(Photo: Tdorante10 via Wiki Commons)

Since the start of the COVID-19 pandemic, jails and prisons have become hubs for infection, with crowded conditions that leave few opportunities for social distancing. The spread of the coronavirus in New York City jails has been well-documented, including at the city’s infamous Rikers Island jail complex, which has been called the “epicenter of the epicenter” of the pandemic. 

But one of the virus’ longer-lasting effects has been on people with mental health and substance abuse issues incarcerated in city jails, according to attorneys and advocates, even as the number of cases among this population has waned in recent months. 

Katherine Bajuk, an attorney with New York County Defender Services, said that a number of her clients had been deemed unfit to stand trial after suffering a downturn in their mental health during the pandemic. As staffing and direct interaction with inmates was reduced in the spring, many lost access to mental health treatment or failed to take their medications due to a lack of in-person reminders, Bajuk said. 

Correctional Health Services, which administers healthcare in city jails, also temporarily loosened regulations on how often mental health professionals had to see inmates with mental illnesses. Inmates receiving medication for mental illness are required by law to be evaluated by a psychiatrist every two weeks, although an already-existing “variance” in the law allows this to be extended to 28 days. But in April, evaluations for “non-seriously mentally ill adults” in the general inmate population were allowed to take place every eight weeks, according to a letter requesting the change from Dr. Patsy Yang, senior vice president for Correctional Health Services, to the city’s Board of Correction. 

In a letter to the Board of Correction on May 8, five New York City public defender’s offices detailed further reductions in mental health care and substance abuse treatment their clients experienced after the start of lockdown procedures in March. Inmates seeking mental health treatment who were not housed in special mental health units — including Mental Observation or PACE units, which offer around-the-clock clinical care for incarcerated individuals with serious mental illnesses — had to utilize telehealth systems, but often could not get access to a clinician, according to the letter. 

“In some particularly concerning circumstances, we have heard from clients who are actively suicidal (and thus have been identified by CHS as taking priority) reing denied care for days,” the letter said. 

The attorneys also reported that substance abuse counseling groups stopped meeting, while access to medication-assisted treatment, which helped aid recovery from substance use disorders, was functioning at a “reduced capacity.” 

While a spokesperson for CHS did not directly address these claims, the department has previously said that it did not reduce access to mental health and substance abuse care during the pandemic. 

Yang testified to the New York City Council shortly after the letter was released in May that “while elective and non-urgent visits were adjusted, access to medical, nursing, and mental health services; ongoing substance use treatment; and medications remained unchanged.” In further testimony in September, she added that “maintaining the health of our patients is critical to helping patients best fend off the disease and to fight its worst effects, should they contract the virus.”

Bajuk said that many of the issues brought up in the May 8 letter have gradually been addressed over the past several months as health workers have returned to the jails and some in-person meetings have resumed. She added that the city also recently added two more PACE units to its existing six. 

But she added that the long-lasting effects on mental health are still unclear, as the pandemic hit incarcerated people with mental illnesses especially hard. According to a June report from the National Association of Social Workers, COVID-19 and measures meant to combat it, including social distancing, are likely to exacerbate pre-existing mental health issues, extreme anxiety and emotional trauma for incarcerated individuals. Bajuk said that many of her clients experienced heightened levels of fear because many of the regular mental health workers at Rikers were no longer there to explain what was going on, even as jails became epicenters of the disease. 

“Let’s say you have someone who’s already suffering from serious mental illnesses like depression, or severe anxiety,” Bajuk said. “Imagine now being incarcerated during a pandemic, and seeing on the news that jails are the most dangerous places — super spreader places.” 

These fears were grounded in reality, as at the height of the pandemic in April, the positivity rate reached 9.9 percent in NYC jails, about five times that of the general city population. According to the latest figures from Correctional Health Services, 579 positive coronavirus tests have been reported among inmates since March 13, while three people have died. 

At the same time, measures meant to reduce the jail population to protect inmates from COVID-19 left out many detainees with mental health issues. After the start of the lockdown measures on March 16, New York City jails released thousands of people who were being held for nonviolent or low-level offenses, or who faced the greatest risk from coronavirus due to age or underlying health conditions. Between March and May, the total population incarcerated in New York City jails fell from 5,471 to 3,943. 

However, a report from the city’s Independent Budget Office found that only 36 percent of detainees with mental health needs were released during this time period, compared with over half of the general population. As of May 18, half of all jailed New Yorkers had a mental illness — a seven percent increase since March.

According to Bajuk, these individuals should be the first priority for release, rather than the last. 

“The best thing that would happen for clients that have serious mental illnesses is that they’re not in jail,” Bajuk said. “As a society, we have billions of dollars that go to all kinds of things that can certainly be diverted to take care of people with serious mental illnesses. The fact that they’re charged with crimes shouldn’t mean anything, except for the fact that if they had these interventions early on, you probably wouldn’t even see them in the criminal justice system.”