By David Brand
Young adults incarcerated in New York City are attending only about half of their scheduled mental health treatment appointments — often because corrections officers aren’t bringing them to sessions, according to a database of reports compiled by the independent agency that oversees city jails.
The rate of attendance for therapy and other mental health services among detainees aged 18 to 21 plummeted last year, and lags behind the rate of attendance among incarcerated adults 22 and older, based on monthly reports by Correctional Health Services (CHS) that were analyzed and published last month by the Board of Correction. The Board sets minimum standards for the city’s Department of Corrections jails.
Appointments for young adults in city custody were considered “completed” at least 70 percent of the time in January, February and March 2018, but the rate decreased to just 54 percent by December 2018.
Those numbers do not tell the whole story of appointment attendance. CHS lists an appointment as “completed” even if the detainee refused to attend the appointment and a clinician signed off on their refusal — a scenario that advocates say occurs at a dubious rate.
“We have real questions about whether or not those definitions and those reasons are valid,” said Fortune Society Executive Vice President Stanley Richards. “As a formerly incarcerated person, if I had an appointment, I wasn’t refusing because that’s the one time you get out of your housing area, the one time you get to be with other people.”
Richards said there was an “operational tension” between corrections and treatment staff. He said he suspects that COs record that a young adult refused to attend a session when the CO did not want to perform the escort. He said COs also show up late to retrieve young adults, at which point their scheduled session has nearly ended.
Consistent access to treatment is “critically important” for incarcerated young people because their brains are still developing and they are at a pivotal time in their identity formation, Richards said.
“If you’re able to engage young people with mental illness with services, you’re putting them on a lifetime path of managing their mental illness,” he said. “And so working with young people with mental illness early on is the right thing to do, and it’s also the long-term thing to do.”
More recent reporting suggests that young adults continue to miss out on roughly half of their scheduled appointments, however.
Most, but not all, young adults are housed at the Robert N. Davoren Complex, one of the nine jails on Rikers Island. A June 2019 report by CHS indicates that detainees at RNDC were seen for just 47 percent of their mental health appointments. In another 16 percent of cases, the young adults did not attend their appointment and were marked as “Refused & Verified.” That means the person refused to attend their appointment and a clinician signed off, technically registering the appointment as “completed.”
“Not Produced by DOC” accounted for 23 percent of missed appointments at RNDC — the main reason for missed appointments at the jail, according to the June report by CHS.
"The observation from our team is that the mental health services at RNDC are not up to par,” said Brooklyn Defender Services social worker Ronald Schneider. “It’s abysmal there.”
Schneider, a licensed social worker, leads the Brooklyn Adolescent Representation Team and works with young people in Rikers Island jails who say they do not trust the COs tasked with taking them to appointments.
“Getting access to mental health services is very difficult because the young people are at the mercy of officers to escort them to any type of services, and the officers are not usually in a hurry to assist them,” he said. “Plus, if officers know young people have had mental health treatment, they use that fact against them. So, there is a mistrust in terms of speaking to the officers."
All children detained in New York City were moved from Rikers Island jails to a facility in the Bronx in accordance with the state’s Raise the Age Law in 2018. Schneider recommends creating a system for young adults similar to what exists in juvenile facilities.
“At juvenile facilities, there are more case workers and social workers, as opposed to DOC employees who do not have training for the mental health needs of young people,” he said.
The DOC said the current rate of mental health appointment attendance is partly due to corrections officers not forcing detainees to attend medical and mental health appointments. Refusal to attend appointments is a major reason why detainees are registered as “Not Produced by DOC,” the agency said.
The DOC said it is implementing a new reporting system that more closely tracks when detainees refuse to attend appointments and adding 30 new officers to facilitate timely production at RNDC.
“The safety and well-being of people in our custody is our primary mission and we’re committed to improving access to care,” said DOC spokesperson Peter Thorne. “We will continue to work with our healthcare provider Correctional Health Services to ensure individuals are produced in a timely and efficient manner so that everyone in need of care is seen by a medical professional.”
The Board of Correction database is part of the Board’s effort to ensure young adults are treated with consideration for brain development and that jail staff are complying with standards set by the Board.
“Since 2015, Board of Correction regulations have affirmed the unique developmental needs of young adults and sought to minimize the adverse effects of incarceration on the health and mental health of young adults in the city’s jails,” Board of Correction Director of Research and Analysis Victor St. John told the Eagle in July.
Access to mental health treatment is important to anyone in jail or prison, most of whom have histories of trauma, said the Vera Institute’s Center on Youth Justice Director Krista Larson. Incarceration is itself a traumatic experience, Larson added.
She said she has heard from young adults who say they were denied access to treatment by COs. Sometimes that takes a more passive form — like COs walking away the moment a young adult says he or she does not want to go to an appointment, she said. She would like to see more training for COs on the importance of mental health services.
“It’s important to have healthcare and security staff on the same page to allow [detainees] the access to care that they need in the best way possible,” Larson said.