prison psych

“I can think of one thing that is worse than being sick and in the prison ward here at the hospital. Being well and at Riker’s.” – CPE supervisor

“The midnight shift here on the prison ward is way better than working during the day at the 23-hour lock-up on the island.” – NYC corrections officer

“I would rather try to kill myself than have to go back to Riker’s.” – prison ward psych patient

Working at the prison psych ward this summer has confirmed for me just how bad Riker’s Island is. And the prison psych ward at Bellevue Hospital, where I am interning this summer as a chaplain, is pretty damn bad.

Almost every day I go through airport-like security to reach the floor. Armed corrections officers abound. Often there are folks in the hideous orange jumpsuits, and in leg chains and handcuffs, and the lucky ones shuffle towards an elevator that will get them to their transportation to court, to Riker’s, upstate to Sing-Sing. The less fortunate are pushed in hospital beds. I wait for one mechanized gate, with its once-white, peeling paint, to slowly slide open. I enter a holding area and wait for it to close. At the end of the hallway, another officer unlocks a door. I enter and wait for her to lock it again. She walks to another white metal gate, with yet another officer sitting on the other side, and opens it. I am finally on one of two prison psych wards.

I walk past men — they are all men, and the vast majority men of color — in faded blue scrub tops and gray sweatpants. Milling around the hall. Walking deliberately around the hall, because some days that’s all the exercise they can get. Shouting in the hall. About using the telephone. About getting a clean shirt. About talking to a doctor. About . . . something unintelligible. Sleeping in their rooms. Using the bathrooms that abut the halls with huge picture windows.

There are tons of corrections officers here, too, as many as there are patients. During my first visit to the floor, the chief psychiatrist warns me, “They are not here for your protection.” They sit in chairs, as do staff who are assigned to the patients under “constant watch.” There is a lot of sitting. There is nowhere to go.

I check in at the nurse’s station: Is there any patient I need to avoid today? I walk around the hall — only the main hall; the second hall, ironically with absolutely no corrections officers, is too dangerous — and ask if anyone wants to talk to the chaplain. Sometimes I knock on doors, where there are two to three patients per room. I usually don’t have to walk long to get a taker.

We walk to an interview room. The patient enters first and sits on the opposite side of the table; I am closest to the door. If he is under constant watch, the staff member sits outside. And then the patient and I talk.

Some of them have committed the kinds of crimes that you read about in the Post: Man tries to kill girlfriend and then himself. Man takes [unusual weapon] to co-workers. Man assaults officers on the subway during rush hour. But some of them are simply folks with mental illness whose behavior has been criminalized. Man shouts in an unruly manner on street. Man violates probation. Man pandhandles. And yet others are the result of decompensation in isolation, or not, on Riker’s.

What I have been struck by most is the detail of care afforded patients by the system — and its simultaneous profound inhumaneness.

Several mornings a week I attend a meeting of the unit’s principle staff: psychiatrists, psychiatry interns, social workers, social work interns, nurses, and clerks. The meeting starts with a report from the head night watch clerk. He goes through what happened with each patient the night before in minute detail. Who got what medications, who refused medication, who slept when, who was awake when, who ate what, who was in what mood.

Then they go over new admissions. They discuss discharges (which always means back into some part of the criminal justice system). And then one of the doctors presents presents her patients in detail. She talks about medications, psychological state, progress. The social worker adds information about the criminal case, family, records at Riker’s or other institutions, contact with lawyer. (A different doctor will go the next day.) Then the daily lists are created collaboratively: Who is at what “level” (and therefore has more or fewer privileges); who can get a haircut; who is going to court; who can attend groups. The information is mostly in these professionals’ heads: They are very familiar with their charges. And everyone refers to each as “Mr. So-and-so.”

There are groups: art therapy, music therapy, spirituality, community meetings. I run what’s called a “Healing Circle” once a week. Almost every day there is recreation on the roof. General freedom of movement on the unit. Three meals a day, plus snacks. Several televisions.

And yet.

There are no personal possessions, which is helpful since the patients are (inexplicably, to me) moved almost every day. The lists created include who needs to be forced to shower. The walls echo with clinical phrases like, “irritable upon approach”; “responds to redirection”; “sexually preoccupied”; “displays suicidal ideation”; “exhibits disorganized thinking.” The view of the East River is almost completely obscured behind feet of thick wire screens. There is an almost uniform schedule for their movement through the criminal justice system (“Arraignment on Wednesday means a court date on Monday”). Most of the men can’t tell you why they were arrested, much less how they ended up on a prison psych ward. Very few of them will ever experience life outside of an institution.