each patient would have had two mental health sessions a week, one with a clinician and the other with a psychiatrist, buttressed by daily group therapy. But now, all group therapy had ceased, and instead of being seen by both a psychiatrist and clinician, each patient was being seen just once a week—either by a clinician or by a psychiatrist, and the contacts were brief. The therapist had little time for more than a quick superficial dialogue, and the psychiatrist an even quicker medication renewal. Even worse, because we were borrowing staff from other jails, the patients rarely met with the same person. Although these contacts kept the treatment in compliance from an auditing perspective, quick encounters with different faces could hardly be called therapy. Far from a higher level of care, the Mental Health Center now provided the skimpiest care possible.
Since our staff presence in the houses was scarce, as soon as I arrived, I was surrounded by a sea of anxious faces with complaints ranging from medication side effects to requests for a return to GP. I jotted down names and issues.
At the head of the dorm, just outside the bubble, three cots were outlined by red tape on the floor. These were “enhanced suicide observation” cots, designated for those at high risk for suicide. Seated on the edge of a cot, a youth quietly wept, a thick pinkish scar circling his neck, indicating a previous hanging attempt.
I walked over to him. “What’s wrong?” I asked.
He looked up at me sadly. “My mom’s in the hospital and she’s doing bad. She got sugar.”
“Sugar” meant diabetes, which was rampant among the inmates and their poverty-stricken families.
“I need to make a long-distance call to talk to her. She’s in a hospital in Jersey. I need to talk to her—she could die. How can I get to Social Services?”
Another anguishing situation. I had to tell him that Social Services was virtually nonexistent. Although we’d been able to arrange long-distance phone calls at GMDC, here we didn’t have the same phone setup, so I was unable to help him with this. But I did tell him I’d pass his name on to the “Social Services Department” just in case something could be done. I also made a note to have his clinician and doctor check on him.
He wiped away the tears and thanked me.
Stepping away, I practically bumped into two young Latinos who’d patiently waited their turn. “Miss, look!” said the older, shorter one, pointing to his skinny sidekick. This was a translator situation, another common scenario. He chattered a quick command in Spanish, and his pal whipped up his T-shirt to display a gaunt rib cage, complete with a gunshot scar. “You see that?” said the shorter one. “He’s losing too much weight! He needs to see the dietician so he can get double portions of food.”
The dietician was just as overworked as the Social Services worker, but, regardless, I informed the inmate of the procedure. “Tell your friend to go to the clinic, and if a nurse or doctor says there’s a problem, then they’ll refer him to the dietician. They’re the only ones who can make the referral.”
“Oh, okay, miss, thank you.” He translated the information back to his friend. The younger patient, who couldn’t have been more than nineteen, backed away, bowing and muttering, “Gracias, gracias.”
At the rear of the dorm, a foul smell was growing stronger, and I traced it to a rumpled-up patient who had to be Josiah Parker.
“He stinks,” shouted one of his neighbors, who was holding his nose. “It’s horrible to have to sleep next to him. He’s up all night looking around the floor for cigarette butts.”
“We take our meds, but he doesn’t. Can’t you get him out of here?” said another.
Parker, completely oblivious, continued his dialogue with no one.
“I’ll take care of it,” I said, pulling out a transfer form. He would probably wind up on the miserable Lower 1 and 3, since that’s where we always seemed to have spare beds.
I was just finishing up the form when I noticed an older man who’d stood back, waiting to speak with me alone. With a cautious expression, he drew me away from the cots. Satisfied we were out of earshot, he whispered, “There’s a gang in here and they’re terrorizing everyone. They’re taking commissary money, threatening to beat up anybody who doesn’t do what they say, and they’re running around at night torturing the really sick guys. You see that guy, Parker?”
“Yes,” I nodded. “He’s going to be moved out of here.”
“Good, ’cause last night while he was sleeping and his feet were dangling off the bed, they were lighting matches and burning his toes. Everybody’s afraid to go to sleep, that they’re gonna get set on fire. It’s really scary in here, especially at night.”
“What’s the CO doing while all this is going on?” I asked, already knowing the answer.
“Are you kidding? He isn’t even on the floor. He’s in the bubble sleeping and nobody better wake him! Even if you wanted to, nobody wants to be a snitch.”
“Snitch” is the lowest form of jail life. “Snitches get stitches” is the oft-quoted, self-explanatory jailhouse mantra, and I knew this man was taking a big chance just talking to me about this. When I asked him to name the culprits, he didn’t hesitate, nor was I surprised, as their names were always popping up as problems at our clinical meetings. I thanked him for the information, which gave me new ammunition in our efforts to discharge them.
I left the house with a growing sense of helplessness. There were so many moments when I’d felt frustrated by my inability to do something for those in a horrible predicament, such as the patient who couldn’t make a simple call to his gravely ill mother. And then there was the kid who didn’t speak English. I was sure he was Dominican; Rikers was full of inmates from the Dominican Republic. Through my sessions with them, they’d described impoverished lives in their native country, of growing up hungry with no medical care, of tapeworms and dilapidated shacks that flooded every time it rained, of no education, no government assistance—just poverty, sickness, and despair, with zero possibility for anything more. With nothing to lose and high hopes for America’s opportunities, young Dominicans flocked to the United States in droves in the early 1990s. With legitimate jobs hard to come by, many resorted to drug trafficking. Despite their plans to make fortunes and return home as heroes, the drug trade usually only led to draconian sentences in US prisons, or a return home in a coffin.
What especially bothered me was that the jails were filled with so many ordinary people who simply had been born into circumstances that most of us couldn’t begin to imagine, and they were just trying to survive. I constantly tried to figure out the whys and wherefores of life’s gross inequities, but it was futile. But the one bright spot for me was always the valuable human attention we provided through our mental health support. In relating to these people with dignity, care, and respect, we were water on arid soil. But now, with all this cost cutting, even that was being chipped away. Maybe from a bean-counting perspective this fragmented style of care was working out well, but from the standpoint of anything meaningful, I feared that all was being lost.