Two urgent issues facing Mayor Adams at first seem unrelated. But the violence and degradation of the Rikers Island jail and the wave of mentally ill street homeless harming the innocent can and should be linked.
Whether the Rikers jail is replaced by lockups elsewhere, or simply by new structures on the island, it’ll leave ample room for other buildings. And as the mentally ill shove subway riders on to the tracks, the need is obvious for a new city inpatient psychiatric hospital — a modern facility to make up for the tens of thousands of treatment beds lost since the 1950s in the misguided deinstitutionalization movement.
Untreated mentally ill New Yorkers who believe they are God (as did the man accused of murdering NYPD Officers Jason Rivera and Wilbert Mora) have far fewer treatment options than they once did — and we have fewer ways to make sure they receive treatment.
The mayor himself rightly drew the connection in the new anti-crime plan he announced this month: “We need a humane and legally informed response to people in need who refuse treatment, especially those with a documented history of violence.”
We’ve known this for a while. As the New York State Nurses Association put it, in a prescient 2019 white paper, “Decades of cuts to mental health services” mean “a greater likelihood that individuals with serious mental illness will have a violent encounter with police.”
The Coalition for the Homeless connects the dots directly to the street homeless: “A large majority of unsheltered homeless New Yorkers are people living with mental illness or other severe health problems.”
This type of homelessness is not just a housing problem. But, just as the troubled homeless plague the subways, so, too, do many wind up behind bars at Rikers. We have no precise count of how many of Riker’s 4,000-plus inmates struggle with mental illness, but the number is substantial.
Rikers’ 400 acres now host eight residential buildings large and small. With the right political will, some of it can be converted to a true psychiatric treatment facility for those whom we now consign to the street, jail or prison.
It’s an obvious place to build back a better inpatient psychiatric treatment center for the city — and any plan to replace the decaying current structures would leave room.
It can be the place to stabilize the troubled, set the stage for court-ordered assisted-outpatient treatment (under Kendra’s Law) and even to provide long-term residential treatment for the most deeply troubled.
It can, and should, be a place where some of those charged with crimes are diverted, by mental health courts, away from the criminal justice system .
And for others committed involuntarily, on the say so of families or psychiatrists. This is actually legal today for up to 60 days; there simply aren’t enough treatment beds available for such persons.
The plan simply requires us to get past the idea that inpatient, long-term psychiatric hospitals must inevitably be hellholes. That was all too true in the 1960s, after states had reduced funding and the federal Medicaid program excluded large institutions. But in the first half of the 20th century, large institutions were newly-built, designed by prominent architects and built with solid materials. They were much more than holding pens.
In her 1951 book “Behind the Door of Delusion,” Oklahoma journalist Marle Woodson describes one such place not as a sordid warehouse but a place bustling with activity. “A floor gang polished the wood floors, and a crew for making up beds did its work with a neatness which would shame many of the maids in good hotels.”
The scale was enormous. In Ohio, the Lima State Hospital was the world’s largest poured-concrete building (before the Pentagon was built). My own great-uncle, a schizophrenic who suffered from delusions, spent 60 years there posing a threat to no one. Today, he might be among those pushing someone onto the train tracks.
New institutions need not be nearly that large. The old ones housed not only the mentally ill but the elderly poor, the syphilitic and terminally ill.
And a new Rikers psychiatric hospital would relieve pressure on the jail system. In 1955, 560,000 patients resided in US state psychiatric facilities, including 55,000 in New York; today the US total is under 50,000. We’ve gone too far in the wrong direction — and we’re paying the price.
Howard Husock is an American Enterprise Institute senior fellow.
