Http://query.nytimes.com/gst/fullpage.html?res=9b06e7df1e3df930

Back on the Streets Without a Safety Net; Critics Assail Lack of Followup Care For Free.
September 13, 1999
Back on the Streets Without a Safety Net; Critics
Assail Lack of Followup Care For Freed Inmates With
Mental Ills
By NINA BERNSTEIN
In the gloom before dawn, under the hulking metal girders in Queens Plaza, the Department of Correction bus cruised to a stop. The doors opened, and 30 Rikers Island inmates poured into the trash-strewn street to freedom. The first man kicked the bus as waiting buddies whooped. Others slapped high-fives and called to the few prostitutes still slouching by at 5:30 A.M. Most, lugging their belongings in oversize bags of clear plastic or brown paper, loped quickly toward the glow of two all-night doughnut shops. But Barry McCrae, a skinny, 40-year-old man without possessions or front teeth, faltered on the sidewalk, peering around like a sleeper awakened from a troubled dream. ''Which way is the subway?'' he asked no one in particular. ''I want to get on a train.'' He was clutching a Metrocard good for two fares, the city jail's parting gift to the inmates it releases nearly every morning at the foot of the Queensboro Bridge. Mr. McCrae is one of thousands of inmates released from Rikers each year who have spent their jail time in special units for the mentally ill. Like him, many have been treated there with anti-psychotic drugs. And like him, many freely acknowledge a problem with street drugs and alcohol. But as soon as they step from the bus between 3 and 6 A.M., they are on their own. ''I got no meds now,'' Mr. McCrae, who has a long history of mental disorders, said, blinking in the fluorescent light of Twin Donut. ''I kept asking about it, but they were too busy. I thought I was going to have a seizure any minute.'' Last month, advocates for the mentally ill filed a class-action lawsuit against the city and its medical provider, charging that inmates treated for mental illness while in jail were being released without proper provision for continuing care in the community. A State Supreme Court judge issued a temporary restraining order on Sept. 6 on behalf of two plaintiffs in the lawsuit, requiring the city to provide them with medication and referrals for expedited Medicaid, treatment and shelter. Citing several court decisions, the judge, Louise Gruner Gans, ruled that the plaintiffs had a strong claim that releasing them without the means to promptly obtain medication subjected them to cruel and unusual punishment and other constitutional violations. Thomas Crane, a senior attorney in the city Corporation Counsel's Office, criticized the judge's ruling as http://query.nytimes.com/gst/fullpage.html?res=9B06E7DF1E3DF930A2575AC0A96F95.
Back on the Streets Without a Safety Net; Critics Assail Lack of Followup Care For Free.
unauthorized by court precedent or legislative statute. ''No law says the city has to provide medicine for mentally ill inmates after they leave jail,'' he told The Associated Press. He said the city would strongly oppose requests for any further relief in the case. Advocates said inmates like Mr. McCrae illustrate the failings of a system that treats more than 15,000 seriously mentally ill inmates as patients each year, but typically releases them the same way it does any other inmate. Experts said good discharge planning is crucial to keeping mentally ill inmates from a revolving door of deterioration and re-arrest. During the hours when Mr. McCrae was being prepared for release, he said, he missed his 6 P.M. dose of medication: Dilantin, an anti-seizure medicine; Haldol, a powerful psychotropic tranquilizer, and Cogentin, which counteracts the trembling that is a side effect of Haldol. Abrupt withdrawal of such drugs can cause convulsions and other abnormal involuntary movements, as well as psychiatric deterioration. Mr. McCrae had been given the drugs regularly while serving six days in jail in a mental health unit for stealing two bottles of hair dye and selling a bag of marijuana, according to his account, later corroborated by records from the Department of Correction and interviews with those involved. An officer on the bus said Mr. McCrae should just go to a hospital. But Mr. McCrae, whose most recent psychiatric hospitalization, eight months ago, resulted from a suicide attempt, wanted to get home to the Bronx to reclaim his place: a park bench at 181st Street and Grand Concourse. ''When I let 'em out, a lot of them just wander the streets,'' said Robert Hamilton, a Department of Correction officer who had driven the earliest bus from Rikers that day, arriving at 3:30 A.M. with the first of the 97 inmates released that morning. ''They go out and come right back to their spot and do something that causes them to be arrested again. They'll get off my bus today, by Tuesday they'll be on my bus again.'' Medical and mental care is provided to inmates by St. Barnabas Hospital under a subcontract with the city's Health and Hospitals Corporation. Gerald McKelvey, a spokesman for St. Barnabas, said that if it is notified in time of an inmate's impending release, it tries to provide at least a five-day supply of medication or a prescription; a referral to a community program or treatment center, and an after -care letter listing agencies that have been involved in the inmate's case. But he stressed that, unlike a psychiatric hospital, St. Barnabas's jail operation has little, if any, control over when and how its patients leave. ''We treat them while they're there, and when they're gone, they're gone,'' he said. Mr. McCrae was gone from Rikers within a week. He had no letter, no money, no prescription, and no Medicaid card to cover the cost of filling one. He has been taking psychiatric medications since 1980, he said, when he was hit by a car and spent 18 days in a coma. ''Since the accident, I forget a lot of things and it bothers me,'' he said. ''I wouldn't say I'm suicidal. I just don't give a damn whether I live or not.'' Later, after a friend supplied details that Mr. McCrae acknowledged, the outline of his life emerged more starkly. http://query.nytimes.com/gst/fullpage.html?res=9B06E7DF1E3DF930A2575AC0A96F95.
Back on the Streets Without a Safety Net; Critics Assail Lack of Followup Care For Free.
His 4-year-old twin sons, his wife and her brother were all killed in a car crash around Thanksgiving in 1979. The following year, Mr. McCrae threw himself in front of a car. He acknowledged several other suicide attempts since then, a few other short stays in jail and nine or ten psychiatric hospitalizations, most at St. Barnabas Hospital in the Bronx. But there was also a period of four or five years when Mr. McCrae had a family life again, staying sober and making a home with a woman and her four children who had fled her abusive boyfriend. Like Mr. McCrae, the 43-year-old woman was homeless when they met in the late 1980's, but she now works as the secretary in the union for city shelter system employees. Mr. McCrae tried to call her after he got off the bus, in hopes of borrowing money. But there was no answer, so he trudged toward the rumble of the elevated subway track. The money Mr. McCrae wanted to borrow from his former girlfriend was actually his own: his Social Security disability benefit. They both said he has his monthly check of about $620 deposited directly into a joint bank account that only she handles. They broke up five years ago over his return to alcohol and drugs, after he ran up credit card bills and sold the family television for crack. Now she doles out small amounts to him, they said, usually $50 a week, and he instructs her to give her children $30 each every month. ''If he didn't have direct deposit, he would never have any money to make it from the first to the end of the month,'' she said. ''He helped me when I needed help. I can't turn my back on him.'' This way, Mr. McCrae said when he was found in the Bronx a week after his release, ''I can pay them back, in a way,''for his behavior during their breakup. He was on his park bench in a small triangle off the Grand Concourse, drinking breakfast: a 50-cent beer he poured into a soda bottle scavenged from the garbage. Mr. McCrae had managed to buy Dilantin, without a prescription, on the street, paying $2 for 60 capsules. ''I have to have it,'' he said. In theory, his disability automatically qualified him for Medicaid. But his Medicaid card had been lost or stolen, he said. It was doubtful whether the card would still be valid, anyway: Under Federal regulations, a recipient loses Medicaid eligibility during incarceration and must reapply for coverage. In the past, being jailed for a short time was unlikely to disrupt Medicaid. But in the last five years, as the city moved to cut public assistance rolls, it began collecting lists of those in jail in order to terminate their benefits promptly, officials said. Mr. McCrae, who said he sometimes hears voices telling him he doesn't belong in the world, found a kind of substitute for psychotropic medication five days after his recent release from jail. ''You want to know the truth,'' he said with a shamefaced smile, ''I went and bought some crack. I got arrested as soon as I got out the door.'' He was held overnight and then released by a judge who told not to come back, he said. Despite his mental and physical disabilities -- his shortened right arm is attached to his shoulder with steel pins -- Mr. McCrae is an adept scavenger. He said he collects bottles and cans to redeem for the deposit and wears clothes discarded by a laundry when people fail to come back for them. http://query.nytimes.com/gst/fullpage.html?res=9B06E7DF1E3DF930A2575AC0A96F95.
Back on the Streets Without a Safety Net; Critics Assail Lack of Followup Care For Free.
In a wistful singsong, he listed former jobs: ''door-to-door salesman, assistant cook, assistant teacher at St. Matthew's day care, maintenance, home health aide.'' He lost the last job six years ago because he kept having blackouts and seizures, he said, ''and they got tired of me.'' He lost his last apartment in 1996, when his roommate died. With 30 cents in his pocket and cold weather looming, he was thinking about trying a detoxification program, he said. Later the same day, he went to a city Medicaid office at St. Barnabas, seeking a temporary replacement for the card he had lost, but was turned away, he said. ''They told me I need I.D.,'' he said in a telephone call from a soup kitchen. . Jenny Watson, a volunteer at the soup kitchen, called later to say she had helped him fill out a form for the city Medicaid office, and told him identification was not a legal requirement for applying. But Mike Harris, a crisis intervention specialist with the Coalition for the Homeless, said denials on that basis are commonplace, and difficult to overcome. In testimony to the City Council last year, Dan H. Still, the first deputy commissioner of the city's Department of Mental Health, Mental Retardation and Alcoholism Services, stressed the importance of insuring that mentally ill inmates receive ''appropriate housing, food, clothing and social support'' after release, to prevent deterioration and re-arrest. ''Without good discharge planning,'' he said, ''even the best of mental health services provided in confinement will have little or no lasting effect when the client returns to the community.'' But the city-financed program that is supposed to manage such transitions handles fewer than 4 percent of mentally ill inmates, according to a study by the Urban Justice Center, the advocacy group that brought the lawsuit. In his last telephone contact with a reporter, Mr. McCrae's speech was slow and slurred. He said he had lost his black-market bottle of Dilantin. ''They might have fell out of my pocket,'' he said, ''while I was sleeping on the bench.'' Copyright 2006 The New York Times Company XML Help Contact Us
http://query.nytimes.com/gst/fullpage.html?res=9B06E7DF1E3DF930A2575AC0A96F95.

Source: http://www.urbanjustice.org/pdf/press/nytimes_13sep99.pdf