Lockdown on Rikers by Ms. Mary E. Buser

Author:Ms. Mary E. Buser
Language: eng
Format: epub
Publisher: St. Martin's Press
Published: 2015-08-06T16:00:00+00:00

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By the spring of 1996, New York City was in the throes of a budget crisis. In a cost-cutting move, the city drastically reduced inmate support programs, with the deepest cuts in Social Services. Responsible for handling veterans affairs, social security issues, and funeral leaves, the Social Services Department provided critical personal support to the detainees. At GMDC, these services were whittled down to one person handling the needs of 2,200 inmates. The only thing that was remotely possible was notifying the men of outside family deaths.

The gutting of Social Services stoked anxiety among the Rikers health-care staff—medical, mental health, and pharmacy workers, all of us employees of Montefiore Hospital. Montefiore had assumed the Rikers contract back in 1973, when the city was desperate to comply with a court order to provide a minimum standard of care to detained inmates, and no other hospital would do it. The contract was quietly renewed at three-year intervals for the next twenty years. The white lab coats with the Montefiore patch, worn by close to a thousand jail-based hospital workers, seemed as permanent as the jails themselves. But things were changing. The new profit-driven approach to health care was making its way to the gates of jails and prisons. Valued at hundreds of millions of dollars, the Rikers contract was now being eyed as a moneymaker. For the first time, the city was in a position to choose among an array of vendors.

Anticipating competition, Montefiore sought to demonstrate its ability at capping costs. For us, this resulted in the creation of the “Mental Health Center.” A step up from the standard Mental Observation Unit, this 350-bed facility was designed to provide a higher level of care to the most severely mentally ill. In the past, inmates who couldn’t be stabilized were transferred to the prison wards of local hospitals at great cost. Now, all such referrals would be to the on-island Mental Health Center instead. If a hospital transfer was still necessary, it was done sparingly and at the sole discretion of the new facility. The opening of the Mental Health Center was greeted with fanfare as the largest jail-based psychiatric facility in the country.

But while everyone was buzzing about it, I paid little attention, keeping my head low and focusing on a demanding caseload. Roughly two-thirds of my cases were from GP, with the remaining eight or nine from our Mental Observation Units. Our mission with the mentally ill was to get them stabilized and, hopefully, discharged back to population. Since medication could not be forced, the initial challenge was to persuade someone in the throes of psychosis to start taking it, which could be quite a daunting task. This is what I faced with a twenty-one-year-old schizophrenic named Michael Tucker. When I first approached Michael, he was sitting in the corner of the dayroom, disheveled and mumbling to himself. I was only able to make the faintest of eye contact with him. Conversation about anything, much less medication, was hopeless.

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