The following post is a chapter from an unpublished book by Mary Buser, who worked in various capacities in the mental health system on Rikers Island. In Buser’s own words: “I worked in the Rikers Mental Health Department as a psychiatric social worker for five and a half years, leaving Rikers in 2000. I started off as a student intern in the island’s sole women’s jail…[and] returned to Rikers to work in a maximum security men’s jail…[then] was promoted to assistant chief of Mental Health in another jail, where I supervised treatment to the island’s most severely mentally ill inmates. From there, I was transferred to my fourth and final jail, which was connected to the “Central Punitive Segregation Unit,” aka, the Bing. Here, I supervised a mental health team in treating inmates held in solitary confinement–determining whether or not someone warranted a temporary reprieve based on the likelihood of a completed suicide. Although I had become disillusioned with the criminal justice system, the Bing was my Rikers undoing. The final section of my manuscript is focused on my daily trips to the Bing, the inmates who occupied these cells, and my struggle to justify doing this work.” Names have been changed to protect the privacy of the individuals involved in the episodes Buser describes.
As jails have come to replace psychiatric hospitals as repositories for people with mental illness, Rikers become one of the nation’s largest inpatient mental health centers (second only to the L.A. County Jail). A disproportionate number of these psychiatrically disabled individuals end up in solitary confinement, doing “Bing time” for rule infractions precipitated by their illness. Buser’s account of her time overseeing treatment in “the Bing” is of particular interest now, when years of activism by the Jails Action Coalition and two scathing reports commissioned by the New York City Board of Correction have finally spurred efforts to reduce the use of solitary and improve mental health treatment on Rikers. These efforts have thusfar yielded at best mixed results. –James Ridgeway
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At the end of a long cinderblock corridor, a guard in an elevated booth passes the time with a paperback book. Across from the booth, a barred gate cordons off a dim passageway. Along the passageway wall are the words: CENTRAL PUNITIVE SEGREGATION UNIT.
The guard looks up as I approach, and nods. As acting chief of “Mental Health,” I’m a regular over here at the “Bing” – an unlikely nickname for this five-story tower of nothing but solitary cells — 100 of them on each floor. Designed for Rikers Island’s most recalcitrant inmates, the occupants of these cells have been pulled out of general population for fighting, weapons possession, disobeying orders, assault on staff. The guards refer to them as “the baddest of the bad” – “the worst of the worst.” I’m not so sure about that.
The guard throws a switch and the barred gate shudders and starts opening. Around a bend, I step into an elevator car. Since the problem inmate is on the third floor, I hold up three fingers to a corner camera, waiting to be spotted on a TV monitor. This is no ordinary elevator — no buttons to push here, likely engineered for some security purpose. The sweaty little box starts lifting, and as the muffled wails of the punished echo through, my stomach tightens — the way it does every time I’m called over here, which is often. Solitary confinement is punishment taken to the extreme, inducing the bleakest of depression, plunging despair, and terrifying hallucinations. The Mental Health Department looms large in a solitary unit – doling out anti-depressants, anti-psychotics, and mountains of sleeping pills. If these inmates had no mental health issues before they entered solitary, they do now. But even the most potent medications reach only so far, and when they can no longer hold a person’s psyche together – when human behavior deteriorates into frantic scenes of self-mutilation and makeshift nooses – we’re called to a cell door.
The elevator rattles open on the third floor. Ahead, a foreboding window separates two plain doors, each one leading onto a 50-cell wing. Behind the window, correctional staff hover over paperwork. A logbook is thrust out, I sign it, and point to the door on the left, ‘3 South.’ When the knob buzzes, I pull the door open and step into what feels like a furnace. A long cement floor is lined with gray steel doors that face each other – twenty-five on one side, twenty-five on the other. Each door has a small window at the top, and on the bottom, a flap for food trays.
At the far end, Dr. Diaz and Pete Majors are waiting for me. I hesitate for a moment, dreading the walk through the gauntlet of misery. The smell of vomit and feces hangs in the hot, thick air. Bracing myself, I start past the doors, trying to stay focused on my colleagues. Still, I can see their faces – dark-skinned, young – pressed up against the cell windows, eyes wild with panic. “Miss! Help! Please, Miss!!” They bang and slap the doors, sweaty palms sliding down the windows. “We’re dying in here, Miss – we’re dying!” Resisting my natural instinct to rush to their aid, I keep going, reminding myself that there’s a reason they’re in here – that they’ve done something to warrant this punishment. The guards, themselves sweat-soaked and agitated, amble from cell to cell, pounding the doors with their fists, spinning around and kicking them with boot heels — “SHUT—THE FUCK– UPPP!!”
I keep going. Dr. Diaz, a silver-haired psychiatrist, greets me with a weak smile. Pointing to a door that’s slightly ajar, he says, “We got a head basher.” He hands me the inmate’s chart. The label on the manila folder reads ‘Troy Jackson.’ “He’s been going downhill for a while now,” Diaz explains. “I’ve upped his meds, changed them– we’ve talked to him — but at this point, we’re out of options.”
“He’s been in for two months now,” says Pete Majors, the lanky therapist who works with Diaz. “With three more to go.”
I wince at the length of punishment. Two entire months spent inside an eight by nine foot cell – just enough room to pace back and forth — about the only activity the cramped quarters allow. No phone, no TV, with one hour of “rec” – which amounts to a shackled walk to an outdoor cage to stand alone and glimpse the sky. Although the maximum punishment for any single infraction is ninety days, there’s nothing to stop the infraction tickets from piling up, which is apparently what’s happened in this case.
“All right, let me talk to him,” I say, with some vague hope of dispensing calming words that might enable Troy Jackson to hang on a little while longer.
The guard pulls open the creaking door and steps back. Inside, a black youth stands trembling, beads of sweat dripping from his chin. He’s barely out of his teens. Behind him, a little mesh-covered window transforms the day’s brilliance into grayness. A dingy sheet is strewn across a cot; across from it is a tiny metal sink and toilet. “Please miss, please,” he whispers. “Help me…”
For a moment, Troy Jackson and I stare at one another. In his jeans and tee-shirt, he looks no different from every other kid on the street. With his wiry youthful frame, I can easily picture him shooting basketballs on a city playground, or bounding up subway steps headed for school. Instead, he’s trapped inside a cement box on Rikers Island. As his eyes plead with mine, blood seeps through his scalp, running down behind his ears. How could his young life have derailed this badly? I feel a clutch in my throat and my mind starts swirling back to my more familiar days on Rikers, when I would have worked with him, listened to his story, helped him to find a better path for himself. But my days as an upbeat therapist are already feeling like something from a distant past. As a newly appointed administrator, I remind myself that I’m not here to get to know Troy Jackson, or even to find out why he’s in solitary. I’m here to make sure of exactly one thing — that he remains alive. “Mr. Jackson, I’d like..”
“I can’t..” he interrupts. “I’m telling you– I can’t. Please, Miss…please. I’m begging you.. I’m begging…”
The blood is trickling down into his eyes, and I realize that we’re well beyond any therapeutic dialogue. “Okay – just give me a minute here, okay?”
Pete, Dr. Diaz and I huddle to the side of the cell, once again finding ourselves at a familiar miserable impasse. Although we have the authority to provide temporary relief in these situations, doing so is hardly a cut-and-dried matter. In the outside world, someone banging his head would be treated with a sense of urgency and alarm. But in here it’s different. Behind bars — and especially in the Bing — these drastic acts are common, and the Mental Health Department is under fierce pressure to not give in to the inmates’ goal of a reprieve from solitary. When I arrived here a few weeks ago, one piece of advice summed it up – “If you authorize the release of every inmate who cuts himself, bangs his head, or fashions a noose — you’ll wind up with 500 empty cells.”
Of course, it’s also up to us to make sure that nobody actually dies. I’m still comprehending the reality of my new job, but it’s already clear that it entails walking the thinnest of a tightrope.
The question we now have to ask ourselves is if the breaking point has truly been reached. If we agree that death or severe injury is likely, then Troy Jackson will be bussed to a smaller more specialized unit in another jail down the road. The bus-ride alone seems to offer the isolation-weary inmate enormous relief. We call it “bus therapy.” Once he’s a little better, though, he’ll be shipped right back here to complete his sentence. Like the weary swimmer treading water but starting to go under, he’ll be pulled out to catch his breath, and then thrown back in. I can’t help but feel that this has the earmarks of torture. But I brush the word from my mind. After all, I live in a civilized country that prohibits such things. Besides, I’m still new to this post and there must be something about this punishment that I’m missing. Although frankly, I’m hard pressed to figure out what it could be.
Dr. Diaz mops his forehead with a bandana. “Medical can stitch him up,” he says, “but if we put him back in, he’ll just tear out the stitches — smash his skull right open – I’m sure of it.”
“If we let him out,” says Pete, “we’re going to get copycats, but if we don’t, this is only going to get worse.”
As acting chief, they look to me for a final answer. I want to give this kid a break, and am just relieved that these two veterans of punitive segregation seem to want the same. “I don’t think we can let this go any further,” I say. “If somebody else tries the same thing, we’ll just have to deal with it.”
“Agreed,” says Dr. Diaz.
“Listen,” Pete says. “We better do something quick.”
A loud moan comes from Jackson’s cell, and we rush back in just as the young man’s head thuds against the concrete. Blood is freely spilling now, the gash in his scalp revealing a patch of glinting whiteness.
“Please, Mr. Jackson,” I say. “We’re trying to help you. We’re going to get you out. Just give us a chance here! Troy, please!”
But Troy Jackson, beyond words, crumples to the floor.
“You’re coming out,” says Dr. Diaz, leaning over him. “It’s over –it’s over now!”
“Cap–tain!” the guard shouts. “We got one comin’ out.”
Dr. Diaz and Pete will resume their rounds, while I start back down to the clinic to begin the mountain of paperwork that this transfer requires. On my way out, I move quickly past the cells, past the clamoring fists and pleading palms. In a day or two, we’ll be standing at any one of these other doors, faced with another scene of human desperation. Most won’t be as lucky as Jackson. For most, we simply offer words of encouragement and walk away, deeming them not yet decompensated enough to warrant the bus trip out. I try not to think about it. One day at a time.
On the ground floor, the big barred gate is inching open to allow a new shift of guards to enter. I hustle through, eager to get out. Wending through cooler corridors, I walk alongside GP inmates who are headed to work details and the Law Library. Passing by the jail’s main entryway booth, guards glance up and wave. In some ways it’s almost pleasant. I manage a weak smile and with a quivering hand, I wave back, all the while struggling to blot out the image of Troy Jackson’s skull.