NY Times story of troubled inmates with mental illness


This story came from a list serve that I subscribe to and tells of very troubled inmates and their struggles with mental illness.

For Mentally Ill Inmates, a Cycle of Jail and Hospitals

New York Times; Michael Winerip and Michael Schwirtz, 4/10/2015

It was not a particularly violent crime that sent Michael Megginson to Rikers Island. He was arrested for stealing a cellphone.

But in jail, Mr. Megginson, who is 25 and has been in and out of psychiatric hospitals since the age of 6, quickly deteriorated, becoming one of the most violent inmates on the island.

In his 18 months there, he was constantly involved in some kind of disturbance, his records show. He fought with other inmates and officers; spit and threw urine at them; smashed windows and furniture and once stabbed an officer in the back of the head with a piece of glass.

At least twice, his bones were broken in beatings by guards.

He also repeatedly hurt himself, cutting his body all over, banging his head against walls and tying sheets and clothing around his neck in apparent suicide attempts.

There were times he became severely psychotic. He once stripped naked and broke the toilet in his cell, causing a flood. “I’m trying to save everybody from the devil with holy water,” he said, according to jail records.

For years, Rikers has been filling with people like Mr. Megginson, who have complicated psychiatric problems that are little understood and do not get resolved elsewhere: the unwashed man passed out in a public stairwell; the 16-year-old runaway; the drug addict; the belligerent panhandler screaming in a full subway car.

It is a problem that cuts two ways. At the jail, with its harsh conditions and violent culture, the mentally ill can deteriorate, their symptoms worsening in ways Rikers is unequipped to handle. As they get sicker, they strike out at guards and other correction employees, often provoking more violence.

Judges, prosecutors, police officers and correction leaders, as well as elected officials like Mayor Bill de Blasio, have grown increasingly vocal about the damage that incarceration can do to these men and women.

By now, Mr. Megginson’s Legal Aid lawyer had expected him to be freed. But his volatile behavior has kept him behind bars, and recently he was transferred to a state psychiatric prison hospital for violent criminals with no set release date.

The New York Times spent 10 months examining Mr. Megginson’s troubled life, conducting hours of interviews with him as well as his family members, doctors and lawyers. With his permission, The Times also reviewed thousands of pages of medical, disciplinary and legal records from his time at Rikers and in hospitals, community programs and supervised housing.

Though there may be a consensus that Michael Megginson does not belong in jail, there is no agreement about where else he could go. At times, he was just as violent in hospitals. He once jumped over a nurses’ station at Kings County Hospital Center in Brooklyn, attacking clinicians; during a stay in St. Barnabas Hospital in the Bronx, he was placed in restraints 11 times.

But unlike jail, psychiatric hospitals treated his behavior as a symptom of illness. If he was out of control, he was often given an injection to knock him out and was placed in a quiet room until he was calm.

In interviews, members of Mr. Megginson’s family said they believed that longer-term hospitalization would be best for him. But that option has all but disappeared. For the last four decades, the push in the mental health field has been to close these hospitals. Since a 1970s Supreme Court ruling that was meant to protect civil liberties, only the very sickest patients can be involuntarily held for an extended period.

Mr. Megginson was repeatedly released from state hospitals against his doctors’ wishes because he did not meet legal requirements for involuntary commitment.

His treatment has cost millions of dollars in public funds. Outside of hospitals, he was enrolled in some of the most successful outpatient and community programs in the mental health field.

He failed out of all of them.

Which raises the question: Is there any place for Michael Megginson?

Over the last decade, the proportion of inmates with diagnosed mental illness has climbed dramatically. Today, they make up nearly 40 percent of the population at Rikers, a total of 4,000 men and women at any given time, more than all the adult patients in New York State psychiatric hospitals combined.

Several have shown that they are more likely than other inmates to be the victims as well as the perpetrators of violence.

In July, The Times documented 129 cases from 2013 in which inmates were beaten so severely during encounters with officers that they required emergency care. Seventy-seven percent of the inmates had a mental health diagnosis.

Mr. Megginson was one of the 129. In October 2013, a nurse found him facedown on a cellblock floor, beaten unconscious. Several bones in his face were broken, and his shoulder was dislocated.

When he returned from Elmhurst Hospital in Queens, he was punished with 127 days in solitary confinement.

National penal experts have been impressed by Mr. de Blasio’s efforts to make Rikers a safer and more humane place. In the last year, the mayor has appropriated tens of millions of dollars to create specialized therapeutic units that reward improvements in behavior. He has also scaled back a punitive system that had kept some inmates locked away in solitary confinement for more than a year.

But individuals like Mr. Megginson burn through resources, requiring services that jails had never been expected to provide. Each Wednesday, the department’s chief, two assistant chiefs and five wardens meet with the jail’s top mental health officials to discuss what to do about a small number of the most disruptive inmates — a group that included Mr. Megginson.

His problems have been a long time in the making. Psychiatrists can’t even agree on what’s wrong with him. He has been confined in psychiatric hospitals at least 20 times and labeled with almost every diagnosis that could be applied to a person with a history of aggressive behavior: schizophrenia, bipolar disorder, polysubstance dependence, attention deficit disorder, impulse control disorder, antisocial personality disorder and intermittent explosive disorder.

From the time he was a little boy, growing up in the Kingsbridge section of the Bronx, he had uncontrollable rages. He bit teachers, fought with classmates, urinated on hospital staff and refused to go to school for weeks at a time. At age 6, he spent nearly a month at Bronx Children’s Psychiatric Center, a state hospital.

His home life was often unstable. His father, who is also mentally ill, was in and out of prison. In 1990, shortly after his mother gave birth to him at age 16, she moved to Florida, leaving him with his great-grandmother for several years.

Many members of his extended family had mental illness and substance abuse problems. His paternal grandparents were both alcoholics, and his maternal grandfather died after falling out a window — or possibly jumping.

His mother, Shakima Smith-White, acknowledged that she was not always there for her son initially. But she said she re-entered his life full-time when he started school. She has been married now for 20 years, works two jobs and is studying to be a nurse practitioner.

“We weren’t perfect, but we tried with Michael,” she said.

When he was 5, she said, she took him to Miami on her honeymoon, to her husband’s dismay. And when Michael was going through a bad stretch in his late teens, she said, her husband took their two daughters and moved out, worried it was too dangerous to stay. “He pretty much gave me an ultimatum, that it was him or Michael,” she said. “And I chose my son.”

“At the time he needed me more than the girls or my husband,” she said.

When Mr. Megginson was doing well, she said, he was wonderful to be around — calm, affectionate, funny.

“Normally something would happen that would be like a great disappointment,” she said. “Or someone would anger him and he would lash out, and from there he would just spiral downwards.”

In an interview at Rikers, Mr. Megginson said his great-grandmother had been the most important person in his life. When he was 10 and she died, he said, it was devastating. “The way my mental illness led to an outbreak of getting worse was when my great-grandmother passed,” he said. “It tore my insides out and gave me a lot of darkness.”

By age 12, he had been admitted to Bronx Children’s Psychiatric Center four times, according to medical records, and in his teens spent time at a Manhattan group home for young people with behavioral problems. Between hospital stays he often lived with his mother, and for a while, she said, she could calm him when he was upset. When he was 19, though, they got into a vicious fight. After he started swearing at her, she said, she struck him. He punched her back, knocking out two teeth, grabbed a knife and tried to stab her, she said.

She called 911 and he was arrested, spending three months at Rikers.

When he was released, she refused to allow him back into the house, insisting that he complete a mental health program first.

For his part, Mr. Megginson said his mother was responsible for many of his problems. He complained that she had not been there for him and blamed her for refusing to put up the $5,000 to bail him out during his most recent incarceration.

“She says a lot of hurtful things, disrespectful things,” he said, “like ‘Oh I wish you wasn’t my son,’ or ‘I wish I got, you know, I almost got an abortion when you was born, I should’ve did it.’ ”

His mother disputed this, saying she was thrilled when she found out she was having a boy.

Mr. Megginson came of age at a time when the public mental health system in New York was going through a major transformation.

By the 1960s and ’70s, state psychiatric hospitals were widely considered failures, inhumane places where patients were routinely neglected and abused. New medications had been developed that allowed patients to be stabilized and discharged, leading to widespread deinstitutionalization. But as the asylums were closed, the states provided little funding for community housing programs. The discharged patients often ended up homeless and, with their illness untreated, could become a danger to themselves and at times a risk to public safety.

On Jan. 3, 1999, Andrew Goldstein, a 29-year-old man with schizophrenia, was standing on a subway platform when he pushed a young woman, Kendra Webdale, in front of an N train, killing her instantly. When asked why he did it, he told the police, “I felt a sensation like something was entering me.”

Mr. Goldstein knew he was sick. He kept asking for help. But there were long waiting lists for supervised housing and case management services, and often he was only given a slip of paper with a clinic’s address. He is currently at a prison upstate, serving a 23-year sentence for manslaughter.

In the aftermath, legislators passed Kendra’s Law, which allows authorities to order people with a history of violence who have repeatedly rejected treatment to take their medication and report regularly to a state-designated program. The state also appropriated millions of dollars for community mental health services.

While the system still suffers from serious shortages, today there are 40,500 state-funded supervised beds where mentally ill people have regular access to clinicians, twice as many as 15 years ago.

One of the most significant innovations available to Mr. Megginson is the Assertive Community Treatment program, or ACT, which is made up of a team that includes a psychiatrist, nurses, social workers and a substance abuse counselor. It is their job to make sure that even the most troubled individuals stick with their treatment. The idea is to avoid costly hospitalizations while enabling people to live safely in the community.

The state requires an ACT team to have a caseload of no more than 68 people and to see each client at least six times a month. There are 46 such teams in New York City, 82 statewide.

On a recent Tuesday, seven members of an East Harlem-based ACT team, who work for a nonprofit agency called the Bridge, met for several hours to discuss each of their 68 clients. Among their concerns: a man with a history of suicide attempts whose cousin had recently killed himself; three people with addiction problems who needed to provide urine samples; a man who was being lewd; and a new client with a history of assault who was acting belligerent toward staff members. “He might need another mood stabilizer,” said Aneeza Ali, the team leader. “Or an attitude check.”

Starting when he was 18 and after numerous hospitalizations, Mr. Megginson was assigned at least twice to ACT teams including the Bridge program. After he assaulted his mother in 2009, he was mandated under Kendra’s Law to enroll with an ACT team as a condition of his probation.

His mother said her son seemed happier in the program because he could live on his own. “He always wanted to feel normal,” she said, adding, “It gave him a sense of ‘I’m O.K., I’m like everyone else.’ ”

ACT teams get high marks from activists. Susan Garrison, a social worker and a member of the Harlem chapter of the National Alliance on Mental Illness, said the program had made a big difference in her son’s life. At 45, despite having severe schizophrenia, he has been able to stay out of the hospital, and at times he has even held a job, including recently working seven hours a week at a Rite Aid in Harlem.

But as good as ACT is, Ms. Garrison said, her constant involvement in her son’s life has been crucial. Without an anchor — a parent, a spouse, a sibling — a person will often go off treatment and deteriorate, she said.

By the time Mr. Megginson reached his 20s, he had lost almost all contact with his mother and was mostly alone.

When his father was released from prison, they made an attempt to reconnect.

At one point, the father, also named Michael, found his son a job working for a storefront tax operation in Harlem. For $100 a week, he dressed in a Statue of Liberty costume and handed out fliers.

But in the fall of 2012, the two had a falling out. The son said his father stole his savings and lost it gambling. The father said he had permission to take the money.

Either way, that November, after a heated argument, the son pulled a chicken from the oven and hurled it at his father. He was committed soon after and remained hospitalized for the next five months.

In recent years, as jails and prisons have filled with the mentally ill, academics and clinicians have suggested that long-term hospitalization could be the best option for more individuals.

Observing a person during an extended hospitalization may improve a psychiatrist’s chances of establishing a reliable diagnosis. It can also provide a safe environment, in which a variety of medications and dosages can be calibrated to the patient’s needs.

In a hospital, Mr. Megginson would be compelled to take his medication, which would help curtail his aggression. At Rikers, clinicians say, inmates frequently go off their medication until they become uncontrollably violent.

Under state law, patients cannot be held against their will unless they are an immediate danger to themselves or others. During several hospitalizations, Mr. Megginson appeared before judges and successfully challenged his confinement. Though doctors disagreed, they had to release him.

His final hospital stay before Rikers lasted five months and ended on a hopeful note. A psychiatrist wrote that he was taking medication and attending substance abuse programs, that his grooming and hygiene had improved and that he was “free of psychotic features.”

“He was very proud of his accomplishment,” an April 22, 2013, progress note said, “and anxious to move on to independent living.”

But after being discharged to a housing program, Mr. Megginson deteriorated rapidly. He stopped attending treatment sessions, according to medical records, and started drinking heavily and abusing marijuana. On June 12, he hit a counselor in the face with a cellphone charger and was kicked out of the program. Two months later, he stole a woman’s cellphone and was sent to Rikers.

Several prosecutors, judges, police and correction officials said in interviews that they were frustrated by the lack of options for keeping people like Mr. Megginson out of jail.

Karen Friedman Agnifilo, the chief assistant district attorney in Manhattan, said she would like to have an alternative to jail for certain convicted offenders who are seriously mentally ill, such as a voluntary confinement that would provide treatment while keeping them off the streets.

“The problem is these individuals have typically been offered every service available,” Ms. Friedman Agnifilo said. “As a result, we have no choice but to continue to cycle them through the system. We wish we could do something else, but we don’t know what that something else is.”

At this point few, if any, alternatives exist for offenders.

The Manhattan district attorney’s office has joined several other prosecutors and judges in voicing support for a treatment model being proposed by Francis J. Greenburger, a Manhattan real estate developer whose mentally ill son is currently imprisoned. Under his plan, people with serious mental illness would plead guilty to certain felonies and avoid prison by agreeing to stay in a locked treatment center for up to two years. If at some point they failed to comply, they would be sent to prison.

For the last year and a half, Mr. Greenburger has been trying to get the state to license a pilot project, with limited progress.

At Rikers, Mr. Megginson became such a problem that at times he was transported in handcuffs and leg irons. He had to wear mittens to prevent him from grabbing things, and because he had a history of spitting at officers, was made to wear a mask.

In his 18 months in jail, he had 70 physical confrontations with officers, according to records, an extraordinary number given that most inmates never have one.

In nearly half the cases, guards used pepper spray to subdue him. Eleven times he was described in records as threatening to kill himself. The trouble often started when he ignored such routine orders from guards as to return to his cell, or to get out of the shower.

In the Rikers interview, he described how enraged it would make him to have no control over his daily life. He said it could turn a minor incident like being denied telephone privileges or getting cold food into a major frustration.

“I just get agitated and, you know, you can’t do anything about it because you behind a magnetically confined door,” Mr. Megginson said. “Mentally ill people should not be confined inside a box; it’s not healthy for the mind.”

“It makes us people we’re not,” he said.

Last year, Mr. Megginson was among a dozen particularly volatile inmates chosen for a new program run by the city’s health department. A case worker visited him three times a week for therapy sessions that included meditation, breathing exercises and conflict resolution strategies.

Martin J. Murphy, the Correction Department’s top uniformed officer, said the time spent working with Mr. Megginson and the inmates like him had resulted in a significant drop in the number of use-of-force cases involving them.

Correction officers, led by union leaders, have long called solitary confinement the most effective punishment for violent inmates. But Chief Murphy said in an interview that the intensive therapy had worked better.

Mr. Megginson spoke fondly of the therapist. He said she had taught him “just to use my thinking instead of using my fists. Like, if I get in an incident with an officer, instead of resolving it in a violent manner, rather just, you know, walk away sometimes. I try to think it out, think what I’m doing first and try to alleviate the situation.”

In the weeks before leaving Rikers, he sounded optimistic, saying he hoped to get a job in building maintenance. “I’m just a one-time felon,” he said, “and my felony is very light. If I had two felonies on my record or three, then it would be rough. I still got a chance. I believe in opportunity.”

Two months ago, Mr. Megginson pleaded guilty to stealing the cellphone as well as to the assaults on the officers. He was given a one-to-three-year prison sentence and, because of his time served at Rikers, was immediately eligible for parole.

On Feb. 18, he was transferred to Downstate Correctional Facility in Fishkill for what was supposed to be a short stay. He had a parole hearing scheduled for mid-March and his lawyer, Jane Pucher, had started looking for a therapeutic program for him in the city.

But at the prison, he was unable to hold himself together. On Feb. 26, he was disciplined for threatening to cut an officer, according to state prison records. On March 4 and 6, he got into fights with inmates, and on March 7 he was written up for smashing a table against a door.

Then on March 15, according to records, he defecated on his cell floor, smeared his feces on the window as well as a security camera and jumped on the metal bed frame until it broke off the wall. When guards arrived, he threw his feces at them.

A few days later, he was transferred to Central New York Psychiatric Center, a state maximum-security forensic hospital, located in Marcy.

In an interview there on Wednesday, Mr. Megginson said he had lost control in prison because he had stopped receiving his medication. Other inmates repeatedly picked on him, he said.

But in the last three weeks at the hospital, he said, things are going well: He is back on his medication, working out and planning to attend church on Sunday.

He said that this time, when he was released, things would be different.

“I’m not going to do nothing bad or illegal,” Mr. Megginson said.

http://www.nytimes.com/2015/04/12/nyregion/for-mentally-ill-inmates-a-cycle-of-jail-and-hospitals.html?emc=edit_tnt_20150410&nlid=69639673&tntemail0=y&_r=0

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