The United States incarcerates more people than any other country in the world— over 2.2 million individuals are currently incarcerated in prisons and jails. This number increased by nearly 500% since the 1980s. One factor contributing to this drastic increase in incarceration is the mass deinstitutionalization of mentally ill persons, which first began in the 1970s (Gainsborough & Young, 2002). Of the 10 million individuals who are arrested and detained in the U.S. annually, almost 1 million have a history of mental illness and are either experiencing mental health symptoms or are in need of psychiatric intervention. The majority also have current or past histories of co-occurring mental health and substance use disorders (U.S. DOJ Special Report, 2006).
In 2004, Brad H. v. City of New York, a landmark New York State Supreme Court case, ordered that discharge planning services be made available for all people in prison who require psychiatric care (Barr, 2004). While this decision is a step in the right direction toward ensuring discharge planning for people in prison in New York City jails, the effort falls short of addressing the mental health needs for incarcerated persons. In addition, the decision does not address post-release mental health services.
One of the biggest problems that contribute to recidivism among mentally ill individuals in New York City is the lack of supportive housing services upon release. The shelter system is overwhelmed with residents who are mentally ill. Overcrowding and lack of supportive services exacerbate the challenges already faced by those in need of mental health services. In addition, a large percentage of the homeless population who sleep in New York City shelters each year suffer from mental illness, addiction, and co-occurring disorders (Coalition for the Homeless, 2016).
Given these challenging circumstances, it is clear that discharge planning is an essential component to successful reentry for mentally ill individuals. In contrast to the procedures that were in place only a few years ago (where incarcerated persons were dropped off at Queens Plaza with $1.50 and a Metrocard), the discharge planning unit at Rikers Island now makes an effort to engage every individual who identifies as being in need of psychiatric services in the discharge planning process upon their intake. In addition, The Fortune Society’s Individualized Corrections Achievement Network (I-CAN) program provides skill-building and discharge preparation services to eligible men and women during their incarceration at New York City Department of Corrections jails, and continues to provide reentry support following their release. While the Brad H. v. City of New York decision requires Rikers to provide these services, an incarcerated person can decline these essential services if they do not disclose having a mental illness. Because discharge planning is strictly voluntary, many incarcerated individuals decline services due to the false notion that if they declare the need for mental health services, they will be incarcerated for a longer period of time.
At The Fortune Society’s newest mental health program, the Court-Based Intervention Resource Team (CIRT), staff often discover that clients are unaware of the mental health services available to them while incarcerated. In addition, the CIRT team also identified that incarcerated individuals believed that receiving mental health services while inside would result in a delayed release. Once a client who received mental health care in jail is released from court, CIRT staff enrolls them into community-based mental health and case management services. We have seen firsthand the positive outcomes that result from individuals engaging in mental health care who receive positive reinforcement and support from case managers specially trained in providing mental health supportive services.
So, how do we make headway in increasing the number of individuals who are connected to mental health services? First, we simply need to increase engagement attempts during an individual’s incarceration. Providing informational sessions, both during and after incarceration, that outline all of the mental health services available is our ideal first step to increase engagement. In addition, we must continue to make it clear during the intake process, as well as during the on-going informational sessions, that disclosing a mental illness will not lead to an increase in jail time.
The stigma associated with mental illness further derails incarcerated people from seeking care, and we must do all that we can to eliminate this stigma. Creating housing areas (not the Mental Observation unit) for individuals who are engaged in mental health services would provide a safe and supportive environment, where people would not feel as if they were the only person experiencing a mental health illness. Furthermore, people with mental health issues should be forbidden from being solitarily confined, as isolation would lead to further trauma and stigma felt by an already vulnerable population. Incarcerated individuals with mental health issues requiring isolation from the general incarcerated population should be moved to a clinical setting rather than isolation, which would minimize the trauma associated with incarceration.
While mental health care during incarceration is essential, the overarching need for it occurs prior to a mentally ill individual being arrested and subjected to a period of incarceration. That need is safe, affordable, and supportive housing. Housing is the first step toward a successful reentry and takes priority above all other needs, i.e. addressing substance use, lack of education, and lack of employment. A person cannot truly stabilize his or her life without having a safe place to sleep every night. In lieu of providing an individual with housing contingent upon their engagement in treatment, Fortune provides individuals with supportive services and encourages them to engage in treatment as a choice– which often results in their maintenance of housing long-term.
Until we can supply sufficient housing and supportive services for the mentally ill, the homeless population in New York City and the number of mentally ill incarcerated persons at Rikers will not decrease. As a result, intake and discharge planning services, both while individuals are incarcerated and upon their release, will continue to be crucial components in addressing this problem. By increasing staff trainings and providing informational sessions that educate both incarcerated people and Correctional staff about mental illness, discharge planning efforts can be maximized, benefiting individuals, their families, and the community. Inter-agency cooperation and strategic planning efforts are crucial to increasing the quality of life for all mentally ill individuals, while simultaneously elevating the public safety of New York City residents. It is society’s responsibility to decriminalize mental illness, and we can only do so by joining forces and advocating for change.