Review faults New York City on solitary for mentally ill

NEW YORK -- Mentally ill inmates in New York City's most notorious jail are too often placed in solitary confinement -- in some cases for thousands of days at a time -- a practice that coincides with an increased rate of violence inside the jail, an independent review of mental health standards at Rikers Island found.

The wide-ranging review, obtained by The Associated Press through a Freedom of Information request, is critical of the city's use of solitary as punishment for inmates who by the very nature of their mental illnesses are more prone to breaking jailhouse rules.

About 40 percent of Rikers' 12,200 inmates have some kind of mental health diagnosis, and about a third of those have so-called serious mental illnesses such as schizophrenia and bipolar disorder. Of the roughly 800 inmates in solitary at any given time, just more than half of them are mentally ill.

The report recommends eliminating the use of solitary for mentally ill inmates as a punishment and instead partnering with a teaching hospital to provide intensive therapeutic services. The study was commissioned by the New York City Board of Correction, which has a watchdog role over the city's Department of Correction.

"Since prolonged solitary confinement can cause symptoms of mental illness to appear even in previously healthy individuals, we strongly recommend against imposing it as a punishment for a predetermined duration even on those inmates not deemed to be mentally ill," said New York University psychiatrist and lead author Dr. James Gilligan.

New York is not the only city to grapple with how to manage a growing population of mentally ill inmates -- and its increased use of solitary mirrors trends in big cities such as Chicago and Los Angeles, Gilligan said. As mental institutions have closed over the past 50 years, prisons have absorbed many more of the mentally ill. There are more than three times as many seriously mentally ill people in jails and prisons than there are in hospitals, according to a 2010 survey by the not-for-profit Treatment Advocacy Center and National Sheriffs' Association.

Solitary, also called the hole or the bing, is doled out punitively when inmates break certain rules, seriously assault someone or attempt to hurt themselves. It can be used by prisons to isolate volatile inmates, as a form of suicide prevention and as a form of protective custody.

The review focused on Rikers, a 10-facility lockup on a 400-acre island in the East River, as the Board of Correction pushes for reforms to the way the mentally ill and adolescents are jailed. It described some Rikers units as filthy and vermin-ridden, with cracked linoleum that inmates break off and use to cut themselves.

Over the past six years, the number of solitary beds in Rikers Island has grown by 61.5 percent, from 614 to 998.

Six inmates have more than 1,000 days of 22-hour isolation and one has nearly 3,000 days in the Mental Health Assessment Unit for Infracted Inmates, a two-tiered housing area where inmates are placed in suicide-resistant, single-occupancy cells with cinderblock walls and food slots through which they can be handcuffed and served meals. An assistant commissioner for the city's department of mental health and hygiene once called them "parking lots for people with mental illness."

Most significantly, the report tied this increase use of solitary with rising overall incidents of violence at Rikers Island.

Use of force incidents by correction staff per 100 inmates have more than tripled from seven in 2004 to 24.7 in the first six months of this year. The number of self-mutilations and suicide attempts by Rikers inmates also increased by 75 percent from 2007 to 2012. Mentally ill inmates account for about 60 percent of assaults on staff and fellow prisoners that result in serious injury, according to the city Department of Correction.

Last August, a mentally ill 25-year-old burglary suspect awaiting trial named Jason Echevarria died after consuming a toxic soap ball while jailed in a MAUII cell. His father claims in a $20 million lawsuit that Echevarria was denied medical attention by guards who walked by his cell as he died.

City officials said the Board of Correction review didn't provide a proper context for reform efforts initiated since 2009. They also scoffed at the notion that rising levels of violence could be tied to an increase of punitive segregation beds.

"It was DOC who saw this striking growth in the percentage of the mentally ill in the jails and we rang the bell," city Correction Commissioner Dora B. Schriro said in an interview.

Schriro said she temporarily increased the number of solitary beds in 2010 by more than 200 as a way to address a backlog of solitary sentences while at the same time instituting reforms. The department has developed new sentencing guidelines, introduced nonsolitary punishments like timeouts for nonviolent infractions, and recently opened 80 beds in two new dormitory-style units for mentally ill inmates at Rikers facilities called Clinical Alternative to Punitive Segregation. The MAUII units are to be closed permanently this fall, Schriro said.

Norman Seabrook, president of the city correctional officers' union, said staffing shortages and a lack of special training made it nearly impossible for the officers to provide the kind of mental health services required. But he also insisted putting unruly inmates in solitary was sometimes necessary.

In September, the Board of Correction voted to begin the lengthy process of changing the rules on when solitary can be used for mentally ill and adolescent inmates.

Dr. Robert Cohen, a member of the oversight board, said the way solitary is currently used for mentally ill inmates is something regulators have worried about long before commissioning the report.

"It's not a model that can work," he said.