How Rikers Island Became New York’s Largest Mental Institution

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 both hands to push her onto the tracks, the police said, injuring her.

Jailed on an attempted murder charge, Mr. Dolo, then 38, soon was seated in front of a court evaluator for a review of his competency to stand trial. Mr. 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 Mr. 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, and 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.

Mr. 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 that 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 that 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, thanks to 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. One man with a history of psychiatric hospitalizations had missed 26 medical appointments in seven months when a guard left him unattended in March 2021. He wedged his head through his cell’s food tray slot, asphyxiating himself.

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, interviews show.

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 unraveling again. But an earlier 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 spokesman said that 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.

At a news conference earlier this month, Ms. Maginley‑Liddie did not directly answer questions about her plans to ensure the safety of mentally ill people in the jails.

“With mental health, we’re going to continue to work with our partners,” she said, “to ensure that people get the appropriate care that they need when they come into custody.”

Back and forth

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.

Mr. Carter had to wait five months in jail before receiving a competency evaluation, and another 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, records and interviews show.

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

Mr. 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, records and interviews show, 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 whistle-blower, 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,” Ms. Kaye wrote.

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

Once a detainee is determined to have become mentally fit, the defendant is supposed to be given a court hearing as soon as possible. But things have not always worked out that way.

It was April 2019 when a homeless man named Michael Nieves arrived on Rikers Island, charged with arson and other crimes after he was accused of breaking into an apartment in Upper Manhattan and starting a fire. Diagnosed with schizophrenia, Mr. Nieves underwent a competency exam that summer and was found unfit because, the examiner wrote, he bore visible injuries from recent attempts to harm himself and had said that, even under the effects of antipsychotic drugs, he still was hearing voices.

Eight months after his arrest, he got a bed at Mid-Hudson Forensic Psychiatric Center, where he steadily improved until April 2020, when he was deemed fit and returned to Rikers Island.

But the courts were reeling from the pandemic, and Mr. Nieves still had not gone to trial that November, when, off his medications in the Bellevue Hospital Prison Ward, he used a shaving razor to cut a gash in his neck — surviving only after emergency surgery.

He had not gone to trial by March 2022, when he was placed on suicide watch after saying he no longer wanted to live. Again, he was committed to Mid-Hudson and forced to take medications and receive treatment. Again, he was found fit to stand trial and returned to Rikers in June 2022.

Still, no trial took place. By that August, records show, more than three years after his arrest, he had fully unraveled once more, and a judge ordered another competency exam. He was spouting conspiracy theories on the day he took another shaving razor and, on the floor of the jail’s most intensive psychiatric unit, used it to slice open his neck.

As Mr. Nieves sat bleeding to death, a guard asked him what he had done. His blood pooling around him, Mr. Nieves, 40, replied: “The state forced me to commit suicide.”

A backdrop of disorder

As the proportion of mentally ill people on Rikers Island has risen, many of them have been placed in the jail’s general housing areas, which have seen almost unimaginable levels of disorder since the pandemic swept across New York.

Early on, as guards failed to report for duty en masse, gang members and other detainees gained near total control over parts of some units, moving freely through staff rooms and other restricted areas.

Open drug use was commonplace, records and interviews show, and detainees sometimes were forced to go without food and basic health care, including psychiatric services. Supervision had become so lax by fall 2021 that a cuffed detainee got behind the wheel of an idling bus and rammed it repeatedly into the side of a jail building.

There was no guarantee that the guards on duty had received required training in preventing detainees from harming themselves. This past June, a correction officer was charged with falsifying records to show that more than 70 of her colleagues had taken suicide prevention courses when they had not.

Since a 30-year-old man named Latif Gina was brought to Rikers on charges related to pushing someone off a subway platform in July 2022, he has had his jaw broken in a fight with other detainees, been injured repeatedly by correction officers and missed multiple mental health and medical appointments, he said in interviews.

During a visit with a Times reporter and photographer earlier this month, Mr. Gina, who has schizophrenia and a history of homelessness, described what his time on Rikers has been like.

“I am going through emotional stress and mental anguish, and they’re not giving me mental health,” he said, adding that he had been on suicide watch and had thought of hurting himself several times. “It’s led me to a dark place.”

During the interview, Mr. Gina became increasingly agitated by the presence of nearby guards until they signaled that the reporter and photographer should leave. Outside, a team of armored officers holding shields and carrying batons readied to move in, shouting for backup before they did.

But in less than two years in office, Mr. Molina also took steps to make the jails less transparent. He ended a policy begun by his predecessor of publicly announcing the deaths of people in custody, temporarily stripped a city jails oversight panel of access to jail video and skipped some of the panel’s meetings. He took direct control of the Correction Department unit that investigates deaths and serious injuries. Immediately afterward, that unit began resisting sharing information with federal authorities, as required by a court order.

Earlier this year, a federal monitor said that Mr. Molina was deliberately concealing injuries and deaths, including those of mentally ill detainees, to make Rikers seem safer than it was.

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

‘Becoming a better man’

When mentally ill people have been released from Rikers Island, the jails have failed to provide them with the discharge planning required under a state court order.

Sued in 1999 over a practice of releasing mentally ill people with no medication or referrals for services, the jails must now ensure that such detainees are enrolled in treatment or otherwise connected to support before leaving Rikers Island.

But one in four mentally ill detainees was never taken to discharge planning appointments before release, a monitor noted in a recent report, and those who were sometimes received shoddy planning at best.

The Correctional Health Service has struggled to staff the social workers who create the plans, and those workers who were on hand have submitted applications to enroll detainees in programs without confirming that the detainees were eligible for them or that the programs were accepting new clients.

When a homeless man named Joval Cedeno got out of Rikers in August, he received some discharge planning, records show, but it proved to be of limited help.

Mr. Cedeno, 43 and diagnosed with schizophrenia and bipolar disorder, had been jailed for 11 months after being charged with randomly attacking strangers on the subway. While on Rikers, he said in interviews, he had felt constantly under threat, sometimes refusing to leave his cell.

On the day of his release, he was driven off the island by two guards and dropped off at a public hospital in Brooklyn. In the weeks that followed, he drifted from the hospital to a homeless shelter to another hospital and back to shelters again. It was a path he had traveled before.

As a 20-something in New York City, Mr. Cedeno had made plans for how his life would go, settling on getting a commercial driver’s license and earning a living as a trucker. If he did that, he figured, he would not have to be around people as much, and could see the country coast to coast. It would be his ticket, he said, to “becoming a better man.”

Over the next 20 years, his illness got in the way. The episodes, when they came on, did not so much involve hearing voices or seeing things that were not there, he said, but rather the overwhelming feeling that danger was close and people were out to get him. He cycled through homeless shelters, picked up intensive treatment teams, received court-ordered monitoring, went to jail and got out again.

Earlier this month, he traveled from his latest shelter in Brooklyn to a nearby library. He took out a book and was studying it closely when the old thoughts returned. He caused a disturbance, the authorities showed up and, as they readied for another trip to the hospital, they gathered up the book he had been reading before the trouble started.

It was a guide to getting a commercial driver’s license.

Susan C. Beachy contributed research.