I. Preliminary Statement
In the last few decades, the criminal justice system has replaced the mental health system as the primary mental health care provider in the United States. In New York City, approximately 25% of the 130,000 inmates admitted annually to City Jails are in need of mental health treatment. Record on Appeal (hereinafter "R.__") 238. And, approximately 15,000 of these patients suffer from serious and persistent mental disorders. R. 238, R. 274. That number is over three times the total population of adult patients in all state run public mental hospitals in New York. R. 274.
The most common mental illnesses suffered by these inmates are psychotic disorders, including schizophrenia, and mood disorders, such as bipolar disorder and major depression. R. 238. Each of these illnesses is described below:
- Schizophrenia is a severe brain disorder that affects approximately 2 million Americans. NAMI, Understanding Schizophrenia 1 (1994). It typically produces major disabilities in thinking, feeling and behavior. Id. at 2. People suffering from schizophrenia may frequently experience visual or auditory hallucinations and paranoid delusions which can significantly impair a person's ability to communicate. Id. at 2-3. Although there is currently no cure for schizophrenia, its symptoms can usually be successfully controlled with medication. Id. at 5.
- Bipolar disorder is a disorder of the brain which, if untreated, is frequently characterized by rapid and uncontrollable shifts between severe mania and severe depression. NAMI, Understanding Bipolar Disorder 2 (1998); see also Frederick K. Goodwin, M.D. and Kay R. Jamison, Ph.D., Manic-Depressive Illness 4-5 (1990). Bipolar disorder is a chronic condition with recurring episodes, much like diabetes, and it generally requires ongoing treatment. If it is left untreated, the disorder tends to get worse and the symptoms become more pronounced. With proper treatment, it can be controlled. NAMI, Understanding Bipolar Disorder, at 2.
- Major depression is a serious medical illness that affects one's thoughts, feelings, behavior, and physical health. NAMI, Understanding Major Depression 4-6 (1998). It is among the most treatable of the major mental illnesses, usually through a combination of medication and psychotherapy. Id. at 9. When left untreated, however, major depression can severely impair mood, concentration, sleep, interpersonal relationships, and performance in work, school and other aspects of daily life. Id. at 4-6. Major depression should be distinguished from "situational depression" which typically lasts for a short period of time. Id. at 2-4. By contrast, major depression may last for weeks or even months at a time and can be profoundly disabling. Id.
While incarcerated, these inmates receive various forms of treatment for these disorders on both in-patient and out-patient bases. Depending on the inmate's diagnosis, the City Jails provide psychotropic medication, individual and group therapy, and/or 24 hour medical supervision. R. 240-42. When released, however, virtually all of these inmates are sent into the community without any discharge planning ?? that is without the provision of a supply of their psychotropic medication, follow up appointments for the continuation of their therapy, and assistance in obtaining housing or other necessary public assistance. See infra part III.3.
Without this assistance, most inmates with mental illnesses cannot continue their mental health treatment after they are released. Many of these inmates were homeless and receiving Medicaid and other forms of public assistance at the time of their arrest. These public benefits are not immediately reinstated upon release, and as a result, many inmates have no way to pay for their medication and treatment. And, even those inmates with resources to obtain treatment need assistance in making the transition from the structured jail environment to the community, where they encounter complex rules, long waiting lists and other barriers to mental health services. In the absence of discharge planning to assist these inmates in obtaining treatment, they are unlikely to obtain mental health care after release. See infra part III.4.
As a result of the abrupt termination of their treatment, many inmates experience a relapse of symptoms of their mental disorder, an increased risk of suicide, and frequently wind up in a "'revolving door' of successive periods of hospitalization and reincarceration, interrupted by periods of release in which their psychiatric treatment is suspended and their symptoms recur." R. 59. Despite these consequences, and the emotional, physical and financial costs associated with them, the vast majority of inmates are released from City Jails without any type of discharge planning. See infra part III.5.
As discussed below, see infra part III.7., mental health professional organizations uniformly require that adequate discharge planning be provided to persons with mental illness before they are released or transferred from treatment by a health care provider. And, defendants do not (because they cannot) dispute that these services are essential. However, in spite of the fact that discharge planning is a widely accepted component of mental health care, defendants fail to provide this treatment to a vast majority of plaintiffs. As plaintiffs complain, defendants' failure to provide this planning violates New York's Mental Hygiene Law, New York's Code of Rules and Regulations and the Constitution of the State of New York.
This brief will describe the need for discharge planning and the consequences of not providing that treatment to these inmates, their families and their communities. For the reasons set forth below, as well as the reasons set forth in the brief of plaintiffs-respondents, dated September 12, 2000, the Order of the Supreme Court of New York should be affirmed and the injunctive relief requested by plaintiffs should be granted.