Mentally Ill Inmates Win Right to Discharge Planning

Mentally ill inmates in New York City jails will soon benefit from individualized discharge planning now that the city has decided to throw in the towel in its protracted legal battle to avoid establishing a discharge-planning program.

Before it decided to settle the case, the city lost two appeals of a July 2000 ruling by a state trial court that ordered the city to begin such a program. The court issued an injunction that barred New York City from continuing to violate the city’s Mental Hygiene Law by failing to implement discharge planning that continues the mental health treatment inmates were receiving when incarcerated.

About 130,000 individuals are incarcerated in New York City jails each year, and 15,000 of them have a severe and persistent mental illness, according to the Bazelon Center for Mental Health Law, which submitted an amicus curiae brief supporting the position of the plaintiff in the case Brad H., et al. v. City of New York, et al. In all, about one-fourth of city jail inmates need mental health treatment.

The suit against the city argued that while city law mandates discharge planning that provides continuity of care for inmates receiving mental health care, the city routinely sends inmates back to the community with no postdischarge arrangements in place.

It is common for mentally ill inmates to be discharged without a supply of the psychotropic medication they were taking while incarcerated, follow-up therapy appointments, or help in obtaining housing or public assistance payments, according to the Bazelon center’s amicus brief.

That brief was also submitted by 11 organizations including the National Alliance for the Mentally Ill, National Orthopsychiatric Association, Coalition of Voluntary Mental Health Agencies, and New York Association of Psychiatric Rehabilitation Services, among others.

Inmates in Revolving Door

Without follow-up care, many of these inmates would have a difficult time accessing treatment services after discharge, since a substantial portion were homeless and dependent on Medicaid at the time of their arrest. “As a result of the abrupt termination of their treatment, many inmates experience a relapse of symptoms [and] an increased risk of suicide, and frequently wind up in a ‘revolving door’ of successive periods of hospitalization and reincarceration, interrupted by periods of release in which their psychiatric treatment is suspended and their symptoms recur,” the amicus brief points out.

The plaintiffs’ arguments centered on several issues including that U.S. jails have become de facto mental health care facilities filled with people who would probably not be there if they had received care in the community or psychiatric hospitals. They also emphasized that mental illnesses can be successfully treated, that almost all major mental health organizations, including APA, insist that discharge planning is an essential part of care for incarcerated individuals, and because inmates lose Medicaid coverage and other public assistance, it is unlikely that they have the resources to restore all these benefits without help prior to discharge.

Among the arguments upon which the city relied in defending itself against the charges are that jails, by their nature, house a transient population, thus presenting an “insurmountable barrier” to comprehensive discharge services. The city also said that a mandated discharge-planning system could not work because many inmates leave jail before jail officials have the chance to arrange evaluations by mental health professionals. Addressing all inmates’ crucial mental health care needs would require financial investment whose dimensions make it prohibitive, the defendants maintained to no avail.

Settlement Mandates

The terms of the settlement, in which the city did not admit liability, require that all inmates receive an assessment of their need for continuing mental health treatment, public benefits, housing, and transportation to that housing. Inmates have the right to decline the services mandated under the agreement.

City officials are also to “create a mechanism to allow significant others and other members of the community who have clinical information. . .relevant to the mental health treatment” of an inmate to relay that information to a jail’s discharge-planning staff. In addition, every inmate is to receive a medical assessment within the first 24 hours of incarceration and, if a need is identified at that time, a mental health care assessment with three days.

A discharge plan for those who are found to need mental illness treatment while in prison is to be completed within seven days of the mental health assessment for those in segregated mental health units, and 15 days for those in the general population. Jail officials are to provide these inmates with a written discharge summary at the time of release from jail.

The settlement also mandates that the city release prisoners during daylight hours, addressing a contention of the plaintiffs that inmates are often left at bus stations at all hours of the day and night.

The agreement also requires that discharge planning include an assessment of the need for medication, case management, substance abuse treatment, and psychiatric rehabilitation services. In addition, appointments for and referral to these services are to be arranged prior to discharge, and the city is to inform the inmate orally and in writing of the time, date, and place of such appointments. Within three days of such appointments, jail officials are to contact the treatment or service program to find out whether the released inmate showed up.

If continuing medication is needed, jail staff are to provide the inmate with a seven-day supply and a prescription for 21 additional medication days. If there is a reason an inmate is denied such medication, officials are to document it in writing.

The city is now also required to help inmates apply for Medicaid or, if they were on it previously, to help them get it reinstated.

The amicus brief is posted online at www.bazelon.org/issues/criminalization/bradh.html. The settlement of the suit is posted at www.urbanjustice.org/litigation/PDFs/BradSettlementMHP.pdf. ▪