Doctors Council Testimony on Mental Health at Rikers Island

Before the Committee on Fire and Criminal Justice Services; the Committee on Public Safety; the Committee on Courts and Legal Services; and the Committee on Mental Health, Developmental Disability, Alcoholism, Substance Abuse and Disability Services

May 12, 2015

Good Afternoon Committee Chairs and Council Members.  My name is Dr. Frank Proscia and I am the President of Doctors Council SEIU which represents thousands of doctors in the Metropolitan area, including in every HHC facility, the New York City Department of Health and Mental Hygiene, New York City School Health Program, and New York City jails including Rikers and Vernon C. Baines Correctional Barge. Thank you for the opportunity to testify today.

As we know, individuals with behavioral health issues comprise an increasingly larger percentage of the total number incarcerated at Rikers. In recent months, the Council and the Administration have introduced various measures and funding streams to address mental health issues in the criminal justice system and Doctors Council SEIU applauds those efforts.

Our doctors working at Rikers Island are keenly aware of the mental health issues on the island. Put simply, even with new programs and housing units in place, detainees with behavioral health issues at Rikers are underserved because of significant shortcomings in medical staffing. For example, there are currently 13 full time vacancies for psychiatrists on Rikers Island out of 50 full time positions – that’s a 26% shortage. In recent years, 6 full time psychiatrist positions have been cut by Corizon. Today, there is only one overnight psychiatrist available for the whole island.

What does this mean in practice? Our psychiatrists have reported they are unable to spend significant amounts of time with patients.  Also, detainees with behavioral health issues sometimes act out in clinical settings, especially with long wait times, becoming agitated and making the visit more challenging for the detainee and the clinician.

Access to mental health services and general medical care is critical. It is unacceptable that in some cases, only 50 percent of detainees in need of care are actually seen in the clinics.

Doctors Council has spoken frequently about the workplace safety issues that can arise from these dynamics. DOC, DOHMH, and Corizon all have a role to play in establishing better protocols for the transport of detainees and the physical plant conditions that can ensure workplace safety in clinics.

Just as important as staffing is the inclusion of front-line doctors in decision-making in assessing new programs and protocols prior to putting them in place by DOC. Doctors at Rikers very much want to be part of conversations about how better to handle detainees with behavioral health issues.

We were pleased to see a bill introduced last week by Council Member Gibson, Intro 0770, a proposal requiring that the DOC establish a crisis intervention program. Our doctors are ready, willing and able to weigh in on protocols to improve across agency responses to crises. We recommend that the doctors at Rikers Island, especially the psychiatrists, be included in the course of planning and training of others for the crisis intervention teams.

Our doctors have echoed the call for expansion of certain services such as drug treatment and detox programs. Furthermore, access to any mental health programs, services or housing units ought to be considered with translation services in mind. For many detainees, English is their second language.

Doctors Council commends the culture of change that has made alternative housing programs like CAPS possible. We also applaud the administration’s funding proposal to provide psychiatric assessments and after-school therapeutic arts programming for all youth under 21 and substance abuse programming for 16-21 year olds. We recommend more of the same in the adult population.

Culture may be the most challenging aspect of reform at Rikers.  Our doctors are absolutely committed to everyone’s safety, and realize the necessary balance of restrictive techniques in a correctional setting along with appropriate medical follow-up, psychiatric counseling and medication management. A culture change though difficult is necessary and possible.

Lastly, an important piece of this discussion should be around continuity of care. We all know the disturbing statistics about prisoner reentry among individuals with mental health issues. We believe discharge services can be better coordinated with HHC directly without subcontracting for outpatient psychiatry. In-jail teams should be trained to connect detainees with local HHC facilities and offer information about enrollment into Metro Health Plus which is HHC’s insurance program.

Thank you for the opportunity to testify today.