NYC keeping people with mental illness on Rikers Island due to hospital bed shortage

Judges are finding a growing number of criminal defendants in New York City’s state courts mentally unfit to stand trial, meaning their charges must either be dropped or they must be held in hospitals, not in jail, according to city health data obtained by Gothamist.

But the hospitals where the defendants are supposed to go for treatment can’t keep up with the increasing demand, mental health officials, researchers and legal experts said. Instead, the defendants are being held on Rikers Island, which faces the threat of a federal takeover amid high rates of violence. Five people have died in city custody — or just after their release — so far this year.

When hospitals don’t have space for criminal defendants with mental illness, it can slow down their court cases, delaying justice for everyone involved. Mental health experts said crowding jails with people with severe and untreated mental illness overwhelms staff and makes it more difficult for everyone to get the care they need.

“They should be as quickly as possible removed from a prison setting and sent into treatment,” said Douglas Stern, a lawyer and professor who specializes in mental health.

While it’s impossible to pinpoint all the reasons why more defendants are being found mentally unfit to stand trial, experts on the intersection of the mental health and criminal justice systems said the psychological toll of COVID-19 and disruptions to treatment during the pandemic likely contributed to the increase. They also cited a rise in arrests in recent years.

Elected officials have vowed to fund more psychiatric beds to alleviate the shortage, but some advocates and mental health professionals said more are still needed. Others said the state should rely less on hospitals to address the surge in demand for treatment.

A process ripe for delays

New York state law allows judges to order psychiatric examinations for criminal defendants when the judges believe defendants can’t understand the proceedings against them because of mental illness.

An order for a psychiatric exam sets off a multi-step process — one that presents numerous opportunities for delays, according to attorneys and observers of the court system. First, psychiatrists have to evaluate the defendant and write a report for the judge explaining whether they think the person is fit to stand trial. A recent report from the Independent Rikers Commission found this part of the process alone takes an average of 43 calendar days to complete. In the meantime, defendants are either detained or await results outside of jail, depending on their pretrial release conditions.

Prosecutors and defense attorneys can either agree with the psychiatrists’ findings or challenge them. Then, a judge decides whether the person is mentally fit to stand trial. If they are, the case moves forward normally.

But if the judge finds that the defendant is mentally unfit, then there are two possible outcomes, depending on the seriousness of the charges. A person charged with a misdemeanor might be observed for a few weeks, but then the cases is usually dismissed, according to legal experts. For a felony, the case is typically put on pause while the defendant goes to the hospital for treatment and education courses about the legal system. The case resumes after the defendant is “restored to competency,” meaning that the person's mental state is stable enough to understand what’s happening and participate in their own defense.

New York City defendants who are mentally unable to stand trial typically go to one of two state-run hospitals: Kirby Forensic Psychiatric Center on Wards Island or Mid-Hudson Forensic Psychiatric Center in Orange County. The number of beds is low, and so is the turnover rate, which means defendants who have been found unfit to stand trial wait on Rikers for weeks or even months to go to hospitals. The average wait time was 79 days as of last fall, according to the Independent Rikers Commission report.

“It certainly increases the likelihood of their illnesses becoming even more entrenched and resistant to treatment,” Stern said. “The longer somebody is disconnected from treatment, the harder it is to treat that individual.”

The number of court-ordered psychiatric exams has climbed in recent years, as has the number of people found unfit to stand trial, which has further strained the system.

Data from the city agency that provides medical care on Rikers, Correctional Health Services, shows the number of people found mentally unfit more than doubled citywide between 2020 and 2024, from 372 to 898. But the number of beds available to restore people across the state to competency has only risen by less than 10% over the same period, according to state data.

While the number of people passing through the courts was unusually low in 2020 due to the pandemic, the number of defendants found mentally unfit to stand trial has continued to rise every year since, according to data from Correctional Health Services. As of March 31, there were 184 people waiting at Rikers for treatment beds.

Experts disagree about solutions

Since taking office, Gov. Kathy Hochul has been working to increase the number of psychiatric beds, including for criminal defendants. She’s already added hundreds of beds at state- and community-run hospitals and also proposed $160 million in funding to create 100 additional forensic psychiatric beds on Wards Island, which would treat patients who are found mentally unfit to stand trial.

“Over the past three years, we have made significant and tangible investments to meet the growing need for pre-trial services and to ensure prompt access to restoration services for the increasing numbers of individuals placed in our care by court order,” said Justin Mason, a spokesperson for the state’ Office of Mental Health.

But according to the Independent Rikers Commission, even more beds are needed. In its recent report, the group urged the governor and state lawmakers to fund 500 more forensic psychiatric beds over the next three years.

Correctional Health Services is pushing for legislation that would allow local jails like Rikers Island to treat criminal defendants until their mental health has improved enough that they can face their charges in court. Dr. Patricia Yang, Correctional Health Services' vice president, said the division already has the staff and resources to provide those services for many patients in city custody.

“We have people in our care who have been effectively restored,” she said. “They’re still in jail waiting to go to a restoration bed, only to be reassessed and then returned back to us for their case to start all over again.”

Yang said some patients would still need to go to hospitals for more acute care, or if they refuse medication, because her staff members are not allowed by law to medicate someone who objects. But when patients are already responding well to treatment while in city custody, she said, Correctional Health Services would be able to start restoring them “immediately.” She said patients would likely receive that care either in therapeutic units on Rikers Island or in outpost units in city hospitals like Bellevue.

“One unnecessary day in jail is one day too many,” Yang said. “This is a clear solution for reducing that possibility for anybody who’s in that situation.”

But Krystal Rodriguez, who helped to draft the Independent Rikers Commission report, said officials need to prioritize making Rikers safer before they can transform it into a rehabilitative treatment space for people with mental illness.

“I think there’s some clinical elements and pillars that are missing from an environment that’s been so plagued by violence and dysfunction,” said Rodriguez, policy director for the Data Collaborative for Justice.

At a jail oversight meeting last fall, a mental health care provider who started working on Rikers Island in late 2023 said Department of Correction staff routinely locked people with severe mental illness in solitary confinement for weeks without access to medication as a punishment for “acting out.” Justyna Rzewinski, former associate director of mental health for Correctional Health Services, described men screaming, banging and smearing feces on themselves.

“I could not believe what I saw,” she said. “I have never seen anyone living in these types of conditions.”

Rzewinski said Correctional Health Services staff members “did the best we could” and were occasionally able to get patients out of solitary confinement for a shower or dose of medication. But she said it took “persistent advocacy with sympathetic [correction officers] and much coordination as if we are asking for an elaborate favor.”

Rzewinski said many of her patients had been found mentally unfit to stand trial and “got worse and worse” while waiting at Rikers for a state hospital bed to open up. She resigned after less than a year, haunted by what she observed.

Dr. Joseph Otonichar said at the oversight meeting that Correctional Health Services has developed monitoring systems to try to identify when patients are locked in solitary. Department of Correction Commissioner Lynelle Maginley-Liddie later told oversight officials that she had asked the city’s Department of Investigation to conduct an independent review of the “troubling allegations.”

Some advocates don’t trust any plan put forth that involves treating people on Rikers. Instead, they recommend reducing the demand for hospital beds by providing outpatient treatment for people who don’t need to be kept in a secure facility.

Nadia Chait, a mental health policy analyst with the decarceration group Center for Alternative Sentencing and Employment Services, said the default should be to treat people in the community, instead of sending everyone to secure state hospitals, which are more expensive and restrictive.

“Doing that would actually often set them up to better improve public safety because they're restored, but they're also connected to the community-based services,” she said.