Committee on Criminal Justice

Welcome to today's New York City Council hearing for the Committee on Criminal Justice. Please silence all phones. If you wish to speak in today's hearing, you could fill out an appearance card with one of the sergeants moving forward. No one is to approach the dais. Chair, you may begin.

Thank you, and good morning once again. I am still Councilmember Sylvina Brooks-Powers. And I am the chair of the Committee on Criminal Justice. I want to welcome everyone to today's hearing on mental health care in New York City jails. The committee will also be hearing Introduction Number 809, sponsored by myself, in relation to requiring the Department of Correction to create and implement policies to address medical needs during and after lock-ins.

Introduction 453, sponsored by Councilmember Stevens, in relation to the provision of mental health services for children visiting incarcerated individuals, and Introduction Number 133 sponsored by Councilmember Kavanagh in relation to extending the minimum duration of and updating other requirements pertaining to the task force created to address policies related to the treatment and housing of transgender, gender nonconforming, nonbinary, and intersex individuals in the custody of the Department of Correction.

I am joined by Councilmembers Marano, Narcisse, Brewer, and Khaman. The issue before us today reflects one of the most significant challenges facing our city's jail system, ensuring that people in custody with mental health needs receive appropriate care while navigating a system that was never designed to serve as a substitute for a comprehensive behavioral or mental health system.

Today, approximately 60% of people in city jails have a documented mental health need, and approximately 1 in 5 people in custody has been identified as having a serious mental illness. For many New Yorkers in custody, incarceration has become the point at which they first receive consistent access to mental health services. Specialized units and treatment models exist, but the prevalence of serious mental illness in our jails raises important questions about whether individuals are receiving care at the appropriate level, whether treatment is accessible when needed, and whether the current system is equipped to support people with complex behavioral health needs.

People experiencing serious mental illness may require consistent medication management, therapeutic services, and specialized housing to prevent further deterioration. When access to care is disrupted, whether because of missed appointments, staffing challenges, housing limitations, or operational issues, those disruptions can have serious implications for individuals' Health and Safety. Today's hearing will examine the continuum of mental health care available within city jails, including mental observation units, Program to Accelerate Clinical Effectiveness, or PACE units, and the city's new outposted therapeutic housing units.

We will examine how these programs function, how individuals are identified for placement, how quickly they can access appropriate levels of care, and whether existing capacity meets the needs of the current jail population. The committee will also examine concerns regarding access to treatment during jail operations, including the impact of lock-ins on medical and mental health appointments. When individuals are unable to access scheduled care, particularly those with serious mental illness who rely on consistent treatment.

It is critical that there are clear procedures to ensure continuity of care. As the city works towards closing Rikers Island and transitioning to a borough-based jail system, these questions take on added urgency. This transition can only happen successfully if our jail population is reduced, And if a substantial share of the population is not having their mental health needs met, then we are not moving towards our goal.

Meeting these needs through treatment inside our jails today, through discharge planning, and through diversion to keep people out of custody in the first place is not separate from the closure plan. It is a necessity for it. For that reason, today's hearing aims to better this council's understanding on how mental health care is provided to the individuals currently housed in our jails and what additional investments or reforms are needed to ensure that incarceration does not become the default response to unmet behavioral needs— health needs.

I would like to thank my staff and committee staff for their hard work. Jahari Frazier, counsel to the committee. Chad Benjamin, Policy Analyst. Casey Lasky, Financial Analyst. Owen Brady, my Policy and Budget Director, and Renee Taylor, my Chief of Staff. I look forward to a productive discussion about how we can strengthen mental health care within our jail system, improve access to treatment, and ensure that New Yorkers in custody receive the support and services they need.

With that, I am going to pause to allow Councilmember Caban to give remarks pertaining to her bill.

Thank you, Chair. Good morning. Entering Rikers Island is a potential death sentence for any New Yorker, but that is doubly true for trans, non-binary, and gender non-conforming people who are incarcerated there. And on top of the other dangers and indignities of incarceration at Rikers, transgender, non-conforming, non-binary, and intersex individuals are routinely denied access to housing that matches their gender identity.

They're forced to live in an environment where they face discrimination and the risk of violence. And I saw that firsthand in my time as a public defender. You know, it's unconscionable that in this city we are treating queer folks like this. The task force on issues faced by TGN-CNBI people in custody has already done crucial oversight to bring this to the attention of council members, members of the administration, community-based organizations, and the public at large.

Their 2022 report did remarkable work bringing the experiences of trans and non-binary New Yorkers in DOC custody to light. Their work is so vital because we cannot pass legislation without understanding the nature and scale of the issue at hand. They need not just a mandate, but our full support. And that is why it is essential that we pass my bill, Intro 133, to extend this task force and ensure that the DOC and Correctional Health Services substantively participate in its work.

And I want to say that alongside Intro 133, I've also put forward Intro 134, which would give New Yorkers incarcerated at Rikers recourse to be housed in units where they will be safe from gender-based and sexual violence. And so I hope that we can consider that bill to act on the recommendations of the task force. Thank you to Chair Brooks-Powers and to my colleagues for supporting the bill, the folks that have signed on, and I'm really glad that it's being heard today.

Thank you, Chair. Thank you.

We're going to ask for the administration testifying to come to the dais. All right, good morning. We will now hear testimony from the administration. Before we begin, I will administer the affirmation. Panelists, would you please raise your right hands? Do you affirm to tell the truth, the whole truth and nothing but the truth before the committee and to respond honestly to councilmember questions.

All right. Thank you. You may begin when ready.

Thank you. Good morning, Chair Brooks-Powers and members of the Committee on Criminal Justice. My name is Dr. Joseph Otonakar. I serve as the Chief of Mental Health for New York City Health and Hospitals Correctional Health Services. I'm joined by my CHS colleague Jeanette Merrill, Senior Assistant Vice President of Communications and External Affairs. We appreciate the opportunity to testify today on mental health care in the New York City jails, an issue of paramount importance.

Since 2016, CHS has been the direct provider of physical and mental health services to people in the custody of the New York City Department of Correction. Approximately 61% of these individuals are patients have received mental health services during their incarceration, and about 22% of the total patient population has been diagnosed with a serious mental illness. The prevalence of mental illness is greater among women, with 85% of our female patients enrolled in the mental health service and 49% of our female patients diagnosed with a serious mental illness.

The challenges and stressors of jail incarceration, which include restrictions on autonomy, And control can prove clinically destabilizing for many of our patients. The circumstances of pretrial detention can be chaotic and unpredictable and can exacerbate or even induce symptoms of psychological distress. Uncertainty about the outcomes of legal cases can create additional tension and anxiety. And this is all occurring at a time when our patients' access to community supports and outlets for coping are reduced.

Nonetheless, many of New York City's most clinically complex individuals receive mental health care on Rikers Island that they may not have had access to in the community. CHS recognizes the opportunity we have to care for this vulnerable population and works to ensure that all of our patients have access to high-quality mental health services during what can be the most challenging time of their lives.

In my testimony, I will provide An overview of CHS's mental health services, starting with the initial mental health assessment and concluding with our reentry services. I will describe the spectrum of mental health care in the jails, including the mental health therapeutic housing units. CHS medical and nursing professionals conduct a comprehensive medical evaluation of all individuals when they are admitted to the New York City jail system.

During these intake evaluations, nurses and doctors obtain vital signs, draw labs, and offer testing for communicable diseases. They also ask patients a comprehensive set of questions about their medical and mental health history and current physical and mental health status. Based on the information obtained during the intake assessment, patients may be referred for follow-up care and/or additional evaluations, including to the mental health service.

Patients may be referred to the mental health service for evaluation either as a result of the CHS intake screening or at any time during their incarceration. During every initial mental health assessment, a licensed CHS mental health provider reviews the patient's full mental health history, interviews the patient, and reviews an extensive social history with the patient, including past personal relationships, educational attainment, adverse past experiences, and socioeconomic stressors.

Clinicians may obtain collateral information from community-based providers to inform their assessment and to ensure that the patient's history is complete and accurate. When available, the clinical mental health staff review past medical records as well as the patient's psychiatric services and clinical knowledge enhancement system, or psyches, report. Which includes historical information about inpatient psychiatric care at a New York State Office of Mental Health facility and Medicaid-funded community-based mental health treatment.

The information the mental health provider obtains during this assessment helps to inform their diagnostic assessment, individualized treatment plan, case management, and reentry planning. The information also enables clinicians to assess clinical risk factors and to determine the patient's most appropriate mental health level of care. Most patients who have mental health needs in the jail system are appropriately housed in the general population, or GP, and meet with mental health clinicians in the clinic for their appointments, similar to an outpatient model of care in the community.

The jail-based mental health therapeutic housing units, conversely, are designed for patients who have more robust mental health needs, and require increased clinical observation and care coordination. These units offer a continuum of care leading up to units that are akin to residential treatment facilities in the community, with CHS mental health staff primarily working on the units to provide enhanced treatment interventions.

For patients who benefit from a level of care higher than outpatient general population, CHS established mental observation or MO units. of which there are currently 17. Patients on MO units are rounded on regularly by mental health staff and receive enhanced clinical monitoring and support. Earlier this year, CHS also implemented the Supportive Transitional Engagement Program, or STEP, within the mental health therapeutic housing continuum.

STEP serves as an intermediary level of care between MO and GP. The most intensive level of mental health care CHS provides on Rikers Island is the Program to Accelerate Clinical Effectiveness, or PACE. These units house clinically vulnerable patients who have the most complex mental health needs, including persons with serious mental illness and/or developmental disabilities for whom a level— a lower level of care is not optimal.

There are currently 10 PACE units in operation, including a 20-bed PACE unit within the Outposted Therapeutic Housing Unit at Bellevue Hospital that houses patients who have comorbid psychiatric and medical complexities. Within each of our PACE units, a multidisciplinary team which includes mental health clinicians, creative arts therapists, treatment aides, and social work and nursing staff works with each patient to provide coordinated care.

CHS mental health clinicians continuously assess the patient's therapeutic needs throughout the individual's time in jail. As those needs change, CHS works with DOC to more appropriately house that individual. If a patient requires a higher level of care than be— than can be offered in the jail setting, CHS initiates transfer to an acute psychiatric hospital for evaluation and possible admission.

Like all of CHS's patient care services, the Mental Health Service closely collaborates with CHS's Reentry and Transition Service, to help connect patients to clinical resources in the community, and to help ensure continuity of care upon discharge from jail. CHS makes core reentry services available to all patients and provides individualized discharge plans to patients with particular clinical needs, including all consenting patients receiving mental health treatment.

Reentry staff work to ensure that at a minimum, patients have Medicaid, a a community provider, access to medication, and awareness of a variety of safety net resources. These resources include but are not limited to CHS Community Reentry Assistance Network, or CRAN, which helps former patients access community-based health and social services. CHS's peer-staffed general helpline called PORTLINE, which helps people navigate community-based services, and the Point of Reentry and Transition, or PORT, practices located at New York City Health+ Hospitals Bellevue and Kings County Hospitals, which provide primary care, mental health care, and wraparound services to formerly incarcerated individuals.

We also invite all patients to drop into CHS's Reentry Services Center on the visitor side of Rikers Island after their release. Patients with serious mental illness are offered additional services, including 2010 supportive housing applications, transitional case management services, and free smartphones with a year-long service plan. The reentry team also works closely with partners in New York City government to help support our patients when they return to the community.

For example, CHS refers patients as appropriate to the New York City Department of Health and Mental Hygiene's Single Point of Access, or SPOA, program, which connects people to intensive mobile treatment, assertive community treatment, and other such community-based programs. In conclusion, so many of our patients enter our care with tremendous sociomedical and mental health needs, and their involvement in the criminal legal system, up to and including jail detention, often exacerbates those challenges.

CHS is proud to provide the community standard of care in a difficult environment to one of the city's most marginalized and vulnerable populations. We remain committed to working with this City Council and other stakeholders to improve the system and to support our patients before and after incarceration, because we recognize that the challenges they face extend beyond the carceral walls.

Thank you.

Happy to take any questions. Good morning, Chair Brooks-Powers and members of the Committee on Criminal Justice. My name is James Boyd, and I'm the Deputy Commissioner of Quality Assurance and Compliance. at the New York City Department of Correction. I'm joining you in a new role overseeing a new portfolio of work, which includes health affairs. Joining me today is my colleague, Assistant Chief Joseph Caputo.

My colleagues and I thank you for the opportunity to discuss this important topic and share how the department facilitates access to mental health care within our jails. New York City jails exist within a continuum of support, intervention, and care that is shared between many stakeholders and partners. Our responsibility to people in our care includes making sure they receive access to medical and mental health treatment they need to support their well-being while in their care— while in our care.

That responsibility is central to building a safer and more humane jail system, which is why Mayor Mondani's administration has been laser-focused on strengthening access to mental health services for people in our, in our city's jails. Our partners at Correctional Health Services bring the clinical expertise, and our dedicated staff makes access possible by escorting people to the clinic, transporting them to outside appointments, and supporting the safe delivery of care within clinical spaces.

In addition, DOC coordinates with CHS to ensure the smooth operation of safe and inclusive housing options to meet a wide spectrum of mental health needs And all uniformed staff receive training to help them better understand and engage with individuals who have mental health needs while keeping them safe. That important work requires daily coordination from all levels of both agencies.

Behind each appointment is a person whose health matters, and our collective work must be measured by whether that person received the care they need. The department will continue prioritizing various modernization projects, including the clinic production dashboard, to improve processes and make this work more efficient. The legislation before the committee speaks to that same responsibility. Intro 133 concerns people whose safety and dignity require our sustained attention.

We value the task force contributions and the experience that advocates and community partners bring to improving the treatment And housing of transgender, gender non-conforming, non-binary, and intersex people in our care. The feedback and collaboration that has been born out of these meetings has resulted in meaningful changes to practices within our jails. We want that collaboration to remain strong and look forward to further conversations.

Intro 453 recognized that incarceration also affects children and families. A child visiting a parent deserves to feel welcomed, supported, and safe. The department has worked diligently over the past few years to build on our family-centered visiting initiatives and has worked with partners whose expertise has helped children and families receive targeted support and attention so that visitation is meaningful and relationships remain intact.

While we agree that children should have access to mental health services should they need it, We do not believe that the department is the best agency to offer those services or make referrals to such services. Intro 809 addresses access to care during emergency lock-ins. Protecting people from immediate harm and meeting their healthcare needs are both essential responsibilities.

In recognition of this, the department continues to escort individuals to medical appointments during emergency lock-ins when it is safe to do so and coordinates closely with CHS To address any clinic encounters that may have been missed as a result of a lock-in, often as soon as the same day. We look forward to working with CHS and the council to address any remaining gaps to ensure that people continue to have access to the services that they need.

This administration is committed to an approach that puts community safety at the center of all the work we do. That remains That means we share a responsibility to ensure people in our city's jail have access to vital services that support their dignity, safety, and health, and to work in partnership with all stakeholders along the continuum, from upstream diversion efforts to post-release community-based care, to work towards better outcomes.

As we often say, there is more work ahead of us. We are eager to build on improvements that are already underway and we are working closely in coordination with the remediation manager and federal monitor and their respective teams to ensure they are part of the process as we move forward. Thank you again for inviting us to discuss these important matters.

We welcome any questions you may have at this time.

Thank you. I'd like to add that we've been joined by Councilmember Stevens, who will give some remarks regarding her legislation. Good morning and thank you, Chair. I'm honored, I'm honored to be here today for Intro 453 legislation that speaks directly to our responsibility to protect and support children and families. Children visiting incarcerated parents or family members can experience fear, confusion, sadness, anxiety, and trauma that often goes unaddressed.

As a city, we have the responsibility to make sure that these young people have access to the supports they need and to process those experiences in a healthy way. This legislation actually came about, as most people know, that I worked with young people for over 20 years. And for a multiple number of years, young people who had family members, particularly parents who were experiencing incarceration, would come to my programs with severe trauma.

One of my young people that I worked with actually came to me and helped me develop this even before I was in council to say, I wish I would have had someone to talk to. I wish someone would have been there process what I experienced and tell me that I was going to be okay because they were like their parent was never coming home.

This young person's father was facing life in prison and did not know how to process that at such a young age. And so this legislation is very near and dear to me. So when talking about incarceration, we cannot only focus on the person who's incarcerated. We have to think about the children and the family who are also impacted.

Thank you. This is why Intro 453 is so important. This legislation would ensure that children visiting incarcerated individuals could receive referrals to mental health services. As the chair of, of the Committee on Children and Youth, I believe that our work must always center the well-being of our young people. We have to meet young people where they are and provide them with the support before trauma becomes a deeper crisis.

Me and my colleagues visited yesterday Horizon And we saw hundreds of children who were in secure detention. And that was because a lot of them did not know how to process trauma. So this is a way and a step that I believe that could help with some of that prevention. If we're serious about breaking the cycles of harm of incarceration, then we must invest in healing, family stability, and prevention.

Every child deserves the opportunity to process their difficult experience with care, compassion, professional support, especially at a time where young people continue to ask for greater access to mental health. When young people tell us what they need, we have the responsibility to listen to them. And more importantly, we must deliver what they're asking for. Intro 453 is about recognizing that incarceration impacts entire families, and supporting children is an essential part of building healthier and safer communities.

I want to thank my colleagues for supporting this and this important legislation, and I urge everyone to continue to support this. Thank you. Thank you, Chair.

Thank you, and thank you for convening yesterday's tour of Horizon. It was definitely insightful. Okay. Let's get into it. First things first, Commissioner, can you let me know when this hearing was noticed? Do you recall when this hearing was noticed? Are you asking when did we receive notification? I mean, I receive it internally, so I got it from our, you know, our intergov team, so I don't recall the actual date.

Do you guys normally get it before it's put publicly? That I'm not totally aware of. I think we normally see a public notification first, but I'm not— I think it's coordinated in terms of the date to make sure that the administration is available. And I ask that because we noticed this hearing on September 2nd, 21 days ago.

I also requested that when coming to this hearing— and I can't speak for any other committee— that we have testimony at least 24 hours in advance. I ask this so that we can have a meaningful conversation. So I'm going to say publicly on the record what I have said privately to the administration. Thank you. The past administration was able to submit testimony in advance.

The MTA, which is a state agency, was able to submit testimony in advance. And I imagine this administration has the capacity to be able to submit testimony 24 hours in advance so that I can properly be prepared to chair this hearing. I do feel it's very disrespectful that I continue to have that request disregarded. And I feel like it's showing that the administration does not have good faith to work together to have a truly productive conversation during these hearings, because it allows us an opportunity to prepare better and not have redundant questions that you may be addressing in your testimony anyway and have to do that in real time.

I really want to maximize the use of my colleagues' time. Your time is mine. Thank you. So I'm going to say it on the record again. My request is that going forward, any agency that comes before the Committee on Criminal Justice has testimony to us within 24 hours of the hearing. And I just want to acknowledge that, and I'm happy to take that feedback.

Obviously, you've had a conversation with them. I've spoken to them, too. Yep. But I just wanted it on the record. We'll certainly take that back. Thank you. Now we can get into it.

Let's start with mental health care and specialized housing. How does DOC currently identify people in custody who need mental health services when they enter the jail system? So I think we can actually take that one, CHS. So as referenced in Dr. Tonitjar's testimony, so everyone who goes through the new admission process at Rikers can be referred to the mental health service depending on their mental health needs.

They conduct an evaluation, they're assessing the level of care that the individual will require when on Rikers, and that can mean specialized housing units. We reference PACE, the mental observation units, and then our new form of housing, STEP. And then that information is shared with the department to transfer the individual into the appropriate housing unit. Thank you.

Thank you for that. Um, how many people are currently housed in mental observation units? Sure. So for mental observation units, the current census is 629 patients, and that's across 17 units. Sorry, can you repeat the number? Oh sure, 629 patients across 17 Thank you. In September 2022, CHS testified that there were 2 CAPS units with 5 people housed in CAPS at the time.

In October 2023, DOC testified that there were 830 mental observation beds consisting of 334 PACE beds and 496 mental observation beds. CAPS was not separately identified in that breakdown. Are there currently any CAPS units operating? There are. There's one CAPS unit in operation. I believe 21 or 23 individuals are currently housed there. There's 23 people currently in CAPS.

There's one CAPS unit currently in operation. Thank you. What steps is DOC taking to ensure a person in their custody has consistent access to their medication at the times they're supposed to take such medication? Well, I mean, that's continued collaboration with CHS. Anyone that's produced that requires access to medication is produced. to the appropriate medication windows or, you know, distributed medication in the housing unit.

I mean, we have frequent ongoing conversations at the exec level but also at the local level in each jail. So all of the wardens have conversations with the CHS staff directly on site to ensure that that continuity of care and access to medication is being afforded. And I'll just add, one of the benefits of the therapeutic housing units is that medication can be provided on site.

So those are units where mental health professionals actually, they have offices, they're engaging directly with patients there, particularly on PACE unit. If a patient wasn't able to receive medication from a pharmacy technician earlier in the day, the nursing staff may be able to engage with them better later that day so they don't miss the dose. Thank you both.

Regarding the Outposted Therapeutic Health Units, how many people have been transferred from Rikers to the Bellevue Outposted So I don't have the total number transferred. I can tell you the current census is 81 patients, and 18 of those patients are on the PACE unit, which as mentioned earlier, the PACE unit at the Bellevue Outposted unit is for individuals who have comorbid psychological and medical complexities.

Most of the beds at Bellevue Outposted are for people who have medical complexities. Thank you. And there are 63 patients for those. So all 104 beds are not operational right now? They're operational, but they aren't currently filled. So in terms of bed capacity, that would differ from ideal clinical capacity. We have to take into account things like patients' acuity, need. the therapeutic milieu of the unit, so we wouldn't necessarily want every bed to be filled at every moment.

That said, I believe Bellevue Outpost is holding some beds for patients who are currently hospitalized knowing that they'll need to be returned to the unit. So with that in mind, are there any plans to expand the number of beds at Bellevue beyond the current capacity? Not at Bellevue. That unit has all the beds, has 104 beds. But we are in the process of opening 2 additional units.

We are in the procurement phase for the construction of the outposted unit at Woodhull. We hope to be in the procurement stage soon for North Central Bronx. And those 2 units, unlike the Bellevue unit, will be focused more on patients with significant mental health needs, particularly Woodhull, as they may have some comorbid medical or substance use needs, but it will primarily be psychological concerns.

And so now that it's in procurement, once it goes from there, I imagine it goes into design? We've been working on design. So we're hoping to start construction of the actual outposted units early next year and then working towards 2029 opening dates for both units, although there's interest throughout the administration in expediting that. So are looking for opportunities to move up that timeline.

On August 19th, Christopher Rodriguez died while being housed at Bellevue Hospital. When he was found, he was in a quote-unquote medical distress state before being pronounced dead at 8:39 a.m. Mr. Rodriguez was the 6th This is the 3rd death of a person in the department's custody this year. Do we know what the cause of his death was?

At this time, we don't, but I will echo Commissioner Richards' statement and extend our condolences to Mr. Rodriguez's family. Our hearts go out to them, but at this time, it is pending investigation, and that final determination regarding the medical autopsy is still pending. Just segueing real quick, just on the autopsies, because we're, I think, up to 8 deaths now for this year.

And every time I get a call, I ask about the previous deaths in terms of the status of the autopsies. And I'm just curious as to why it's taken so long, because even with the toxicology reports, I understand they take a little bit longer in time, but— I think the earliest death may have been like February, March, if I'm not mistaken, and we still don't even know the cause of death for that person, and we're now in September.

But if a regular New Yorker needed to go through the medical examiner and have an autopsy and a toxicology report, we would have had the results by now. So what is the delay with the department for these results? Well, that determination regarding how somebody succumbed to whatever, you know, happened to them is through the Medical Examiner's Office, and so it can take a few months before we receive the final determination.

We understand that, you know, those final determinations can bring the family members closure, and we'll support them throughout this process and make sure they know who to contact, but I'm gonna have to defer to the OCME regarding their timelines to make that final determination. That's not something that the department looks into. We rely on our partners to share that information.

So the department doesn't ask why it's taking so long or what the timeline is? I mean, we will engage with them, certainly. I mean, we've had a longstanding partner with OCME, but, you know, they— Because it's taking longer than the average New Yorker, and you all are an agency. Correct. A sister agency. So I would imagine you would be able to get the information sooner.

I mean, we can certainly circle back and we can have those conversations with them. You know, they're looking at this from the citywide lens as well. Um, but we can— we're open to have those conversations to see what we can do. Absolutely. Um, do you know when he went into distress? We know when he passed, but do we know approximately the time he went into distress?

So we wouldn't be able to speak about any particular patient case here. Um, I will say, you know, the department works with all of the various oversight bodies, reports the death. We do our own processing Internally, including a Joint Assessment Review, a JAR, that's joint with the department. We review our— under our own mortality and morbidity review committees.

The New York City Board of Directors, Health and Hospitals Board of Directors, also reviews. But because of patient privacy concerns, I'm not able to discuss publicly. Can you share what was done once he was found in distress? I think those conversations are still ongoing with the department and under investigation. I will say there is a Board of Corrections report that ultimately will come out and that will provide more information.

When will that report be out? I would defer to BOC, Board of Corrections. Are any policies at Bellevue being evaluated as a result of Mr. Rodriguez's Part of the JAR, the Joint Assessment and Review, is examining any policies, procedures that may have played a role. I think it's, again, premature now, but that could be a corrective action following a patient death.

And to your point with the JAR, which people or what entities are involved in investigating Mr. Rodriguez's death? For investigation? Yeah, that's the State Attorney General's Office, the Department of Investigation, as well as the Board of Correction.

We're going to pause the hearing and open back up the vote so that Councilmember Salaam can Cast his vote. How you doing? Greetings everyone. Continuation roll call vote, Committee on Criminal Justice, proposed introduction 246A, Councilmember Salam. Aye. Final vote is now 6 in the affirmative, 0 in the negative, and no abstentions. Madam Chair, to close the vote.

With that, the vote has been closed. Thank you. One moment, everyone, while we reset.

All right, we'll now continue the hearing. I am going to yield my questions for the moment and move to member questions, starting with Councilmember Narcisse.

Thank you, Madam Chair. Thank you. I have to start by saying thank you, Madam Chair, for always being present and on point. We have, I mean, a question about how mental health is affecting people that's not even in incarceration. So having like kids, and I'm so happy that you're on board with us with the children because we have to be mindful of the folks that's not present in the background.

So thank you for all your leadership. We hear that routine medical appointments, right, are often missed. Is the same thing happening with mental health appointments? How many were missed in the last fiscal year? because DOC did not produce the patients, and what share of all the scheduled mental health appointments is that? Specific to mental health appointments? Uh-huh.

So I have for a calendar year to date, so the first 8 months of this year, there was over 60,000 mental health appointments. About 10% of those appointments were due to non-production that could have been related to either no escort or an alarm, a TSO, or lockdown. And so that's a really small percentage when you compare it to the total amount of scheduled appointments.

And so again, we do prioritize medical appointments in the jails. That is a daily ongoing conversation every day, 24/7, right? And so if someone missed their medical appointment in the morning, DOC staff in that particular facility is gonna be working with CHS staff staff to see if they can produce them the same day. And so there's always ongoing conversation to make sure we're giving people access to the care that they need, and that's an ongoing partnership we have with CHS.

And so there are things we're going to internally do, you know, to figure out how we can make this process more efficient, but we're moving in the right direction, and we strive to make sure people are produced to their clinic appointment. In all honesty, I can say it's progress because it's only 10%, but the 10% still matter.

So, and I'm happy to hear that you're going to make every effort because every appointment, especially when it comes to mental health. What share of people leave with the discharge plan, a medication supply, and a scheduled appointment in the community? How are you tracking whether they actually make that appointment? We spoke back and forth about that before.

Are we doing the follow-up? Yeah. Yes, yeah, so I guess to start, we provide core reentry services to every person in custody. Crucially, that is ensuring that they have Medicaid access on their release, so we're checking whether they came in with coverage. If they did not, then we can help them apply. We're also sending prescriptions to the pharmacy of their choice on their release.

We're connecting them or referring them to the various services as Dr. Uttanachar referenced in his testimony. We have the community reentry network. We have the PORT primary care practices at Bellevue and Kings. We have a PORT line that individuals can call. And then patients who are enrolled in mental health service can also leave Rikers with meds in hand.

I will say all of our services in the jails, as well as you know, any community referrals are all voluntary. So we aren't necessarily tracking or ensuring, but we are trying to remove as many barriers as possible so that if someone wants to access that care in the community, they're able to. The voluntary part bothers me because when a lot of folks end up in the community, and especially the Black and brown communities, now more than ever, you see now our young folks walking around with serious mental health problems and there is no place to go and no community arrangement.

I think we have to make maximum effort to make sure those populations that are coming from incarceration are being addressed. Now, another question I'd be remiss not to ask, how about those folks that have no medical coverage and that on the TPS or different reason, they don't have no paperwork and they're not getting insurance in the outside world?

Are you making maximum effort to refer them to a place where they can get support? Yes. So about 85% of people in custody, we estimate, will have Medicaid coverage on their release, either because we've helped enroll them or they're previously enrolled. I think we're— that's where we're incredibly fortunate to have New York City Health+ Hospitals in our city, because the system provides care to everyone regardless of, you know, their ability to pay.

And that is something that individuals can certainly call PORTLINE, which is the peer-staffed reentry line, to help get connected there, or they can go into CRAN to get connected.

Chair, may I ask 2 quick questions? How is interpretation handled in a therapy session? Are sessions offered in multiple languages? So we adhere to the community standards of care. Of course, if somebody is not a native English speaker, it's of paramount importance that we offer services in the language of their preference. And typically we do use interpreter services, uh, um, for that, either in person or through a telephone or video system.

All right, me and my chair are going, but I'm gonna circle back. I'm gonna circle back. But the budget is interesting for me because I want to know how much money is being allocated when it comes to psychiatry. Thank you, Madam Chair.

We're going to go to Councilmember Marano. Thank you, Chair. Thank you all for your testimony. I'd love to begin with Dr. Otonishore. You testified that most people with mental health needs are appropriately housed in general population, and I want to be very precise about the word appropriately. When CHS says someone is appropriately housed in general population, does that mean CHS believes general population is the clinically best placement?

Or can it mean it's simply the best placement currently available? So we continuously assess throughout an individual's incarceration what their clinical needs are, how closely they need to be monitored. Similar to the community standard, patients who are able to function higher and less in distress are able to be brought to their appointments similar to the way you and I would go to an outpatient clinic.

For those individuals who are more vulnerable, who benefit from closer monitoring, who benefit from greater support, we would transfer those patients onto a therapeutic housing unit until those needs are stabilized. If they— and we often will keep them there indefinitely if it is recommended. So specifically among people with serious mental illness, who are currently in general population, how many would be in a more therapeutic setting if every clinically appropriate bed were available today?

I'm sorry, can you rephrase your question? So among people with serious mental illness who are currently in general population, how many would be in a more therapeutic setting if every clinically appropriate bed were available today? We consistently do assess the needs and assign patients to whatever level of care is appropriate. Currently, all patients who require a particular level of care are transferred to that level of care.

So what we have is sufficient? Particularly understanding. I think another way of thinking about it, there's currently 24 patients who are awaiting placement on a PACE unit, so they do require a higher level of care. We had an influx of hospital returns, and so those individuals are being closely monitored on MO, but they do require PACE. But I do think it's a common misconception that anyone who has a serious mental illness requires a residential treatment level of care.

Understood. So GP is clinically appropriate. Deputy Commissioner Boyd, obviously you're responsible for Quality Assurance and Compliance. If CHS recommends a higher level of care and Department of Corrections can't provide the bed, is that recorded somewhere as an unmet clinical recommendation? And if it is, do you publish that number? I think if there is a concern regarding the placement, then that's where we'll have that conversation.

If it's a concern about the safety of individuals where the requested placement for these individuals should go to, then we're having that conversation with CHS to see if they could be placed somewhere else. And so if there's really serious concerns about a challenging detainee who might need to be placed in PACE or another unit, and we think they might be a threat to the safety of other folks in that particular housing unit, then that's a conversation with CHS to see if they could be placed somewhere else and still receive the same level of care.

I don't know if that answers your question. I think it does in part. I guess what I'm wondering is if there's specific data available about people that are being recommended for a higher level of care when we don't have the resources for that bed, and I'm wondering what that number is. So, good morning, everyone. Good morning. I'm Joseph Caputo.

I'm the Assistant Chief of the Criminal Justice Bureau and Facility Operations. So in reference to your question, we are partners with CHS. CHS is aware of the number of beds that are available when they make the placement recommendations. So like it was alluded to as far as the PACE unit, that there is individuals that they're tracking based upon space and ensuring that they meet their clinical needs while depending on beds.

We are not rejecting people that need a higher level of care in the mental health, especially in that mental health population aspect of things. And we're partners with CHS in making the— affecting the placements, and they're aware of the number of beds when they make those recommendations. So just so for context, the reason why I'm asking is, as you know far better than I do, the city currently has thousands more people in custody than the 4,160 beds planned for the borough-based jail system.

And the city itself says those new facilities are supposed to provide appropriate housing for people with medical and mental health needs. So I'm just wondering if we're not already there, if we're going to be exacerbating the problem under the new capacity. But I know my time's up. Thank you.

Next, Councilmember Caban. I'm out of breath, but I got back in time. Good morning. Thank you, Chair. I'm going to start with questions about my bill. The TGNCNBI task force, they recommended that gender-aligned housing be the presumptive placement Unless the individual incarcerated requests otherwise. So the question is, why are transgender people being sent to gender misaligned facilities upon intake?

And why is DOC denying nearly half of all applications of requests for transfers to gender-aligned facilities? And that's based on y'all's own data. That's the information we're getting from you. So I'll start there. Hi, my name is Nell Colon. I'm the Deputy Commissioner of Programs and Community Partnerships. And just for context, within the Division of Programs and Community Partnerships, the LGBTQ Affairs Unit is housed.

And so just to speak to this, I mean, when considering placement, the department does— one of the primary focuses is complying with the national PREA standards. Each determination is made on a case-by-case basis, but I think to what you just indicated is that yes, there are times where somebody may have an indication and when they're transported from court to a site, it may not be the right site.

But once we become aware and a conversation happens and a person is able to state their preference based on their gender identity, we make our best attempt to make sure that they're in a gender-aligned facility. Okay. But at this point, half of those applications are— more than half are being denied. To your point about the PREA guidelines, we had a hearing on this last term, and specifically we had conversations about how PREA is obviously meant to protect people, but it is misinterpreted by folks in, in the DOC and outside in ways that actually disproportionately harm transgender individuals.

And that's something that needs to be reassessed. And that's also a reason why this task force is so incredibly important. Can you talk about the specific criteria that accounted for the 106 denials out of the 231 applications for gender-aligned housing? Yes. So when a placement decision is being made, there's a number of factors that are considered. One is the individual's stated gender identity as well as their preferred placement, SCU, gender-aligned housing, et cetera.

With that, there's also overriding security and management concerns that are factored in. And I'm sorry, just to interrupt, because I have limited time. What specific criteria accounted for the denials? We're aware of what the factors are, but which factors accounted for the denials, 106 denials? Well, I think that that's what all of these factors are put in place on a case-by-case basis.

So if we're talking about, let's say, the overriding security and management concerns, PREA screening information, mental health or medical concerns, classification, all of these things may be factors based on somebody's housing placement. So of the 106 denials then, how many involve a finding that the individual presented a current danger of committing gender-based violence, which is the standard recommended by the task force?

Yes, I actually specifically don't have the gender-based violence indicator number for you, so I just want to be transparent. I can't. Okay. Can you get it? Yeah, but I don't know. That would be great. And then if DOC relied on other grounds for denying the applications, other grounds outside of the current danger for committing gender-based violence, I'm assuming you don't have a breakdown of what those grounds were.

Is that correct? No, not in the context of what we have to give you today. So I would also ask for those numbers. I think it's really important to get a sense of you know, what other factors are serving as the basis for denying placement of cisgender people in gender-aligned facilities. I mean, the DOC is essentially continuing to use criteria that's inconsistent with the task force's recommendations.

And obviously, when you provide that information, you know, appropriately redacted, but we want to see it. Thank you. From there, I want to ask why DOC hasn't implemented the task force's recommendation for automatic independent review of housing denials, right? That the task force recommended that every denial of gender-aligned housing should be supported by a detailed written decision identifying the evidence relied on and receive automatic independent review within 3 business days by officials who weren't involved in the original decision.

Have you implemented that recommendation? At this time, we have not implemented that specific recommendation, but I do know, I just want to put this on the record, that our policy is under review. And actually, many of our policies are under review, particularly now that we're under a remediation manager along with our current leadership. And so all of our policies are being thoroughly reviewed to make sure that we're taking in these.

Chair, because I'm going to leave to chair another hearing, can I have a couple extra minutes? I'm going to give you 2 extra because they said they don't have a problem with it. Thank you. I appreciate that. I just want to say I'm glad that it's being reviewed. I hope that you take those recommendations to heart, and especially making sure that it's the reconsideration process is not merely allowing an individual to request reconsideration, but that it's an automatic independent review.

My other questions, and I know that the chair is going to do a phenomenal job picking up on these mental health questions, but the number of people in DOC custody with serious mental health illness, it's increased by over 80% since 2022. It's a much steeper increase than the general population that we're seeing. And so my questions are, how does this increase affect your ability to provide quality care for people in custody, which I know that my colleague Councilmember Murano alluded to.

And when you refer— I'm just asking them in succession— when you refer somebody to ACT or IMT, do you confirm if and when they have been placed? And how long, in your experience, how long does it take to assign somebody to a team? And then I'm going to close that out and finish by just saying that with that serious mental illness increase by over 80%, it speaks to a larger problem outside of corrections.

You don't control who comes into your care, and I understand that. But what are you guys doing with other agencies to ring the bell on this crisis? These are people who are living with serious mental illness. They should not be criminalized for said mental illness. And that means that there's a deep, deep failure in the continuum of care outside of corrections.

And so what does that work in collaboration look like? Those are the 3 questions. Thank you for indulging me, Chair. Okay. So I think to start, care for the SMI population, we have seen an increase as we referenced. You know, it's about 22% currently. When we look back in prior years, it ranged from about 16 to 20% in recent years.

And part of, you know, ensuring we meet their needs does involve these assessments that we do and then constantly evaluating based on referrals to the mental health service. That said, we do recognize we have some very psychologically complex patients in our care. We do have the ability to refer those individuals to Bellevue or Elmhurst for potential hospitalization as needed.

But generally speaking, we're— through the therapeutic units and then clinic appointments, we're able to address their needs while they're with us. But that's not to say that the jail environment is in any way conducive to mental health. In terms of work that we do with outside partners— Can you repeat that process? Sure, yes. So we do, based on clinical criteria, refer individuals to the New York City Department of Health and Mental Hygiene's Single Point of Access, SPOA.

We're not the only ones making those referrals. The shelter system, health and hospitals also refer refers individuals, and then they are making those determinations for appropriateness and acceptance into things like intensive mobile treatment teams, the forensic assertive community treatment. So they would be the best position to speak to sort of numbers. But we otherwise work with our partners in, you know, DSS HRA for housing applications.

So everyone who is homeless in our care and has serious mental illness and is interested, we will help them complete a 2010 supportive housing application. And then we do more broadly work through our clinical court advocacy team. They can serve as a resource to defense bar. We can write clinical condition letters. Those tend to skew more for the medically complex.

And then we work on the jail population. We're a partner in providing with consent patient information around health and mental health to help get people out of jail. Do you confirm and keep track of placements? Which placements? Of the number of referrals we're making? Specifically for ACT and IMT. We would have the number of referrals. In terms of placement, I think the department would be best.

If you can make the response tight, we're going to pivot to Councilmember Brewer next. Good morning. I'm Ellie Epstein. I lead our reentry and transition services for Correctional Health Services. So as you're aware, the vast majority of our patients are pretrial detainees. If they have— when they receive a SFOA assignment while they are still in our care, we're obviously tracking that and facilitating connection to the team.

When folks are released from custody, we notify DOHMH if they have not yet been assigned so that they're aware of the release. But no, we recognize that when patients leave our care and leave custody, they often don't want to have continued contact with our system. So we will outreach, but we really defer to DOHMH to make those connections and to be tracking the longer-term placements.

Thank you. Thank you very much. 2 questions. One is, maybe I misunderstood Bellevue. I've been to the new wonderful facility twice, I think, with Dr. Katz. There are 104 beds. I thought they were 100% medical. Is that incorrect? That's what he told me. No, that's true. Everyone there has complex medical needs. It's just the PACE unit is for individuals who have those medical needs as well as significant psychiatric needs.

So there is a medical component to it then. Yes. Second, how many people do you know within the categorized as mental illness are also homeless so that when they are released they're going back to I don't know what? Yeah, so we actually do have that analysis from January through June of this year. 31% of our homeless patients also have serious mental illness.

So 31% would be homeless and mentally ill is what you're saying? Yes, and I will say the way we categorize homelessness, it's self-reported by patients whether they didn't have housing before they entered or likely to be unhoused on release. Okay, that's a pretty high percentage, 31%. It's just higher than the general population, so about 28% of people on Rikers right now are unhoused.

So when they get released, they're going somewhere, so that means that medication may not be easy to obtain. That's why we send the prescription to the pharmacy of their choice, and then if they're enrolled, they can also leave with medication. Maybe my colleague wants to— No, but I know this population. They don't go where they're supposed to go.

Yeah, they do lead, yes, complicated lives. We do prescribe Walking medications for people to take with them as well. I don't— okay, so individuals who receive mental health treatment upon their release from custody, if they're being released from Rikers Island, will come into the clinic and we make available, as my colleague mentioned, we'll make available physical medications so they can leave with some medication in hand.

We also have a variety of different resources. To your point, our PORT line, which is the peer-staffed hotline, we often have patients or providers working with those patients call in and we reroute prescriptions. So for example, if they are no longer able to get to the pharmacy that originally made sense, we also proactively call patients where we have contact information to remind them about the pharmacy where those prescriptions were sent.

Okay, I mean, I just know how folks are. Okay, number 2 is, do you have any sense of those recidivism who have been in your mental health programs who may or may not be homeless, but what is the recidivism rate for those who have been at Rikers Obviously awaiting something, and who are returning who are mentally— you consider mentally ill.

Do you have any sense of that? So we're not tracking recidivism as the healthcare service. We do know that many of our patients do return. We know that. Yes. But we don't have any sense of those that are mentally ill. In terms of analysis, we could look into what we have. Other agencies may have data on returns, but I don't think we do.

Okay.

I mean, that's what the issue is. out there in the community. That's what's said, whether it's true or not. In terms of Brad H., I know that the most recent compliance report noted that CHS hired 3 more social workers, up to 90%. So have you had any more social workers hired? Do you have any sense of recruitment?

Because the issue for me is the discharge plan staff categories. It should be 100%. I guess I'm concerned. I'm still concerned about those that are leaving having enough support? And I guess you've never quite been in compliance with this discharge planning. Can you bring us up to date on staffing, discharge planning, et cetera? Yeah, so we've made a lot of efforts towards recruitment and retention of social workers.

We know the quality of our discharge planning service is dependent upon those staff. Our vacancy rate, I'd have to double-check, but I believe we only have one posting, I think, at the moment. So we are very close to to full staffing. Again, much of the challenge is that most of our patients are pretrial detainees, and so we don't have an expected discharge date, which really makes planning and being able to put together a solid plan extremely difficult.

And I apologize, what was the other part of your question? No, well, you mostly did it. I guess the issue— that's enough to answer. But my other question is, what's the average time between a mental health referral and the person's initial clinical evaluation? And I must say, when I go, I'm no expert, obviously, but it doesn't seem like there's a lot of services.

A lot of mental illness, maybe just because that's the day that I'm there. James and Chelsea know that. But it doesn't seem like it's under control. And so I guess my question is also in terms of the medical clinics on site at Bellevue, how many of them are, how many appointments are for mentally ill on a daily basis?

How are those clinics used? When I was there, Nobody was at the clinic. I can start with the first part of your question. So in terms of how long it takes, so looking at July data from this year, we completed about 1,800 intakes. Of that, about 1,000 individuals were referred to mental health, and 95% of them were seen within 72 hours.

Otherwise, we can make stat referrals in general to mental health service, uh, which is, uh, trying to see people within— or schedule people within 24 hours. Um, more routine appointments, uh, will be scheduled within 72 hours. Uh, in terms of the Bellevue Clinic, because that is a therapeutic unit and individuals and staff are on site, our utilization rates are higher.

Um, we can follow up with you on, um, any, uh, specifics related to mental health. Okay. I'll just leave it that this is the biggest problem in the city right now. Number one. And so it needs even more attention than this wonderful chair is doing. And I know you're kind of saying everything's okay. It's not okay. It's not okay.

And so, I mean, obviously more follow-up, but this— out on the street, a lot of your focus, people who have been at Rikers. So you just need to do a lot more. Thank you. No, I understand, and I think your point about homelessness is a good one. Yeah, they're not going to take that. They're not going to any pharmacy of their choice.

They don't know what the hell that is. It's hard to, you know, they're out. Thank you.

Thank you, Councilmember. I'm going to ask a few questions and then I'm going to— oh, no, sorry. Councilmember Salam has not gone. Go ahead.

Thank you, Chair. Just a few questions. About 40% of scheduled mental health appointments go unseen. How much of that is refusal? How much is officers not bringing people to the clinic? How much is lock-ins? And what explains the gap with Bellevue's early 81% rate? Which point in time are you referring to, Councilmember? Which point in time? I guess since the open.

Specific to Bellevue Hospital, the OTXB? The, the prison, yes. I don't have that granular data, but we can certainly follow up on any missed medical appointments. I don't know if there's anything else you want to add, but I mean, I don't know if you visited, but you know, it's the whole kind of intent of this space is to make sure that there are direct access to services, which is on site on the second floor.

But however we can follow up on that data in a follow-up. No, I appreciate that. For Intro 133, how many yearly reports has the task force issued? If the fifth is already out, does this bill extend anything? So the task force issued a very large report in 2022. The department responded to it. It was one report. And at this time, the task force still continues to meet regularly on a quarterly basis, although technically the timeframe for the original task force based on the original local law ceased, but we continue to participate in the task force meetings on a quarterly basis.

For Intro 453, who would actually deliver these services and how would it be funded since DOC is not a healthcare provider? That's a great question. So we greatly support making sure that children and young people visiting family members and loved ones and parents do receive the support and referrals that they need. I think part of this bill— so DOC, as you mentioned, we currently do not provide mental health clinical treatment.

So DOC staff providing it would not be the answer in this scenario. I don't think that we at this time have an exact determination of who would be best suited to provide that treatment. We do have multiple partners that we actually work with right now on smaller-scale initiatives. And I can, I can share some of those. You know, first and foremost, we have a partnership with the Mayor's Office of Criminal Justice with the Visiting and Family Assistance Program that partners with Our Children and the Osborne Association with a small subgroup of participants and parents that get and receive additional support for their children.

We also participate with the Administration of Children's Services, ACS, who has the longstanding CHIP program— I mean, decades-longstanding CHIP program— that provides support to children, but that's specific to those who might be in the foster care system. We recently started a partnership with the New York City Public Schools where we're working with their counselors and caseworkers at the New York City Public Schools in a televisits pilot with parents who are also incarcerated.

And a core component of that is that the parents are going through a parenting— a parenthood program simultaneously. And then last, one of our most successful parenthood programs that we've been working with is in partnership with DYCD. And that partnership has— grew from one pilot to multiple facility sites now. And that parenthood program also offers support through family days and activities intended to improve family, like parent-child bonding.

And then we have obviously partnered with the Children's Museum of Manhattan and the Brooklyn Children's Museum. to provide offsite visits. We've worked with the Children's Museum of Manhattan to improve our visit spaces. But I think when we think more globally about partnerships and who would be that primary person for the referrals for clinical mental health treatment, I don't know if we at this time know exactly who that would be or where that funding would come from and how much funding would be necessary to make sure that the right provider or the right agency is providing that level of treatment and services that is Definitely agree.

Last question.

BOC rules already require DOC to track how lock-ins affect care. Is DOC complying, and why are 7 out of the 9 involuntary lock-ins BOC found in mental observation units? Sorry, Councilmember, can you repeat your question? Sure. BOC rules already require DOC to track how lock-ins affect care. How is DOC complying, and why were 7 out of the 9 involuntary lock-ins BOC found in mental— into mental observation units?

My team might have— not made that as clear as possible, so I'll sideline that one. Okay. Yeah. Thank you, Chair. Thank you, Councilmember.

Next we'll have Councilmember Marano. I have one quick question from my colleague Councilmember Narcisse, who had to run, and then a couple quick questions of my own. She asks how many budgeted mental health clinician positions are vacant right now psychiatrists, psychologists, social workers, and nurses. And knowing Councilmember Narcisse as we do, this is usually the portion where she would mention that she herself is a nurse.

So I'll mention that on her behalf. So we currently have 244 FTEs in the mental health service and 33 vacancies. I will note we have really stepped up our recruitment efforts in mental health. It is an incredibly sought-after profession generally, and carceral mental health care is particularly challenging, and then Rikers itself has unique challenges as well. But they do a phenomenal job meeting the needs with the current staffing.

Returning to Deputy Commissioner Boyd, you indicated that the department is laser-focused on improving access to mental health services. And I think that's something that we're all appreciative of and grateful for. What's the single most important metric that you use to determine whether access is actually improving? Well, I think in my, in my kind of short tenure overseeing this portfolio, I have been laser-focused on the data regarding production.

And I want to improve that data and improve transparency within the department. Most of the department's processes is a reliance on paper, and that's why I've been advancing the clinic production dashboard, which I mentioned at previous hearings, is an electronic database that the department is going to use to track the universe of clinic appointments, whether scheduled, unscheduled, and walk-ins.

And I think that process is going to strengthen coordination with CHS and enhance production so we can communicate and track production in real time, right, to see if the person was moved from the housing area to the clinic, and I can look up on a dashboard and see if that actual person was produced as opposed to relying on paper, which somebody has to physically bring to you.

And so, you know, it's in progress. We rolled it out at 2 facilities. It's still in a pilot phase, but we're really excited about that because that is the path forward. That is a legacy project. So since you specifically cited the clinic production dashboard as one of the department's modernization projects, Does that dashboard distinguish between a patient who refuses an appointment and a patient who wants the appointment but the Department of Correction fails to produce?

It does track, well, departmental policy is that if someone refuses to be produced to a clinic appointment is that we track it on Body-Worn Camera. And so if an escort officer is going to the housing area and the person in custody says, I don't wanna go, they are to tap their body-worn camera and record that encounter. I have to go back to see how do we document that into the clinic production dashboard.

I don't think we're there yet, but it's something we can definitely consider. Do we know, for instance, what percentage of missed mental health appointments this year were attributable to refusals versus the department? I don't think I have that broken out by refusals for mental health appointments, but for the universe of appointments, about 61% were related to PIC refusals, right?

And if an appointment's recorded as a refusal, does anyone ever go back and verify that that individual actually refused and wasn't simply unavailable because DOC couldn't move them? So the way we codify the missed appointments, that category of refusal is one. If an individual was out to court or if he was at another service, those are all different categories that we codify that under.

So it's not under the blanket of refusal if the individual was at a different service or out to court. We don't codify it that way. That's not a refusal. Thank you very much.

Thank you. Pivoting to deadlocking, can the Department assure the Council that deadlocking is no longer occurring at all? Good morning. Sorry, good morning. James Conroy, General Counsel for the agency. Yes, that is something that we've represented and testified about in the past. The Department of Investigation, when this first was brought to our attention a couple of years ago, I guess at this point, at a Board of Correction hearing, it was referred to the Department of Investigation for them to look into these allegations, and they came back with a report, or at least made a determination— I don't know if they issued a full report— that they had not found instances of this as alleged at the Board of Correction hearing.

So obviously the previous and this administration in particular is committed to ensuring that that is not going on and that any types of lock-ins are appropriately documented and appropriate in and of themselves. Thank you. Still with deadlocking, are there regular inspections done of the mental health units around deadlocking? I'm not— I wouldn't categorize it as that specifically.

Obviously, any of these types of lock-ins. We have an obligation and supervisory responsibility to ensure that any lock-in, if they are taking place, are documented, appropriate, and within guidelines. So that's a department-wide thing. I wouldn't necessarily limit that to the mental health spaces. And who would be the one doing that type of, like, regular inspection or check-in?

It's a tiered system, obviously, on a supervisory level. It starts with the supervisors at the housing area and then moving up into the facility and then, of course, going to our overarching executive staff on a uniform level. Have correctional staff received any additional training or support to avoid them feeling that they need to resort to deadlocking? At the time and continuing since that, this was raised as an issue. issued memoranda or teletypes and trainings to indicate that this is not an appropriate method to— at all.

It's not an approved practice whatsoever. So I would say overall, yes, but again, I don't think it's necessarily focused or pointed to be specifically that word, deadlocking. This is something that we do overarchingly for the entire department about what is the appropriate use in any circumstance of a lock-in or otherwise. Have any staff been disciplined for deadlocking?

I would have to get back. I don't know that I have that data. You know, this goes back a couple of years for that investigation, but not to my knowledge, but we will certainly follow up. Did CHS discipline employees for refusing to cooperate with the Department of Investigation's I'm not aware of that. I would need to follow up with you.

Sorry, can you repeat that? Sorry, the question was whether we've staff related to deadlocking? Yes. So I believe that DOI's investigation found that there was deadlocking done by CHS employees, that they were aware of it. Excuse me. Okay. So I can't speak to any particular disciplinary actions, but I will say for the service, we did reinforce with staff that at any time one of our clinicians encounters a barrier to accessing a patient to provide care, they are expected to report that to their supervisor.

Generally, that's dealt with on the local facility level in partnership with DOC, and then we can always escalate as needed for persistent or systemic issues.

Pivot into the mental health treatment. How many people currently in the department's custody are receiving active mental health treatment? So the 61% of individuals who are enrolled in the mental health service represent individuals under active mental health care. Do you have a number, though? Yes. That number— About 4,000. Sorry? About 4,000, 4,018. Thank you. How many people are currently receiving psychiatric medication?

About 3,000 individuals in custody. How many people are receiving individual psychotherapy? So that would be a standard component of our mental health service, which Again, about 60% of individuals are under the care of the mental health service. Of course, what that looks like on an individual basis depends on patient need and interest. How many are receiving group therapy?

Similarly, so group therapy is available on the mental health units, of which about 14 Or excuse me, 1,100 patients are currently housed in a mental health therapeutic housing unit. That's not to say that every patient would choose to engage in group therapy because again, all of our services are voluntary. Can you explain how CHS staff interface with mental observation units?

Like how they— do you want to talk about that? Well, yeah, so our staff We do, like all of our mental health therapeutic housing units, provide services on-site on the mental observation units. We do regular rounding on those units to check in on all the patients, and we have a higher frequency of visits that we see patients for clinical services.

We also offer groups therapeutically directly on-site on our mental observation units. Medication as well is provided on-site to those patients. Thank you. And can you explain how PACE units are staffed? Yeah, so we have a very robust multidisciplinary team on our PACE units that includes a psychiatric provider, mental health clinician, clinical supervisor, nursing staff, treatment aides, and discharge planning social workers who work together, meet regularly to talk about the care of each of the patients.

The most recent BRADH compliance report noticed— noted that CHS hired 3 additional social workers, bringing the social worker staffing rate up to 90%. Has CHS hired any additional social workers since The last reporting period, June through December 2025? Yes, that's what my colleague Ellie referenced. I believe we only have one current vacancy, so we have staffed up.

Is there an estimate to when that last position will be staffed? I believe we're actively recruiting. I can let you know. Has CHS created any sort of retention and recruitment plan to increase the discharge plan staff categories staffing rate to 100%? For that specific, I might call up my colleague. Sure. So we actually, over the last couple of years, have worked really hard to try and increase salaries, to start engaging more with different school programs.

We have an incredible internal program to support social workers who are pursuing their clinical hours and licensure. So we've done a lot of work to try and advertise the incredible opportunities available within our department, and we think that that's really making a difference. Thank you. CHS has never been in compliance with court orders from April 2014, September 2014, and April 2021, which all required full staffing of all discharge planning positions.

Why do you feel that's the case? It is an incredible calling, and to work and serve folks who are in custody is— can be quite a daunting professional challenge. You know, there's also some practical considerations. It's a tough commute, and so it can be difficult to find folks who have that level of skill and who are also called to do this work, and it's a real testament to the incredible team that we have, that we have the kind of retention rate, and that we have been able to recruit as many talented, wonderful professionals as we have.

Thank you.

Pivoting to my bill, Intro 809, um, how many lock-ins have occurred across the department facilities in 2026? I don't have that raw data when regard— unique to appointments or just in general? Just in general. Yeah, I would have to follow up with you, Councilmember. While we're asking the questions, can someone check in so you could get it to us?

We can try. What do you find is the most reasons for lock-ins? I will turn it over to my colleague. I don't have specific data, but, you know, reasons that encompass a lock-in could be for a tactical search operation, obviously an emergency in reference to an incident. Those are the most prevalent reasons for a lock— lockdown of a unit.

What is the average duration of a lock-in? Um, I don't have specific data relevant in reference to how long is the average, but we do try to lift the lockdown as soon as it's safe to do so. So we are very limited in that. How many lock-ins have lasted more than 4 hours? Again, I can follow up with, with that information.

So the concern I'm about to have now, because my bill is about lock-ins, I would imagine that you all would come with data about the lock-ins. So do you have any data available today for us to talk about the lock-ins? We did not supply data in reference to lock-ins specifically, no. So how, in this oversight hearing, is the Department going to help to inform us in terms of the— this legislation and whether or not it's something that is feasible or not?

Because the Department came with an opinion about The bill, but yet no data. I'm not following that. So the one data set we do have is specific to medical appointments that are scheduled. And in regards to appointments that were, you know, rescheduled due to lock-in, that was 0.1%. And so the department has made a lot of progress when it comes to producing individuals in custody to their appointment, especially during a lockdown when it's safe to do so.

And Councilmember, you've been in our facilities and you've seen the corridors. If something's happening on one side, an incident that's happening on one side of the building, we're not going to move people around until it's safe to do so, especially with a population who might, you know, either retaliate or react to another person in custody in the corridors.

We want to be very conscientious of that, but we work very closely with CHS that if someone has missed their medical appointment due to a lock-in, we try to see if they can be produced the same day. And so that's progress. In addition, again, this clinic production dashboard, I think, is the path forward to strengthen that coordination, track things in real time.

I welcome the opportunity for you to come tour GRVC and see the clinic production dashboard yourself. And engage with uniformed staff to see how it's working. We think, you know, modernization is the key here. You know, we can follow up when it comes to specific lockdown incidents, but it's all incident-driven, right? Each situation is unique, and so I would just take that into consideration.

Lockdowns are not just a broad brush, right? It's incident-driven, dependent on whatever the situation is that precipitated it. The 0.1% that you mentioned, is that for 2026? January 2026 through August 2026. And how does DOC notify CHS when a lock-in begins? Do you have something to answer? I mean, that's constant conversations, right? The wardens are very much aware, and I— you can speak to the abbreviation of the HSA from CHS that assigned to the jail.

Each facility has an HSA assigned to them. The warden and their leadership team are having various daily conversations with the HSAs. I'm not sure if there's additional titles or leadership. CHS could speak better to that, but these are ongoing conversations that they facilitate these engagement efforts to see what's going on with specific individual custodies, how we can produce people, if there are challenges to produce people.

And so that's ongoing. It's happening right now. It happens every day. And so it's— Yes. That's the best way I can, I guess, answer your question. So for CHS, are you generally notified before the lock-in begins? Do you know at what part you're notified? We wouldn't be notified in advance if it were an emergency lock-in. We, of course, would know if someone wasn't produced to an appointment, at which point we would work to reschedule the individual based on acuity.

And are the lock-ins only when Like a crisis moment happens, to your point, is that the only time the lock-ins are happening? So if we have credible information that needs to be investigated, that can be a reason obviously that we would lock down a unit for investigation into actionable intelligence or— And in that moment, are you notifying CHS in advance?

So it's not going to be in advance unless it's something that is prescheduled. Most of those obviously events are not prescheduled. events unless it's a search, which again, we would notify them as close to the event as possible just for, you know, to make sure that we are able to conduct a thorough search in a surprise nature.

We have daily huddles with CHS. We are in constant communication with them. We have officers that are assigned to the clinic that work in conjunction with CHS. So the officers in the clinic will be immediately notified. and then our partners would also be notified. Just because an area is locked down doesn't mean that we cannot produce that person, obviously, and it's escalated based on the nature of the, the appointment and the emergent need for that person to be produced.

If an individual is needed, they will be produced. How does CHS prioritize patients for appointments missed because of a lock-in? So I, not even specific to lock-ins, but anytime there is a missed appointment, we're looking at clinical acuity need. I don't know if you wanna speak to— Yeah, we look at medication adherence, any incidents documented, what were they looking like in their most recent visit, what has been their level of stability.

Those sorts of factors are taken into account as to prioritization and triaging. What information does CHS need from the department to safely manage care during a lock-in? So I think because a lock-in is just this temporary moment in time, I wouldn't necessarily focus non-production to clinic on lock-in. I think, you know, it's broader. I think the work, as referenced earlier, that our health services administrators are doing with the officers in the clinic and conversations that are happening at the leadership level are really to address systemic production challenges.

I— for our purposes, you know, whether someone missed an appointment because of court or lock-in or barbershop or any number of reasons, it wouldn't change our clinical assessment and need. for continued care. Thank you.

This panel is complete. Thank you. Next, we will bring up Arden Armbruster and Claire Salant from the Independent Budget Office, and counsel will swear you in. All right. Before we begin, I will administer the affirmation. Panelists, please raise your right hands. Do you affirm to tell the truth, the whole truth, and nothing but the truth before this committee and to respond honestly to councilmember questions?

I do. Yes. Yes. All right, you may begin when ready.

Good morning, Chair Brooks Powers and members of the Committee on Criminal Justice. My name is Arden Armbruster, and I'm a lead budget and policy analyst at the New York City Independent Budget Office, IBO. I'm joined today by my colleague Claire Salant. IBO is a government agency whose mission is to enhance understanding of New York City's budget, public policy, and economy through independent analysis.

We appreciate the invitation to testify today at today's hearing on mental health care in New York City's jails. IBO has been closely monitoring the changing jail population in light of the mandate to close the facilities on Rikers Island. Today, we will share preliminary analysis from a forthcoming publication about people in DOC custody with a history of mental illness and/or homelessness.

While previous IBO publications have noted that the city has diverted many people facing lower-level charges The jail population is still larger than the capacity of the borough-based jails. The rates of mental illness among people in custody have historically been higher than the general public, but the share of the jail population with mental health needs has been increasing even as the city has expanded its diversion programs.

However, the overall population with a mental illness is not homogenous. To understand this population in more detail, IBO analyzed DOC jail stay data through the end of June 2026. IBO identified 2 distinct populations with mental health needs in DOC custody: those with co-occurring histories of homelessness and those with a history of mental illness alone. Though this hearing is focused on mental health, we cannot talk about this population without also talking about housing needs.

Of the 19,000 unique people discharged in fiscal year 2026, 58% had a history of mental illness, 30% had a history of mental illness and homelessness, and 26% had a history of mental illness, a history of homelessness, and a prior stay in DOC custody. Because DOC stay data was IBO's primary source, our analysis may not include individuals who have histories of mental illness and/or homelessness documented in other data, nor does our analysis include other co-occurring needs such as substance use disorder and experience with domestic violence.

IBO recognizes the importance of these factors in addressing the needs of people with mental illness but due to data limitations, we will not be speaking to them in this testimony. IBO found that certain groups of people in custody were more likely to have a history of mental illness and/or homelessness. When looking at differences across gender, IBO found that while transgender, gender non-conforming, and non-binary people— TGNC and BI people— are a very small share of the jail population, they have higher rates of mental illness and homelessness than cisgender people in custody. 93% had a history of mental illness, and 67% also had a co-occurring history of homelessness.

They were also more likely to have a prior stay in DOC custody. Cisgender women, who make up about 10% of the jail population in 2026, were also more likely to have a history of mental illness and a co-occurring history of homelessness compared with cisgender men. Given the higher level of mental health and housing support needed among TGN-CNBI people and cisgender women, increasing services for complex needs would support these groups in particular.

People with a history of homelessness also tend to be older, including people with a co-occurring history of mental illness and people who— and particularly people who also have a prior jail stay. Among those with a prior stay, the median age for people with neither a history of homelessness nor mental illness was 33. For people who had history of both, the median age was 39.

The link between incarceration, accelerated aging, and poor health outcomes has been well established. Outside of carceral settings, people are typically considered older adults beginning at age 65. In correctional settings, that threshold is 55. We'll now talk about charges and length of stay. The remainder of this testimony focuses on people with a prior stay only, so people who've returned to custody.

People with a history of mental illness and a co-occurring history of homelessness typically face less severe charges than those with solely a history of mental illness. In recent years, people with a history of both needs were half as likely to be charged with the most serious charge, an A or B felony, as people with a history of neither need.

The most common charge for those with a history of both needs discharged in fiscal year 2026 was petty larceny. In contrast, people with a history of mental illness alone without a history of homelessness were charged with A or B felonies at similar rates to those with a history of neither need. Their most common charge in fiscal year '26 was assault in the second degree.

People with documented histories of mental health needs also have longer lengths of stay for the same charges than people without a history of mental illness. For example, the median length of stay on a second-degree assault charge for people discharged in fiscal year '26 was 6 days for individuals with neither history 36 days for individuals with a history of mental illness alone, and 74 days for individuals with a history of both mental illness and homelessness.

Lastly, in fiscal year '26, people with a history of mental illness had bail set at similar rates to other populations, but paid bail at a lower rate, especially those with a co-occurring history of homelessness. People with both needs paid bail in just 9% of their stays where bail was set. Compared with 39% of among people with neither a history of mental illness nor homelessness where Bearwell sat.

In summary, as the city considers how to support people with mental health needs who come into contact with the criminal legal system, IBO's findings show that these populations have distinct characteristics and therefore needs. Further details will be shared in our forthcoming report. Thank you again for the opportunity to testify, and we look forward to answering your questions.

Thank you both. Um, Can you explain how you did your analysis? Absolutely. So IBO has, through our charter-mandated powers to receive data from city agencies, has data on every stay in DOC custody from fiscal year 2008 through 2026. We use that data to identify people who were sort of ever in the dataset either flagged for a BRADH class member, so someone who is likely receiving mental health care in city jails, and/or had a discharge to state hospital for competency restoration.

So that's how we identified people with a mental illness. And we are— our numbers may differ for sort of other reported numbers because we are looking across multiple stays, given that many people have— do have very short stays in custody. It's not uncommon to see stays of 5 days or fewer. And so people may not make it through all of the processes to be identified as someone with a mental illness in those short stays.

As it relates to people with a history of homelessness, we did a couple of different things. We used the address data in the DOC data that we have available to identify keywords. So sometimes you'll just see in that address data homeless or shelter. So we flagged those keywords as well as matched to shelter addresses that IBO also is aware of.

And again, we looked across people's histories to identify people in case they weren't flagged when they had those very short stays. Thank you for that. You mentioned data constraints. Can you expand on that? What data, like, do you need? So I think in particular with this analysis, what we wanted to make clear is that this intersection of mental health needs and housing needs is not the only intersection that people should be aware of.

So something, for example, we don't look specifically at serious mental illness because in the data that we have available, we don't have a marker for that specifically. Data limitations like that. Similarly, substance use disorder or a history of experience with domestic violence, those other factors that are often considered when creating programs and diversion programs for these populations.

Thank you for that. Are there specific recommendations to address the mental health crisis So IBO doesn't make recommendations. However, we do hope that our forthcoming report and this testimony can help policymakers make— develop programs, as you so decide, that are responsive to the complex needs of these individuals. And so we hope that our forthcoming report will dive a little bit deeper into that to support your decision-making process.

And do you know how much the city spends on mental health care for people that are in custody with the department? I did not bring that with us today, but that is something that we can certainly look into and get back to you. Sure. And when you let us know, it'll be good to know also how is that spending separated between DOC and CHS?

Absolutely. Okay. Thank you. And thank you for your testimony.

I now open the hearing for public testimony. I remind members of the public that this is a government proceeding and that decorum shall be observed at all times. As such, members of the public shall remain silent at all times. The witness table is reserved for people who wish to testify. No video recording or photography is allowed from the witness table.

Further, members of the public may not present audio or video recordings as testimony, but may submit transcripts for such recordings to the Sergeant at Arms for inclusion in the hearing record. If you wish to speak at today's hearing, please fill out an appearance card with the Sergeant at Arms and wait to to be recognized. When recognized, you will have 2 minutes to speak on today's hearing topic, mental healthcare in New York City jails.

If you have a written statement or additional written testimony you wish to submit for the record, please provide a copy of that testimony to the sergeant-at-arms. You may also email written testimony to testimony@council.gov. Thank you. Within 72 hours of the close of this hearing. Audio and video recordings will not be accepted. For in-person panelists, please come up to the table once your name has been called.

And now I will call the first panel, and I will just say, I ask that everyone please adhere to the 2-minute limit. You can submit additional testimony in writing. So just so that we have a smooth public testimony process, I ask again that everyone adhere to the 2-minute limit because we do have a number of people signed up and we want to hear from everyone.

So for the first panel, we are going to have Barbara Hamilton and Raji From the New York County Defender Services. You can begin when you're ready. Just come off of mute.

Good afternoon, Chair and committee member. Thank you for the opportunity to testify. My name is Barbara Hamilton. I am the director of the Incarcerated Client Services Unit at the Legal Aid Society. I'm going to comment on mental health. Every day my office sees people who are in acute crisis over mental health issues at the Department of Correction.

We talk to people in the city jails who have serious mental illness, are in psychosis, thinking of self-harm, and just trying to receive care. And often what we see is that they are met with isolation and punitive measures. So for example, we have a client who has been deadlocked for about a year on and off. Our staff reported this individual was receiving receiving— having hallucinations, and there was no meaningful treatment until there was an act of self-harm.

We have another client who was deadlocked in the PACE unit who had suffered from serious mental illness. She was not receiving recreation, access to programming. When staff went to see her, her clothes were visibly stained with menstrual blood, and she was using cereal boxes to make sanitary products. We have this matter in court, and we're now in contempt proceedings because the Department of Correction is not obeying a court order to allow this client out of cell time.

So generally what we see is a punitive system that is failing. The council has an important role to play, and we urge them to exercise this oversight of DOC and CHS, demand transparency about what's happening in these units, scrutinize and end the use of isolation and restrictive practices, as well as supporting housing, alternate programs for incarceration and treatment so people don't end up in jail in the first place.

Thank you.

Thank you for that. And just a follow-up question to your testimony. So just to confirm, you're saying that you have several clients that have been allegedly deadlocked at Department of— like within the Department of Corrections? Yes. And there's actually 2 court orders in place, and we're in contempt proceedings in 2 cases because the Department of Correction has not followed those court orders to clients who have been deadlocked.

And when were these instances that they took place? Were they in 2026 or prior to? 2026. One client we had that didn't have a court order was 2025 to 2026, but we have 2 individuals— the cases are live. They're happening. So we're talking off the top of my head, winter, spring of 2026 and continuing to this day.

If you would not mind to provide the committee staff information about those instances so we can follow up with the department, because they just testified under oath that there has not been any deadlocking. So I'd like to follow up on that. Yes. We can provide the copy of the court orders and any pleadings that we've initiated to this committee.

Please do. Thank you.

Good afternoon, Chair and committee member, and thank you so much for this opportunity. My name is Raji Dayatmangalam, and I'm a licensed clinical social worker and senior policy social worker at New York County Defender Services. I'm here to testify that community recovery and reintegration are not a pie in the sky. I want to share about 2 clients who might have been written off as lost causes, but for many of us banding together and refusing to give up on community-based solutions.

When I first met my client, I'll call Harry to protect his confidentiality, he'd been street homeless for decades. He was severely depressed, had serious opioid use issues, he was estranged from his family, and facing a long prison sentence on numerous violent felony charges. By every measure the systems use, there was no hope for Harry. After a great many struggles on Harry's part and a great deal of advocacy to get in the right community services, he turned the corner.

He began to excel in every aspect of his ATI mandate, and he graduated from Manhattan's Felony ATI Court with flying colors. A few years have passed, and Harry continues to thrive. He's well, he's a working taxpayer, he's reconnected with his family, and he's remained stably integrated in the community. One employer even wrote to the ATI Court I truly mean it that I'd hire 15 Harrys if I could.

Another NYCDS client, whom I'll call Tom, was extremely ill when his attorney met him at arraignment. And he was charged with a violent felony, homeless, completely disorganized in thought and speech, and had been in the throes of untreated schizophrenia for decades. He also struggled in various ways. He also had substance use issues. And what I'm gonna say is that the DA objected to treatment court but the judge saw something in Tom and gave him his real first chance at community integration.

In respect for the time, I'm gonna cut short and say that at his ATI graduation, the DA said, quote, you have proven us wrong, quote, and called watching his journey inspiring. Neither Harry nor Tom recovered at Rikers Island. They recovered because many of us fought to get them into services in the community, And because in Tom's case, a judge was willing to overrule a prosecutor.

Let's just take a step back for a moment. We've tried caging human beings in state-run asylums. We then shifted to a whack-a-mole approach of, since 1963, and now that's what got us to where we are today with yesterday's asylum and today's Rikers. In the morning, we were talking about outposted therapeutic housing units in our latest iteration of what I fear is whack-a-mole.

And— I'm going to ask you to wrap up, please. Yes, yes. And I would say that the time to invest in community infrastructure is now, and that I would say that treatment courts provide critical case management and oversight, holding both participants and community programs accountable. We at— in finishing, we at New York County Defender Services are asking the council to support and put the Treatment Court Expansion Act on your Albany agenda without any further delay. so that we can divert as many people as possible away from jails and towards David community integration.

Thank you.

You can submit the rest in writing. Thank you. Thank you so much. Next panel, Ethan Lowe with Legal Aid, Camila Ruda, Legal Aid Society, Rachel Golden, Maya Zelkind, Lucas Marquez. I ask everybody to please adhere to the 2-minute limit. And you can begin once you're ready. Just come off of mute.

Good morning. My name is Ethan Lowe, and I am a staff attorney in the LGBT LGBTQ Law and Policy Unit at the Legal Aid Society and a member of the New York City Task Force on Issues Faced by TGNC and BI People, that is transgender, gender nonconforming, nonbinary, and intersex people in DOC custody. The task force was created in 2019 following the death of Layleen Polanco, a transgender woman who died on Rikers Island.

Her death brought attention to the dangerous conditions that TGNC and BI New Yorkers have long reported experiencing in DOC custody, including unsafe housing placements and high rates of violence and harassment. The task force was established to examine these conditions and recommend changes to DOC policies and practices. Those conditions remain urgent today. TG and CNBI people, particularly transgender women and transfeminine people, continue to be involuntarily placed in men's facilities, where they face heightened risk of physical and sexual violence and the daily psychological harm of being confined in a setting that denies their identity.

Those seeking safer gender-aligned housing must navigate an opaque request process, and DOC's own fiscal '26 data show that approximately half of gender-aligned housing transfer requests are denied. Each denial can leave a person in a facility where they face harassment, violence, isolation, or pressure to conceal their identity simply to survive. That is why the task force work remains necessary.

It creates a forum where directly impacted people, advocates, and government agencies can identify systemic failures and press for solutions. We support Intro 133 to extend the task force because the city must continue that work, but renewal must come with structural changes needed for the task force to function effectively. We urge the council to adopt the amendments proposed by the advocates of the task force and pass Intro 133 as amended.

We also urge that the city hears Intro 134, which is a bill to establish enforceable protections around gender-aligned housing. Intro 133 extends an important oversight body, but the task force recommendation can only go so far if they are not adopted by DOC. Intro 134 would directly change policy affecting TGNC and BI people in DOC. custody. Thank you.

Thank you. Sorry. Okay. Good afternoon. My name is Maya Zelkind, and I'm a legal intern with the Civil Rights and Law Reform Unit at Brooklyn Defender Services. I want to use my time to bring the voices of TGNC/NBI people directly affected by DOC's practices into this hearing to show that the conditions that the task force was established to address continue to exist, and our work is not done.

The following is an account of someone formerly placed in Rikers who experienced violence and struggled to navigate a men's facility while targeted for her identity. When I was on Rikers Island, I went through so much because of my gender identity. I experienced being sexually assaulted by officers and inmates. I'm a transgender female. As a transgender female, I wasn't accepted in population with other inmates because they didn't accept anyone in the LGBTQ community.

Corrections officers used to get a kick out of me and other transgender females getting either sexually assaulted or beat up and jumped. We had no type of protection whatsoever, so me being from the projects and the streets, I had to start to conduct myself in survival mode. Before that, I requested for a female facility and was denied numerous times because I didn't have long hair, breasts, butt fat, and I wasn't doing sexual favors.

Gang members all messed around on the low, and they provided some type of protection and security. So I ended up being around them, but then I ended up being labeled as a gang member because of that. So I started using that as an advantage and ended up putting myself deeper into trouble and not realizing that a lot of transgender people get threatened for their safety and get offered drugs for sex or sexual favors.

I don't do that. I had to figure out a way. How am I going to protect myself without getting into fights or trouble? We get no medical care or medical attention. Thank you.

Thank you. Good afternoon. My name is Camila. I'm a paralegal from the Legal Aid Society. Society who works directly with TGNC incarcerated individuals, and I'm also a part of the task force. I'm here to share testimony from a trans woman who was formerly held in DOC custody. I made a mistake in my life which landed me incarcerated.

At no time did the judge tell me that I would be treated differently, that I would suffer the abuse and torture sustained for for merely being myself, a trans woman housed with males sticking out like a blinking red light. The abuse, the torture that I sustained was at the hands of the incarcerated males and the officers alike.

My body was brutally raped. I was sexually assaulted multiple times, groped many times. I was horrifically threatened, escorted, Extorted, spat on, with urine thrown on me and semen thrown into my face, called derogatory names daily. All of this was the norm. I asked the officer for help. He told me that you're housed with males, deal with it.

They will find you hanging here and they will rule it as suicide. The trans woman in the cell next to mine, she couldn't take the abuse any longer. And she took her life. INTRO 134 would have saved me from all this abuse and the torture that was placed— that the torture that my body was placed through. I am a person.

I'm a human being. We are all collectively constituents here. We have families, friends, and loved ones. We deserve safety, respect, and dignity just the same as any other human being. I am forever altered by the trauma that I was forced to endure. We urge the council to extend the task force by passing Intro 133, and I will add that we can also please add Intro 134 to the agenda, please.

Thank you.

Thank you. And just for the record, I am a co-sponsor on Intro 134 and requested that it be a part of this hearing, so I am hopeful that we are able to hear that bill at some point. Thank you. Thank you.

My name is Lucas Marquez. I'm the Director of Law Reform at Brooklyn Defender Services, and I work with our jail services team. I've served on the task force since 2023. The task force advocates want to support Intro 133 but believe amendments are needed, and I'll just explain why. At the outset, I want to emphasize that we are eager to work with DOC and CHS.

We understand that it's vital in doing so to reduce the risk, violence, and indignity that people face when they're placed in DOC custody. But over the last several years, the task force produced important work despite serious structural problems. It has lacked dedicated administrative support, the ability to obtain information, and to move its work forward. Agency participation has been uneven.

Representatives frequently did not have the relevant experience, authority to answer critical questions, or buy-in to push changes in the agencies. DOC has not been transparent in providing key policies or providing important updates for years. And as you heard today, we were told that the principal directive governing the treatment and housing of trans, intersex, and gender non-binary people was under revision, but at no point were we given details about that process or advised or engaged to opine.

The result is that there had been no changes to that directive. Furthermore, major decisions were made about department actions that seriously impact trans and nonbinary population without informing us. For example, people housed at RMSC, where the Special Consideration Unit is located, were transferred to an entirely different correctional system as part of the emergency response at Rikers. Another example is that people housed in RMSC units and PC were merged, in order to allow cis men into RMSE.

However, in neither of these instances was the task force consulted or even provided details about these actions after implementation, even though these moves created obvious risks for trans/nonbinary people. Our amendments respond directly to these failures. They give the Board of Correction responsibility for administering the task force. They require agencies to designate representatives with relevant Experience and sufficient authority to participate meaningfully.

The amendments require facility tools and meaningful opportunities to hear from people in custody. They require agencies to provide relevant policies and written notice of changes, improve reporting, and require consultation with the task force. I'm going to ask you to wrap up, please. Consultation with the task force before major changes impacting people are implemented. Thank you.

Thank you so much. Good afternoon. My name is Rachel Golden, and I am a member of the task force and have been since 2022. I'm a psychologist and forensic evaluator and have worked extensively with people in custody in our city jails and state prisons. In August of 2022, the task force published a comprehensive report on the treatment and housing of TGN-C and BI people in DOC custody.

The report did not just identify problems, it offered detailed recommendations on intake, housing, mental health and wellness, reentry, staffing, and accountability. Those recommendations were grounded in the experiences of TGN-CNBI people in custody and in years of work by directly impacted members, advocates, and agency representatives. 4 years later, virtually none of these recommendations have been implemented, and we are not aware of corresponding changes to DOC housing policies.

TGNCNBI people are still routed through gender misaligned intake, denied safer housing, and left without a meaningful and transparent way to challenge those decisions. The fiscal year '26 denial figures show that the problem is continuing, not resolved. This is why the council should have heard 134 today. 133 renews the task force, an advisory body. 134 addresses the underlying policies that this advisory body has spent years asking the city to to change. 134 would actually establish enforceable protections around gender-aligned housing, clearer procedures and review when a request is denied, and greater transparency and accountability in DOC's decisions.

The nongovernmental advocates of the task force have identified Intro 134 as our number one legislative priority. Renewing the task force while declining even to hold a hearing on its central recommendations risks asking impacted people and advocates to repeat the same work without an actual path to implementation. The task force can document and recommend, as we had since our inception, but it cannot compel DOC to change.

If the council is serious about addressing the conditions TGNC/NBI people face inside, it should pass Intro 133 with the advocates' amendments, and it should promptly hold a public hearing on Intro 134. The city should not treat continuing the task force as a substitute for action. Thank you very much.

Thank you, and thank you to this panel. We'll next have Zachary Katzenelson with Independent Rikers Commission, Victor Herrera from Freedom Agenda, and Darren Mack with Freedom Agenda.

Uh, thank you, Chair Brooks-Powers and committee members. Thank you for holding this hearing. My name is Darren Mack, and I'm a co-director of Freedom Agenda. I'm a survivor of Rikers, and our members are people who have experienced Rikers. We also coordinate the campaign to close Rikers. Many of our members have struggled to get mental health services at Rikers or tried to help their family members get services.

They've also experienced the tragic irony Of waiting months or years for quality treatment in the community and then finding a jail cell offered immediately once they reach the point of crisis. Their experiences are reflected in the data. There are over 1,500 people at Rikers Island who are diagnosed with a serious mental illness, and that number has increased by 83% since 2022.

49.6% of people leaving Rikers with a mental health diagnosis return within a year. These numbers are shameful. There's no one solution to address this, but there are many actions the mayor and city council can take immediately. By diverting as many people as possible, as quickly as possible, DOC and CHS stand a much better chance of improving care for a smaller number of people.

For example, they could house everyone with serious mental illness, mental health needs, in dedicated units with clinical staff on the unit. We need investments in community-based programs that cannot wait. another 9 months or more. City Hall should make substantial investments in the November budget modification to start addressing this crisis, including at least $20.3 million to immediately open 150 units of low-barrier housing for people with court involvement and mental health diagnoses, a $3 million capital investment to open more dual-diagnosis residential treatment capacity, at least $1.7 million to develop an outpatient competency restoration pilot, Sufficient funding to open the remaining 132 units previously promised, sufficient funding to eliminate the waitlist for community-based mental health treatment teams, and other recommendations outlined in our full written testimony and our Countdown to Closing Rikers policy brief.

We, in conclusion, we look forward to continue to work with the City Council to ensure that everyone's DOC custody can get the healthcare they need and get support and community ensure they don't return. And I echo the advocates' recommendations that the council and the committee endorse and pass Intro 134. Thank you for letting me testify today.

Thank you. Good morning. Good morning, Chair, members of the council. Thank you for the opportunity to speak today about the urgent intersection of mental health, public safety, and conditions at Rikers Island. My name is Victor Herrera, a formerly directly impacted Rikers survivor. I appreciate the council's attention to the policies that connect people experiencing behavioral health crisis with appropriate care, protect the safety and dignity of those in custody and reduce the use of incarceration where treatment and community-based support would better serve both individuals and the public.

It is more the reason that I stand for community-based support aligned with those with the Close Rikers and Treatment Court Expansion Act, both of which would fast-track reduction in the jail population and finally putting Rikers Island in our past and moving forward with truth in public health and treatment. Behavioral health emergencies require response that protects immediate safety while addressing the clinical conditions driving the crisis.

Integrating licensed mental health clinicians into public safety systems gives responders access to clinical assessments, trauma-informed de-escalation, and direct pathways to care. Improved access to care intervention at critical phases of such encounters of people experiencing mental health crisis, clinicians can arrange referrals, safety planning, follow-up, and connections to community-based services rather than the reliance Yes. —solely on transport, citation, or arrest.

Linking individuals to ongoing treatment and social support can address underlying needs that otherwise generate repeated emergency calls. These links and referrals should expand the greater need for intense mobile treatment if a triage of public health remedies is allocated locally at each of the city's central booking stations. Unlike Correctional Health Services' proposed treatment on Rikers Island testimony before you today, I would have to ask this committee to look at the crisis compared to responses by CHS health clinicians, and how such approaches have not met the need for people experiencing mental health crisis.

Words such as DOC overriding security management and disciplinary and involuntary hospitalization has been a serious underlying factor of people losing their lives to mental health and treatment solely because CHS were offered before you to justify NYC DOC continued detention of people with mental health concerns. Thank you. I have shared my own testimony and forward proposals toward a more robust approach to treating people with mental health and chemical dependency concerns during response, arrest, and prior to detention.

Thank you. Thank you.

Good afternoon, Chair. Zachary Ketz-Nelson with Independent Rikers Commission. Thanks for holding this hearing. I want to echo the budget concerns that Darren raised and support those and just talk about a couple things that came up in the hearing. Deadlocking. Disappointed to hear from the Department of Corrections. It sounded like the only thing they changed when deadlocking came, came to light was to tell people to stop.

It's the same type of supervision they had before. There's no new training, there's no new inspections. Nothing has changed except don't do it. And what has happened over the last several years is that training that staff did receive, crisis intervention training, which was a national model where corrections staff and healthcare staff trained together, then worked as teams in those units, That has completely fallen apart.

It fell apart during COVID It has been brought back in a watered-down, halfway form. Correction Department and CHS don't train together anymore. They train completely separately, and we see the results. As you alluded, staff feel like they don't have a choice but to resort because they don't know what else to do but deadlock people, and that is utterly wrong to them and particularly to the people that are being deadlocked.

That has to change. In terms of people Getting out, I just want to mention a couple things. One is that, as you know well, over 1,000 people a year get approved for supportive housing at Rikers, right? Almost all of them end up in the streets or in the shelters. There are systems we have, emergency transitional housing, people could be in there if they're not getting directly into supportive housing, but it's falling apart, and it's falling apart in large part because there is no city agency that's actually in charge of making sure that people get what they need.

As in, CHS does its part, then they hand it off to DOHMH, and HRA is involved, and DSS, and all these different entities, but nobody is overarching. Nobody's looking over this whole thing and saying, is this actually working? Are we getting people connected with the care? Providers don't know that people are getting out. They're not told they're being released.

They don't meet people before they come out, which is a huge factor in success, people actually using the services. There are lots of things we know we could do, and I really hope that when the administration releases its plan to close Rikers, that they're going to address these types of real bureaucratic failures that are preventing people from getting care.

Thank you so much. Thank you.

Thank you to the panel. Next, we'll hear from Giselle Castro with Exalt Youth, Tarini Garamella, Osborne Association, Nadia Chait with CASES, Miriam Goodman, With Women's Prison Association. I'm also going to add Jeanette Bacanegra with Justice for Families Ltd.

Good afternoon, and thank you, Chair Brooks Powers, and the members of the committee for this opportunity. My name is Dr. Giselle Castro, and I am the CEO of EXALT. I have spent over 20 years working in and around the criminal justice system. And what I know is this: the young people that EXALT serves are ages 15 through 19, and they have never been given a clean slate.

They come to us with trauma, with grief and anxiety that no one has ever named, let alone treated. I will reference a young person experience. As a teenager, this young New Yorker experienced family violence and became involved with a child welfare system. They were struggling with grief and with their emotional psychological well-being. But the support that they needed was missing.

When they came to Exalt, someone showed up for them. Through consistent mentorship, advocacy, educational guidance, and opportunities, she is now— and this person is in higher education completing their graduate degree in future mental health, wanting to participate in changing a system. This story is not an exception. It's the pattern, and it's what extols supports for the proposal that were and are still being discussed today.

Intro 133 recognizes that representation in form of public policy matters. Intro 453 recognizes that children with incarcerated loved ones carry that weight too. And Intro 809 recognizes that care can't disappear whenever a facility locks down. But laws don't deliver care, people do. What I recommend, what we recommend, are 2 things. First is the multi-year flexible contracts for frontline organizations so they so that their work completely does not stop when funding cycle ends.

And lastly, the second one is a formal role for community organization in implementing these bills. And thank you. I will submit a copy.

Thank you. Good afternoon, Chair Brooks Powers. My name is Serenee Garamella, and I'm a policy associate for the Osborne Association. I'm testifying on behalf of the community members of the Rikers Visiting Work Group in regards to Intro 453. My testimony outlines ways in which this bill is too vague as written and could lead to harmful practices, and my written testimony will share more in-depth recommendations.

We built— we believe this bill is well-intentioned, and we are eager to collaborate with Chair Stevens to strengthen this legislation to support the mental well-being of children who have incarcerated parents on Rikers Island. This bill was originally introduced in 2018, and we and several, several of our partners opposed it then. We are deeply concerned about how this bill will expand DOC's role into assessing and providing referrals for children to access mental health services.

We should instead be investing in community-based services and improving the visiting experience for children. We agree with DOC that they should not be the ones assessing children for referrals and providing mental health services. DOC currently struggles to provide adequate mental health care and support to the people in their custody and their staff. It seems outside the scope of DOC's mission and expertise expertise and is an unnecessary burden to now add children, many of whom DOC has no background information, history, or understanding of their needs, to the list of those in their care.

Instead, information about community-based mental health resources could be made available at the Central Visit House and on DOC visitor buses so families can voluntarily connect themselves to services they feel would benefit them. Visiting Rikers is still such a traumatizing and dehumanizing experience for children and families and the incarcerated people they visit. Under the best of circumstances, it is exhausting, stressful, and includes leaving your loved one behind, worrying about their well-being and safety.

The best way to support children and families' physical, mental, and emotional health is to ensure their interactions with DOC staff are child-sensitive and child-friendly, and that their visits are protected. And ultimately, we must collectively work together to expedite the closure of Rikers Island and return their loved ones home safely. Thank you.

Thank you. Good afternoon, Chair and members of the committee. My name is Miriam Goodman, and I'm the Senior Director of Clinical Care at the Women's Prison Association. For more than 180 years, WPA has served women impacted by the criminal legal system. We provide a continuum of care working with people in the community, at Rikers, at Bedford Hills, and as they return home.

Our work includes case management, housing, reentry support, and trauma-responsive clinical care. We appreciate the intent behind Intro 453 and its recognition that children impacted by a parent's incarceration may need mental health support, but we, along with other advocates, strongly believe that care should be provided by trained mental health professionals through trusted community-based organizations, not by the Department of Correction.

Incarceration impacts entire families. When a parent is incarcerated, Children experience that separation too. Their lives and relationships are disrupted. We cannot talk about healing without acknowledging the systems that have contributed to that harm. The system that causes or compounds harm cannot also be the system we ask families to trust with their healing. Trauma-responsive care is built on trust, safety, choice, consistency, and relationships.

Those things are incredibly difficult to create when care is tied to the very system that meant many families experience as a source of trauma. Community-based providers can offer something fundamentally different, care that is independent of the correctional system and relationships that do not end when someone leaves a jail. At WPA, we see every day what that kind of care can look like.

Our team provides individual and group counseling that recognizes both the impact of both interpersonal and systemic trauma. We meet people as the whole, not as a diagnosis, a charge, or a moment in their life. And because we work across the continuum, relationships can start in community, continuing through incarceration, and back when someone's home. That is what we believe we should be investing in.

We urge the council to invest in community-based mental health services and fund organizations at levels that allow us to recruit and retain excellent clinicians and provide families with the quality of care they deserve. Healing should be rooted in community with trusted providers who can be there during incarceration, through reentry, and long after someone comes home. Thank you.

Thank you. Good afternoon, Chair Brooks-Powers. I'm Nadia Cheate. I'm the Senior Director of Policy and Advocacy at CASES. We serve over 12,000 New Yorkers annually with a specialty in serving folks with serious mental illness and criminal legal system involvement. DOC and CHS described a world today that I wish existed for our clients, but it doesn't, and it is frustrating to see those agencies continue to state that they are providing adequate care and producing people for their mental health appointments when their own data, as well as the numerous monitors of the city's various consent decrees that they are continually not in compliance with, show that that is not the case.

And so I'd like to share a story of one of our clients who recently experienced what happens when DOC and CHS fail at their basic duties. And I would like to state at the front that this was a client with a known release date, so this is the easiest scenario for them to succeed, right? And this was an individual coming into our Nathaniel Act Alternative to Incarceration program.

The individual was due for their long-acting injectable on the day of their release. They did not receive it. The individual's Medicaid should have been active. It was set inpatient, which means that they can't receive community care. The individual's prescription was not sent to a pharmacy, so even though that prescription would be covered by the city's medication grant program, which is designed to cover that gap when individuals' Medicaid is not active, they had no coverage for that prescription.

And this was an individual who was on electronic monitoring, and so they were very, very hesitant to leave their residence and go somewhere to seek the injection, like a hospital, you know, where they could have been forced to wait many hours and where there could have been potential compliance implications. We were ultimately able to get the medication called into the pharmacy the following day and pick it up and bring it to that individual's residence, but that was a 24-hour delay in this individual receiving their needed medication.

And this is for people with, like, the best scenario of wraparound care. So instead, we should really focus on diverting people before they interact with the system and in earlier stages, which my written testimony details. We also oppose Intro 453 as written. Thank you.

Thank you. Peace and blessings. Thank you, Mr. Chair. Chair and members of the committee, my name is Jeanette Bocanegra, and I'm the executive director of a nationally family-led organization in the Bronx. I am also a mother and a longtime advocate for families impacted by the juvenile and adult system. Justice for Families strongly opposes Intro 453. Though the intentions are great, this bill misguided and— is misguided and should not be moved forward.

It needs to be rewritten. We absolutely support providing children with healing and mental health resources. However, the Department of Correction should not assess or provide mental health services to children simply because they are visiting an incarcerated parent or loved one. The department continues to demonstrate that they need to be improved. These children are visitors. They are not in the Department of Corrections custody.

Maintaining a relationship with someone they love should not expose them to additional screening, surveillance, labeling them, and another system involvement with ACS, another system that outcomes are horrible. We want to shrink those systems and build the community's capacity. Families already are traveling long distance and endure long waits, lockdowns, cancellations to visits, and confusing rules to maintain contact with their loved ones.

Children should not be encouraged to remain on Rikers any longer than necessary. Rikers Island is not a healing center. I am deeply concerned that these assessments could open a door to child welfare involvement for families. if they're not already involved in that system. A child visiting an incarcerated loved one should never become an opportunity to investigate or further regulate families.

It is true— it is— if this city truly wants to help our children, they should provide outside support, independent community-based organizations. I'll submit mine. But children need healing. We've acknowledged that. Thank you. Rikers Island contributed to a lot of the trauma that our communities are facing today. They're not the answer, so we strongly oppose 453. Thank you.

Thank you to this panel. Next, we'll hear from Chaplain Dr. Victoria Phillips with Jails Action Coalition, Marcos Barrios Urban Justice Center. Jennifer Parrish, Urban Justice Center. Maxima Rodal, Make the Road New York. And Mateo Guerrero, Make the Road.

Sorry about that. Good afternoon. My name is Jennifer Parrish. I'm the Director of Criminal Justice Advocacy at the Urban Justice Center Mental Health Project. Thank you for convening this hearing on mental health, and thank you, Council, for asking questions specifically related to discharge planning services, because that's a really important component of connecting people who are inside who are receiving mental health treatment with services on the outside.

One thing we didn't hear about in this hearing is the noncompliance that still goes on despite the fact that there's been a court-ordered settlement in place for more than 20 years. The city is still not complying with really important components of that, specifically related to the quality of discharge planning services that are provided. In the latest monitor's report, they detail the findings specifically related to services that are for people with serious mental illness, like applying for public assistance, getting connected with supportive housing, and also the quality of those services.

In only about slightly over half of the cases that the monitors looked at did people get overall quality discharge planning services. And I want to connect this with what Nadia Chait said from CASES. The reason the person— they described a perfect example of what happens when someone doesn't get, or the kind of situation a person can wind up in if they don't get mental health, if they don't get discharge planning services.

And why was this person ultimately caught was because we had CASES there who was connected and tried to fill all of the holes in discharge planning that happened. And that connects really to what Zachary Katznelson said, is we can't just look at what's going on inside of the jails. We have to connect it to what's happening in the community.

If we don't have enough assertive community treatment teams, if we don't have enough supportive housing, if we don't have providers that can connect with discharge planning, it doesn't matter how much we improve that, we're not really gonna be able to serve people in the way that they should. So thank you for looking at the quality of mental healthcare.

There's lots that needs to be done to improve that, but we also need to fund the connections that happen outside. Thank you.

Okay. Where do we start? Should I start? You can go. Okay. Good afternoon, and thank you for having me. My name is Marco Barrios. I'm the criminal justice advocate at the Mental Health Project of the Urban Justice Center, where my primary responsibility is monitoring New York City's compliance with the Bratage settlement. I'm also a member of the Treatment Not Jail Coalition, which champions the Treatment Court Expansion Act.

Furthermore, I'm a veteran in the United States Armed Forces and served in the Gulf War, and I'm also a survivor of the criminal legal system, where I did 24 years and 6 months. But now I visit Rikers Island weekly, and I see up to 20 clients each time. I'm here to tell you what I see in those jails.

One, a punitive setting cannot be a punitive setting cannot be a therapeutic space. The forces used to exercise control often makes things more out of control. You cannot run a program that promotes recovery, which requires self-direction, respect, and hope, inside a system that demands submission, strips people of their humanity, and fills them with despair. Now, mental health treatment in jails and prisons is centered primarily around the provision of medication.

Medication should not be the only option. There should be different modalities of treatment. At Rikers, other treatment methods are limited at best, and for some, nonexistent. The one-on-ones with clinicians are brief, and group therapy is also limited. The treatment plan should be a growing plan that provides for the individual needs of each person in response as they change over time.

And even if they receive appropriate psychiatric medication, that is a challenge. Psychiatric medication management is supposed to be ongoing structured partnership between a patient and prescribing provider to evaluate, adjust, and monitor psychotropic medication for safety and effectiveness. And the consequences are predictable. The individual's previous experience with medication and understanding of the illness is at times ignored. Rather than listening and responding to the needs of each person, That was quick.

Okay. My action is to support the Treatment at Jails Act. Thank you. And I have the written testimony. There's a lot there. I know. Do you want this? It's okay. Thank you.

Hi. Good afternoon. Sheriff Brooks, thank you so much for hosting this hearing today. My name is Mateo Guerrero. I am an organizer at MakeThrough New York, and I'm here to give public testimony on behalf of MakeThrough New York. We serve over 30,000 community members across New York City for services from immigration to housing to employment discrimination, et cetera.

We also have particular— a particular group that serves trans and queer immigrants. It's called our Transmigrant Project. And one of the things that I want to highlight is that trans and queer immigrants are consistently being criminalized very often and facing the potential of being incarcerated. One of the clear examples that we have seen is Operation Restore Roosevelt, which has been ongoing since October 2024.

It started with the prior administration, Eric Adams, and it's still ongoing under the Mandani administration, criminalizing and particularly targeting sex workers in Jackson Heights. one of the populations that engages in sex work particularly are transgender women. And the reason why today we're here to show our strong support for Intro 133, as well for Intro 134, is because we believe that trans communities, first of all, should not be incarcerated, but if incarcerated, that they receive the support to be able to— I'm sorry— to be able to have a dignifying life while incarcerated.

When incarcerated, trans and queer, transgender, non-binary, and gender non-conforming people who are housed in a facility that does not align with their gender identity, they are often exposed to harassment, violence, discrimination. And oftentimes it also creates a fear to even request basic services, such as hormone replacement therapy, out of fear of the interactions that they will have with other folks who are incarcerated as well.

Being housed in the wrong facility can also force trans and gender-expansive folks to constantly have to explain and defend who they are in an environment that already— where they already have very little control. This is why Intro 133 and 134 are important steps towards addressing these harms. Intro 133 will strengthen oversight and accountability for how the Department of Corrections treats trans and nonbinary people in custody, and Intro 134 will require the Department of Corrections to house people according to their gender identity unless they choose otherwise.

This legislation recognizes that something that should not be controversial, which is that trans and gender-diverse people should be treated with dignity and respect, including when they're incarcerated. Thank you. Thank you so much.

Good afternoon, everyone, and thank you, Chair Brooks-Powers, the members of the Committee on Criminal Justice, and the New York City Council for holding this important hearing on Intros 133 and 134, which will strengthen protection for transgenders, gender nonconforming, nonbinary, and intersex people in the Department of Correction. detention and custody. My name is Maxima Rodas, and I'm a leader with the Trans Immigrant Project at Make the Road New York and several community organizations across New York City.

I think everyone here will agree that the ideal scenario is to avoid incarceration altogether. But for many transgender, gender-expansive, and gender-diverse people like myself, Our experiences with discrimination and policing can increase our vulnerability to the criminal legal system. For people like me who identify as non-binary and trans, being placed in a housing unit with people whose gender identity does not align with ours can be overwhelming and traumatic.

We should not have to give up our dignity or sense of safety simply because we are in custody. That is why Introduction 134 is so important to me and why I'm here today to share my personal testimony. The legislation would require the Department of Corrections to consider a person's gender identity and personal sense of safety when making housing It will also establish additional screening and a formal process to appeal housing decisions.

The mockery, abuse, and violence we face on the streets, in the shelter system, in public places, and even within our own families are already excessive and enough. It is unjust. That on top of all of that, when we have the misfortune of being incarcerated, we suffer the same dehumanization and humiliation within the penal system. We urge the Council to pass Interests 133 and 134 and to ensure that transgender, gender non-conforming, non-binary, and intersex people in custody are treated with dignity, respect, and humanity.

Humanity. Thank you very much for your time. Thank you. Thank you.

Peace and blessings, Chair, and all other council members. My name is Chaplain Dr. Victoria Phillips. Everyone calls me Dr. V. I'm the CEO and founder of Visionary V and Visionary V Ministries. Just very quickly, I want to say I support Councilmember Caban's bill. Don't remember the number off the off the top of my head, with the suggested amendments.

I also want to say strong communities make police obsolete. So for Intro 0453, I want to highlight that 68% of those incarcerated right now with known mental health concerns do not receive adequate mental health treatment. And of course, being one of the ones who fought many years ago for 16, 17-year-olds to be removed from the island, again, As co-chair to Young Adults Task Force for DLZ, I'm going to highlight they still should not ever be responsible for anyone's children or the care.

And I will take it a step further to say families, even with DOE, stop allowing your children to be a part of government systems to say you need to receive help. That help needs to come from community resources and services. Also, with the lock-ins, Intro 0809, I do believe an amendment need to be added to that. And I would highly suggest that medical directors from each facility on Rikers Island be called to these meetings.

I've said it before, they want to come, but they aren't allowed to come unless they're directly requested to come and speak their truth on the record. And there are many colleagues that spoke on several things, but I want to highlight something before I go on around PREA and budgets. So we still are waiting for our PREA report. reports.

And this is something that I'm going to keep highlighting because I put on the record, even at BOC, around officers being assaulted by officers, and BOC can't follow up when it's staff on staff because it's not a detainee involved, but the council can. And I say that because even recently I mentioned something at the Board of Corrections around a senior advisor that was made assistant commissioner with sexual allegations, and he is being investigated.

But the allegations that were mentioned were only one. There's about 2 or 3 other people that came, and I want this city council to make sure that that's also followed up. Because if we can't change things from the top on down, how are we expecting the uniformed officers to actually be different? And I'll just finish with this.

When it comes to the budget, please, can this council find out who's still on payroll while being investigated and why? And I maybe even want to find out who's still on the job. Thank you. find out, are any old commissioners still on D.C.'s payroll? When we talk about money and where it's going, we need to know where every dollar is being spent.

Thank you for that. And I appreciate the recommendation in terms of inviting the staff from the particular housing units. So— The medical director. The medical director specifically. And so when you see these hearings coming up, Like, if you don't mind just shooting a note, because I do like that recommendation to be able to get more in the weeds on the topic.

So thank you for that. And thank you to the panel.

Next, I'm going to call up Jenny Stover. Hi, Councilman, and thank you for having this hearing on mental health. I'm a participant with a lot of different organizations. On behalf of all individuals who are detained in New York city jails, prisons, and forensic facilities with mental illness is overwhelmingly harmful than helpful due to the fact that the Department of Corrections are more focused on punishment than treatment, in which massive deaths are occurring in New York and other states from overdose, suicide, paranoia, abuse, etc.

Individuals with mental illness are suffering with trauma, Isolation, lack of care, and long-term damages under DOC custody. Before mental illness individuals are detained, they are already suffering and not receiving professional medical treatment. Some don't know they have symptoms of mental illness. The ones who are diagnosed are not being compliant with their medication, who are self-medicating themselves with alcohol or drugs.

They end up in the criminal justice system with minor or misdemeanor charges. If the abnormal behavior continues, they end up as a felony charge. Instead of the arresting officer acknowledging at their own discretion that these individuals have symptoms of mental illness and substance abuse or both, my patients are taken to the hospital to evaluate. Thank you. evaluated.

Once evaluated, they are— Once evaluated, escorted into the civil court system under Mental Hygiene 94.3 petition, and the Mental Hygiene Parity Act states no one is denied treatment. Once in the criminal justice system and the 730 evaluation is requested and the mental illness individual is unfit and sent to Rikers Island after a plea or pleas, And wait until a forensic facility has availability.

Then the mental illness individual has to be compliant and the clinical acknowledgment progress and assessments is taken. If the treatment court— court to plea again, this is double jeopardy and maybe the individual may receive lesser charges, charges, or confinement. This is definitely a challenge of torture. This is why the Treatment Court Expansion Act should be passed for individuals who are diagnosed with mental illness to receive professional medical treatment and educated of their illness and disease and given an opportunity to know how to live safely on a daily basis and a productive life.

How do I know? Because I have a loved one incarcerated in our prison system. I'm going to ask you to wrap up, please. Okay. Loved ones struggling with mental illness and it affects the family. And if you have not experienced the concern, you don't know what the issues are. In New York City, there's 1.2 million to 1.5 million individuals with mental illness.

Throughout the United States, there are 1.5 million with mental illness. Thank you. Thank you.

Next, we're going to hear from Danielle Regis online. Good afternoon. My name is Danielle Regis, and I am a senior supervising attorney in the mental health representation team of the criminal defense practice at Brooklyn Defender Services. Thank you to the Committee on Criminal Justice and Chair Brooks Powers, for the opportunity to testify today about mental healthcare in the city jails.

As a public defender, I have represented people in the Brooklyn Mental Health Court for nearly a decade. The people I represent often encounter police when they are in crisis and seeking care, or when the absence of available care has led to the decompensation of their mental health. Too often, untreated mental illness becomes criminalized simply because the appropriate The appropriate systems of care were not accessible when they were needed most.

Jails are not therapeutic environments and are not appropriate settings for people to get meaningful mental healthcare. In our written testimony, we highlight a number of concerns about mental healthcare provisions inside the city's jails. But in my limited time, I want to highlight some upstream solutions to prevent people with serious mental health needs from entering jails in the first place.

First, bail amounts are regularly set without regard to what a person or their loved ones can afford. Judges should make individualized decisions when setting bail. Under state law, bail is a tool that should only be used to ensure people return to court. In practice, judges routinely set money bail that functions as a detention order. Incarceration disconnects New Yorkers from their communities, resources and support networks.

It means treatment, medication, and services are interrupted. Next, we urge this committee with the Committee on Mental Health and Substance Use to address the gaps in access to low and no-cost mental health and substance use treatment in the city. Many of the people we represent have tried for years to access mental health and substance use treatment but struggle to find providers who accept their insurance, speak their language, or have the skills needed to treat complex conditions.

They are often discharged from hospitals without proper follow-up care and lack appropriate resources in their communities. People seeking care remain on waitlists for months or years for assertive community treatment teams, supportive housing, psychiatric visits, or other care they require. Individuals are routinely discharged from psychiatric hospitalization Time expired. It's nothing more than a referral. I'm sorry? The time has expired.

You could finish your sentence though. Okay. My apologies. Well, I just want to say the city can no longer rely on a broken or dysfunctional jail system to serve as the largest mental health treatment center. Thank you for your time, and I welcome any questions. Thank you.

Next, we will hear from Chris Payton. Good afternoon, Chair and members of the committee. My name is Chris Payton. I'm the Associate Vice President of Behavioral Health at Exodus Transitional Community. I'm a licensed clinical social worker and have been practicing for about 11 years. Along with this robust reentry trauma-focused programs, Exodus has the Genesis Clinic, an Article 31 MOTARS mental health clinic in East Harlem, which I oversee.

I'm here today to speak about Bill Intro 453 to provide mental health services and referrals to children visiting incarcerated individuals in New York City jails. Many of the patients we see at the Genesis Clinic are returning to society from incarceration, and many have children. And anecdotally, our patients discuss the profound trauma their children or those children they may have cared for prior to incarceration experienced because of their parent caretaker's incarceration.

A child is deeply affected by their parent's incarceration. As we know, when one person is incarcerated, it affects the entire family and community's ecosystem. When a parent is incarcerated, children can experience grief, loss, confusion, shame, financial hardship, family instability, and the pain of having an important person in their life physically and emotionally absent. For some children, visiting a loved one in jail may be the most difficult traumatic experience in their life.

Trauma can show up as anxiety, depression, violence, anger, problems in school, distrusting others. We know from the CDC's research of adverse childhood experiences that it can affect the developing child's brain and immune systems. So referrals to mental health in the community should be available for children of incarcerated parents.

Thank you. Next, we'll hear from Sharon Content. Sharon, are you still with us? Sharon, we don't hear you. If you are able to, like, raise your hand to signal that you can hear us. Hi. All right, Sharon, try speaking one more time. We see your hand. Okay, I was waiting for it to be unmuted. Can you hear me now?

Welcome. Yes, thank you. Thank you. Can you guys— everyone hear me okay? We can hear you. Okay, good afternoon. Good afternoon to Chair Brooks Powers, Council Member Stevens, and to the members of the Committee of Criminal Justice. My name is Sharon Content, and I'm the founder and president of Children of Promise NYC. I seem to be a bit delayed.

Are you guys— is everyone hearing me okay? We can hear you. Okay, fabulous. I am the founder and president of Children of Promise NYC, an organization that 17 years ago has worked specifically with children and families impacted by parental incarceration. I'm the founder of this organization. It is one that I have remained committed and passionate about from day one.

I want to thank you for the opportunity to speak today regarding Introduction 453-2026, which would establish a voluntary mental health services program for children under the age of 18 visiting individuals incarcerated in New York City jails, including referrals and whatever practical onsite mental health services. At Children of Promise NYC, we know firsthand when a parent is incarcerated, the child serves a sentence as well.

The child may not be behind bars, but they experience the separation. They experience unanswered questions. They experience anxiety, fear, anger, shame, and sometimes the responsibility of trying to protect everyone around them while attempting to understand what their fam— what is happening to their family. When they ask— when you ask that child to walk into a correctional facility to visit a parent they love, research shows that parental incarceration documents the emotional and behavioral challenges that can accompany parental incarceration.

And it also shows the impact of visitation on children is complex. The quality of the visit, the environment surrounding it, and whenever appropriate support is provided makes a significant difference. That is why the implementation of this legislation matters greatly. From the experience of Children of Promise NYC, there are several elements that should be considered as this program is developed.

A child— first, mental health support should begin before the visit, not after, not only after the child has visibly been distressed. A child may need to understand what they're about to see, what the facility will look like, why their parents are dressed differently, what security procedures, procedures they may experience, and how they are feeling and seeing before leaving or while they're leaving their parent.

Second, support should continue after the visit. For some children, the most difficult moment is walking away from the facility. Not only walking in, walking out is just as traumatic for our young person. Sharon, we're going to just ask you to wrap up. You can submit the rest of the testimony in writing though, but if you could close.

Okay. Children of Promise stands ready to share our experiences and work with the city to help develop a model that recognizes the child will simply not as a visitor to a correction facility, but also as a young person trying to navigate one of the most complicated experiences a family can face. Thank you for the opportunity to testify this afternoon.

Most importantly, for centering the needs of children whose voices are too often absent from conversations around incarceration. Sharon Kenton, thank you so much. Thank you so much.

And we have now heard from everyone who has signed up to testify. If we have inadvertently missed anyone who would like to testify, In person, please visit the sergeant's table and complete a witness slip now. If we inadvertently missed anyone who would like to testify virtually, please use the raise hand function in Zoom and a member of our staff will call on you in the order of hands raised.

I will— Oh, did you submit a form? You didn't complete one? Yeah. While we wait, anyone else while we're in the room? I'm still waiting. Mar Henriquez. Okay, we ready?

Hi, thank you so much for, um, for holding this hearing, and thank you so much, um, council member and chair, for your support of Intro 130. 133 and 134, and holding the space today. I'd like to start by saying I'd like everyone here to imagine being locked and confined in a place where you're held against your will and your identity makes you a target.

The people in charge are aware and nothing is being done to stop it. I sat here in dismay listening to DOC once again reiterate that they are doing everything as is required by law, and they're following PREA guidelines, which is really disappointing to hear because one, we know based on our clients, I work for the Legal Aid Society, I've been with the Legal Aid Society for 8 years in the LGBTQ Law and Policy Unit, and we see all too often how not only are humans completely disregarded for being incarcerated, but that is exacerbated by trans identity.

And I'd like to run through some stats that highlight the precariousness of the situation that our clients and community members find themselves in. So I'd like to iterate my support for 133, which would enable the task force to continue and encourage the amendments that will be introduced to be enforced, but also highlighting 134, which was not added to the agenda, which is one of the top recommendations of the task force in actually addressing the harms that folks are experiencing on the inside.

We recognize, one, that 40% of New York City's runaway youth population are LGBTQ+. These numbers are only going to go up with the fact that on a federal level, people experiencing an inundated amount of attacks on their identity. The Lemkin Research Institute for Genocide has addressed has issued a 3rd red flag because trans people are under attack in this country. 31 to 46% of youth who exit foster care experience homelessness.

We know that homelessness is criminalized in our communities and that therefore leaves people susceptible and vulnerable to incarceration. The majority of our clients in the LGBTQ+ unit who are incarcerated made first contact with NYPD when they were minors. These are people who are forgotten, who fell through the cracks because of lack of infrastructure, lack of familial support, and are then left to rot at Rikers Island. 90% of our clients report violent abuse in DOC custody.

And this is just what's being reported. We should really assume it's 100%. So I'm really asking for folks to really advocate and continue to advocate for trans and gender nonconforming people. There is a lack of understanding in our communities, and that is state-sanctioned violence. From K through 12, we do not discuss trans and gender expansive identities. People think that they're up for debate, and then as a result, people are left to rot in prison and in jails and on the streets, and they deserve better. more and we deserve more.

And if we are to truly call ourselves a sanctuary city, we have to stand by our incarcerated population. Thank you so much for your time.

Thank you so much. And if there's more, you can submit in written testimony. So seeing no one else, I would like to note again that written testimony, which will be reviewed in full by committee staff, may be submitted to the record up to 72 hours after the close of this hearing and by emailing it to testimony@council.nyc.gov. With that, I thank everyone who lent their voice to this important hearing today, and this hearing is now adjourned.

Thank you.