Incarcerated Individuals With Mental Illness Need More of Psychiatry’s Attention

APA’s 2024 Annual Meeting in New York City was held on May 4 to 8. As a chair of the General Sessions Subcommittee of the Scientific Program Committee, I had the opportunity to organize and participate in an “edutour” of the Rikers Island jail and learn about its mental-health services through NYC Health + Hospitals/Correctional Health Services (CHS).

Prior to the edutour, Danielle Kushner, M.D., and Elizabeth Ford, M.D., chair of APA’s Workgroup on Correctional Psychiatry, as well as Derrick Stroud, a social worker with lived experience, shared their experiences in correctional (carceral) psychiatry, a subspecialty of community psychiatry.

Three jails in the United States are the nation’s largest mental-health service providers, one of which is Rikers Island. Despite working in a correctional facility, I was apprehensive about what I would witness. After all, Rikers Island often makes headlines for allegations of abuse and system failures. After stepping onto the grounds of Rikers Island, I immediately began to gain an increased understanding of the facility and never stopped learning until I departed. Rikers Island is not just one jail but a complex consisting of eight jails. These facilities hold individuals awaiting trial, those accused of violating parole, and those serving a sentence of less than one year.

While our group experienced minor inconveniences such as undergoing background checks, submitting two IDs weeks prior to our visit, and chartering a vehicle to transport us to and from the complex, we were well aware of our privilege, as friends and family members of individuals in custody often take two or three buses and travel many hours to reach the island. After our identifications were verified, we boarded CHS vehicles that transported us to a staff trailer. There, in a session led by Joseph Otonichar, D.O., we were educated about the daily routine of Rikers Island patients and the extent and variety of mental-health services available to them, including services located at Bellevue and Elmhurst hospitals. We then broke into three groups, each visiting one of the eight jail facilities on the island. My group visited Rose M. Singer Center (RMSC), the facility for women ages 18 years and older.

At RMSC, once again our IDs were checked. Dr. Kushner escorted our group through the facility along with a social worker and a correctional officer. We encountered patients who had committed petty crimes but were in custody because they could not meet bail. Each person appreciated our interest and concern and expressed a desire to live different lives upon release. Our visit included a stop at the mother and baby unit, where select mothers can live with their babies for up to one year after birth.

After our tour, the entire group came back together to share our impressions. Collectively, we vowed to increase our efforts to advocate for justice-involved patients and their community, but what is possible when the criminalization of mental illness is so complicated and widespread?

APA is the oldest national medical organization in the country. Its mission includes the promotion of “universal and equitable access to the highest quality care for all people affected by mental disorders, including substance use disorders.” For decades, as an organization and individual members, we have advocated for mental health parity and improved access to care across the board, but we need to do more for incarcerated people with mental illness. Correctional facilities are severely underserved, and people of color—who are greatly overrepresented in these facilities—again bear the brunt of health-care inequities.

We must all do more to advocate for change. I call on you to advocate for the men, women, and youth in custody and their families. There are many ways to advocate or get involved, including accepting a full- or part-time position to provide direct clinical care; educating trainees about correctional psychiatry; increasing your understanding of the experiences of individuals in custody; working with our organization to advocate for increased access to mental health care, early-detection and prevention programs, diversion programs, and increased trauma screening; and offering ongoing education to our members.

Visit https://www.psychiatry.org/psychiatrists/advocacy to become involved now or donate to APAPAC. The staff of APA’s Division of Advocacy, Policy, and Practice Advancement is eager to provide information and connect you to your members of Congress. ■