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Mentally Ill, Chemically Addicted - And Stuck In Jail

by Sue Young Wilson, Nov 14, 2003
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When Prisoners Come Home, Gotham Gazette's Social Services topic page update for January, painted a disturbing picture of how much support released prison and jail inmates need to have a chance at productive lives on the outside, and how little New York City and New York State tend to give them.

Now, several legal advocacy groups, including the New York-based Urban Justice Center and the Legal Aid Society of New York, are pointing out how the state fails one of its most vulnerable and fragile groups of newly released prisoners - those with both serious mental illness and a substance abuse problem. On October 21, the groups filed a federal lawsuit on behalf of the hundreds of seriously mentally ill New York City parolees who their advocates say are unfairly denied community-based mental health and substance abuse services each year, often remaining in jail for many additional months for no more reason than a lack of community treatment slots that they can be referred to.

The suit charges that the state is illegally discriminating against these "dual-diagnosis" parolees -- who are mentally ill as well as having substance abuse problems -- because there are many more residential treatment programs available for parolees with substance abuse problems only; and these parolees are typically released days, not many months, after state officials agree they need treatment and not more jail time.

Dually-diagnosed parolees are generally only eligible for so-called MICA (Mentally Ill, Chemically Addicted) programs, of which there are far fewer in the city. Empty beds in these programs are a rarity. One of the key aims of the lawsuit is to force the state to increase the number of, and parolees' access to, these programs.

Currently, the filers of the suit say, a typical scenario involves a mentally ill parolee returned to jail - and then warehoused there -- for minor parole violations, such as missing appointments with their parole officers. The complaint claims that these violations are typically related to, if not directly caused by, the parolees' mental illnesses and co-existing substance-abuse problems. Even when, as frequently happens, their state parole officials decide that release and treatment for these parolees' illnesses would be more appropriate and effective, as well as better serving the interests of justice, than additional jail time, the re-imprisoned parolees tend to languish in jail for months waiting, often in vain, for one of the handful of state-funded treatment beds in the community that they might qualify for.

"I've met people who've had to wait a year to get out of jail again, even after their parole officers have determined that they need community treatment, not more jail. Six to nine months' wait is typical," said Heather Barr, an attorney with the Urban Justice Center. "And often in the end they don't even get the community beds they were waiting for - they're just released - eventually -- because no beds have come open. And then they end up back in jail for more parole violations that probably would have been avoidable if they'd gotten some help out there.

"And I've seen people who actually have to be kicked out of jail in the end, because they might be getting some kind of treatment in there, maybe psychiatric medications and some observation, which is better than nothing. Have you ever been to Rikers Island? It's a horrible, horrible place, but people have so few options, and such bad options, that even a cell in Rikers seems like something. They know they need continuing and/or better treatment and support to function outside in society, and there just is no treatment for them out there. There's no bed; there's no hope of a bed."

Barr said that there are probably a couple of hundred Mentally Ill Chemically Addicted beds in the city, but almost all are full at any given time. And parolees are discriminated against for admission, either deliberately or by default, she said.

"For instance, on one day this past September, there were 18 MICA beds open," Barr said. "Now, twelve of those beds were at places that won't accept parolees - they demand on-site interviews for admission and won't allow telephone interviews, and people in jail can't get to the places to be interviewed. That leaves six beds total for all the homeless people with mental illness and substance abuse problems, people with addiction problems just discharged from the psych wards, and so on, in New York City. And there's a big focus on providing treatment beds for the homeless, which is great, except parolees usually can't qualify on those grounds -- the rules say that if you weren't homeless before going to jail, you're not considered homeless for treatment-eligibility purposes -- even though many if not most of them have no place to live anymore when they get out of jail, which is pretty typical."

As for how these extra beds are to be paid for, Barr notes that it costs $70,000 a year to keep someone locked up at Rikers Island, but only about $12,000 to provide them with a year of residential treatment at a Mentally Ill Chemically Addicted program.

She says she's optimistic the coalition will win the suit - eventually. "Some of these cases can drag on for years," she said. "But it's so clear, in this case, that the state is denying people with specific disabilities the same care as others, like people with just substance-abuse problems, that we pretty much have to win. That's illegal. It violates the Americans with Disabilities Act, among other things."

The full text of the complaint (in PDF format)is available on the Web site of the Washington, D.C.-based Bazelon Center for Mental Health Law, another of the groups that filed the suit against Governor George Pataki and other New York officials.

The complaint is being brought specifically on behalf of two incarcerated parolees, William G. and Walter W., and the class that they represent of mentally ill parolees in New York City jails waiting for community treatment. The parole officers of both the two recommended MICA treatment for their serious, long-term mental illnesses (schizophrenia and major depression, respectively) with accompanying substance abuse problems. But the two have remained at Rikers respectively for seven and nine months to date, while they wait for the elusive MICA beds to open up. For Walter W., indeed, the wait could well be too long - the state's parole hearing officer in charge of Walter's case, while he agreed back in May that such treatment is the most appropriate option for Walter, has also said that if no such bed opens up, Walter will be sentenced instead to time in a state prison.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

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