How Rikers Island Became New York’s Largest Mental Institution

NEW YORK — One night in fall 2015, an 18-year-old woman was standing on a subway platform in the Bronx when a homeless man named James Dolo came up from behind and used his hands to push her onto the tracks, police said, injuring her.

Jailed on an attempted murder charge, Dolo, then 38, soon was seated in front of a court evaluator for a review of his competency to stand trial. Dolo smelled of urine, the evaluator noted, had described a history of psychiatric hospitalizations and did not seem to understand the gravity of what he was accused of doing.

The evaluator marked him down as unfit, citing schizophrenia, and a judge ordered Dolo committed to a state forensic psychiatric hospital — a secure facility for incarcerated people — to be restored to mental competency. He spent nearly two years there before he was shuttled to a public hospital in Manhattan, then to the city jails on Rikers Island, and then to the forensic hospital again.

Now, eight years later, having never been convicted of a crime in the subway shoving, he is back on Rikers Island, where guards once found him sitting in his own excrement and refusing to eat or leave his cell.

Dolo’s case, which has not been previously reported, illustrates one reason Rikers Island has become a warehouse for thousands of people with psychiatric problems: Many detainees with severe mental illness have moved back and forth between the jails and state forensic psychiatric facilities for months or even years before standing trial. Some have spent more time in this cycle than they might have served in prison had they been convicted.

Records show more than half the people in city custody — some 3,000 men and women — have been diagnosed with a mental illness, and on any given day, hundreds of them are awaiting evaluations or in line for beds at state forensic psychiatric hospitals, with scores more being treated at those facilities.

The competency evaluations are meant to ensure people understand the charges against them and can assist in their own defense. The process of restoring competency is supposed to last no longer than a year. But because of a limited number of beds in state forensic psychiatric hospitals, the grinding machinery of the state courts and the inability of city officials to resolve a long-simmering crisis on Rikers Island, the restoration process for some detainees has dragged on for three years or longer, records and interviews show.

One 66-year-old man awaiting trial on an attempted murder charge, Bernard Derr, has cycled between Rikers and state forensic psychiatric hospitals for 15 years.

“The state has designed a system that on paper is intended to ensure people get treatment when they are found unfit,” said Elena Landriscina, a staff attorney with the Legal Aid Society, which represents indigent people charged with crimes in New York City. “In reality, it is not providing that treatment in a timely way.”

In the jails, mentally ill detainees have been subject to harsh conditions, inhumane treatment and inadequate supervision, records and interviews show. Guards have routinely failed to bring them to medical appointments or court appearances and have often left them unattended, even if they have been flagged as suicide risks.

At least 18 mentally ill detainees have died by suicide, drug overdoses and other causes in the past three years alone.

When detainees do make it to the jails’ medical clinics, they must take their place among a crush of patients clamoring for care. In the face of soaring need, the city agency that provides medical care in the jails, Correctional Health Services, has faltered, leaving overburdened nurses in some psychiatric units responsible for dozens of patients at a time. Other clinic staff members have medicated detainees inappropriately or neglected patients because they were afraid of being harmed by them.

When mentally ill people are released, the jail system is supposed to connect them to housing, treatment and other services to help prevent them from regressing again. But an earlier New York Times review, based on hundreds of interviews and tens of thousands of pages of documents, pointed to widespread failures by the jails to do so.

Rikers Island has long struggled to care for mentally ill detainees, with lapses chronicled in regular reports by court monitors appointed to oversee reforms in the jail system. But the problem has become more urgent. As officials have moved to reduce the number of people in the jails, the proportion of detainees with serious mental illnesses has doubled in the past decade, reaching a monthly average of more than 1,200 earlier this year. Even so, records show, the jails’ specialized mental health units can hold no more than 980 people at a time.

To improve care for mentally ill detainees, city officials have introduced intensive treatment units, therapy programs and other measures in the jails, citing some progress. But jails are not allowed to medicate detainees against their will, and many people refuse to take medicines that had previously stabilized them.

The administration of Mayor Eric Adams has focused on reducing violent incidents on Rikers Island and has rejected calls for a federal takeover of the jails.

The newly appointed commissioner of the Department of Correction, Lynelle Maginley‑Liddie, declined to be interviewed for this article. A department spokesperson said correction officers receive mental health training and work with the jails’ health service to ensure mentally ill detainees are placed in housing areas that meet their needs. He added that, in cases in which detainees miss medical appointments, it is most often because the detainees themselves refuse to go.

Dashawn Carter was living with untreated schizophrenia when he landed back on Rikers Island in spring 2021, accused of stealing Red Bull from a 7-Eleven on Staten Island years earlier and committing robbery and assault in the process.

Carter had to wait five months in jail before receiving a competency evaluation and an additional two months before he was found unfit. He waited two months more for a state forensic hospital bed to become available. In the hospital, he spent nearly six months being medicated and drilled in legal concepts before he was found mentally fit and returned to Rikers in May 2022.

Two days later, in a general housing area where he had been placed despite his long history of mental illness, Carter took a bedsheet, tied it to the window bars in his cell and hanged himself. He was 25.

Carter’s case shows the harm that can stem from the delays that plague New York’s process for evaluating detainees and restoring them to competency.

Competency examinations can be initiated by a judge, defense lawyer or prosecutor, and they typically take weeks or months. The examinations are conducted by two court-appointed evaluators. If the defendants are found unfit and they face misdemeanor charges, they are typically sent to public hospitals, and the charges against them are dropped. If they face felony charges, the law requires them to be committed to a state forensic hospital, where they receive treatment intended only to ready them for trial.

Most are found fit within months. But under New York law, the state can keep mentally unfit people in custody without trying them for up to two-thirds of the length of the maximum sentence carried by the most serious crime they were charged with.

Restoring a person to competency can be costly both in terms of time and money. Since 2020, the state Office of Mental Health has charged more than $1,000 per person per day for such services.

The process also has been marred by mismanagement and political interference, especially in the five years since the Correctional Health Services took over the citywide court clinics.

One forensic evaluator working for the city often struggled in conducting interviews and writing reports, causing delays in cases, according to a letter sent by a whistleblower, Dr. Melissa Kaye, to a jails oversight panel in 2020. Another routinely showed bias against detainees and misdiagnosed psychotic people as malingerers. A third once fell asleep while conducting an exam and, during others, appeared manic, “leading to speculation about drug abuse or mental illness,” Kaye wrote.

A representative of the Correctional Health Services did not respond to several requests for comment.

The jail system has been under intense scrutiny in recent months as a federal judge has weighed whether to strip control of the jails from the city.

Louis Molina, until recently the commissioner of the Department of Correction, said conditions on Rikers Island had improved dramatically under the Adams administration.

But in less than two years in office, Molina also took steps to make the jails less transparent. Earlier this year, a federal monitor said Molina was deliberately concealing injuries and deaths, including those of mentally ill detainees, to make Rikers seem safer than it was.

Months later, Molina was promoted. He is now the city’s assistant deputy mayor for public safety.

This article originally appeared in The New York Times .