New York County Defender Services

Testimony of Raji Edayathumangalam, MSc (Microbiol.), PhD (Biochem.), LCSW 

Senior Policy Social Worker 

New York County Defender Services 

Before the New York City Council Committee on Criminal Justice 

September 23, 2026 

I am Senior Policy Social Worker at New York County Defender Services, where I have worked in direct practice and policy roles for seven years. I am also a Licensed Clinical Social Worker and a part-time psychotherapist at a community mental health clinic in Manhattan. Prior to NYCDS, I worked at a health center in East Harlem providing mental health assessments, treatment planning, and psychotherapy to children, adults, couples, and families. I have taught graduate clinical courses on mental health and practice at Columbia School of Social Work, and an advanced clinical workshop on suicidality at the clinic where I still practice. Before becoming a social worker, I had a long career as a life scientist studying the molecular mechanisms underlying Alzheimer's disease, and the biochemistry and structural biology of gene expression. I also serve on the New York State Judicial Task Force on Mental Illness. 

I am here to testify that it is very much possible for people with long histories of complex needs and innumerable cycles across various institutions to exit Rikers Island, and successfully integrate and thrive in the community. I want to illustrate using the examples of two clients. 

Read about two NYCDS clients who got out, and stayed out. 

When I first met my client (whom I will call Harry to protect his confidentiality), he had been street homeless for decades, had serious opioid use issues, was severely depressed, and estranged from his family. He had never had access to appropriate mental health treatment. He was charged with numerous violent felonies in multiple counties across the city and he was facing a long prison sentence. By every measure the criminal legal system uses, there was no hope. After a great many struggles on Harry’s part, and a great deal of advocacy by many of us to get him the right kinds of community treatment and programming, he finally turned the corner and began to excel in every aspect of his ATI mandate. From that point forward, Harry never looked back and he subsequently graduated from Manhattan’s felony Alternative-To-Incarceration (ATI) court with flying colors. It’s been a few years since Harry said goodbye to the courts and he continues to thrive to this day—he is well, he is a working taxpayer, he has reconnected with his family, and he remains stably reintegrated in his community. One of his employers who rarely writes letters even wrote a letter to the ATI Court that said, "I truly mean it that I'd hire 15 [Harrys] if I could and we plan to continue to promote him into new roles over time." 

Another NYCDS client whom I’ll call Tom (again, for confidentiality) was very very ill when NYCDS first met him at his criminal court arraignment. He was dishevelled, completely disorganized in thought and speech, and in his overall presentation. He made claims of representing a very famous musician. He had been in the throes of untreated schizophrenia for decades, and like Harry, he too had been homeless for a long time. He also had unaddressed substance use issues. For decades, Tom experienced the ‘revolving door,’ cycling across jails, prisons, hospitals, state psychiatric facilities, and shelters. Again, his situation too seemed impossible to remedy and the District Attorney objected to his placement in treatment court. However, a treatment court judge saw something in Tom and overrode the DA’s objection, thereby offering him his first ever real chance at re-integration in the community. Tom made the best of this once-in-a-lifetime chance, and despite all of the trials and tribulations, Tom only came out strong at the end of every ordeal. Like Harry, he too eventually began to excel at his court mandate and never looked back. At his felony ATI Court graduation, the DA said on the record, "let me begin by saying that you know that you have proven us wrong, and I can't tell you how much that pleases us…you have committed yourself time and time again to your own well-being and your own health, and watching you on this journey it has been inspiring." 

I invite the Council to take note of what sorts of infrastructure produced such successful outcomes for Harry and Tom. Neither client recovered at Rikers Island, but in the community. Both of them were able to successfully re-integrate in the community because many actors banded together and fought hard to get them off the island; pieced together the necessary community treatment, housing, and wraparound services; and because, in Tom’s instance, a judge was willing to overrule a prosecutor. The difference between these two clients and a significant proportion of the 1,600 or so people with serious mental illness held in our jails in December of 2025 is largely about access to community infrastructure, and also about such access being determined by the strength of the advocacy and luck in each instance. 

Jails cannot be reformed, and the reason is structural.

There is an inherent tension between providing some health care in a carceral setting, and providing intensive treatment, housing, wraparound services, and prosocial integration in the community to promote recovery and integration. This tension is the whole argument. We cannot reform mental health care inside Rikers for the same reason that we cannot reform Rikers and we must close Rikers. The security function and the therapeutic function are not competing priorities that, somehow, a better management of Rikers could balance. The security function and environment create heightened and ever present states of panic, terror, and hyperalertness, which obliterate any real possibility for the development of a strong therapeutic alliance between clinician and patient, which is foundational to effective trust-building, engagement, treatment, and recovery. These two functions are therefore fundamentally incompatible, and in a carceral setting, the security function wins every time and meaningful treatment never has a chance. 

Further, how could people with complex needs ever integrate effectively in their communities, if they do not receive comprehensive and coordinated services that simultaneously address housing, treatment, and other social and service needs, and in the very communities they are meant to be integrating into? Importantly, successful treatment and reintegration are not only about achieving some bare minimum symptom reduction, and that too, largely only through medication management (as at Rikers), but essentially they require a comprehensive array of clinical interventions that help people learn new ways of being, relating, and functioning in the world. 

The claim is clinical, not rhetorical. 

A comprehensive review published this year in the International Journal of Law and Psychiatry synthesized the literature on mental health care in carceral settings.1Its findings are not about any one jail. They are about what the carceral form does to clinical practice everywhere it is attempted, and it describes prisons as increasingly serving as de facto psychiatric institutions in settings designed primarily for punishment rather than treatment. 

The authors identify the same conditions I have pointed out above and elsewhere. Confidentiality is compromised by the presence of non-medical staff and by physical layouts that prevent private consultation, and in a closed environment, information travels fast enough that disclosure carries real risk of stigma and punitive consequence. Clinicians occupy a dual role, serving both the patient and the institution; and like I pointed out before, the literature also associates such role confusion with mistrust, perceived betrayal, and reduced treatment effectiveness. Again, the environment itself—characterized by constant surveillance, overcrowding, rigid routine, and restricted social contact—is not conducive to any close collaboration with the person being treated and across systems, is described as inherently detrimental to psychological well-being and retraumatizing, and as reducing the effectiveness of treatment relative to community care. 

Those are the preconditions for effective mental health treatment: adequate and experienced staffing, specialized services, confidentiality, engagement, trust and rapport building, and robust integrated care and services. Security imperatives do not just simply degrade them at the margins. They make them entirely unavailable. The review’s conclusion is that structural factors, principally overcrowding and under-resourcing, compromise the feasibility of equivalent care in jails, in the first place. Equivalence of care is the standard the Nelson Mandela Rules impose on every state that detains people.2 New York does not meet it, and the review explains why no jail operating under these conditions can. Importantly, these concerns apply even more so to Rikers Island, which has been plagued for decades by chronic dysfunction and mismanagement even as to its core security function, leading to alarming levels of violence and deaths. 

The scale of what we are asking Rikers to absorb is of staggering proportions. 

The share of people in New York City jails receiving mental health care has risen to 60 percent, and the share diagnosed with a serious mental illness rose from 17 to 22 percent, according to the Data Collaborative for Justice at John Jay College and the Katal Center.3 New York City Health+Hospitals/Correctional Health Services' (CHS) own patient profile for December 2025 puts serious mental illness at 23 percent of an average daily census of 6,948 people, which is roughly 1,600 people in a single month.4 Approximately 85 percent of people held on Rikers are detained pretrial, and approximately 70 percent of them return to the community without serving a state prison sentence, according to the Mayor's Office of Criminal Justice.

We are not discussing a population simply passing through on its way to prison. We are discussing our neighbors, presumed innocent, most of whom will be back in this city within months, and whose clinical condition on the day they return is something this Council has the power to affect. 

Treatment exists only at the extremes, and that is by design. 

PACE is akin to inpatient psychiatric care or partial hospitalization programs. It is the highest level of mental health care available on the island, and by the accounts of people who work in it as well as those of my clients who have received care in these units, the units are calmer and the care is real. 

But PACE is small and it is deliberately kept small. Earlier this year, the PACE system was holding roughly 290 people in a system built for 334. CHS explained the vacancy directly: “PACE is designed to operate below full capacity in order to maintain a therapeutic environment, and filling every bed would undermine the units' ability to function as intended.”

I want to be clear that I believe CHS and that this is the correct clinical judgment. At the same time, it is also a concession and rationing of limited resources with enormous implications. CHS is telling us that a therapeutic environment inside a jail requires density, staffing, and stability— conditions that the rest of the jail cannot provide—and that the moment you scale the model to meet demand, it stops being therapeutic. Three hundred and thirty-four beds is the ceiling of what Rikers can hold to a clinical standard. Sixteen hundred people with serious mental illness are on the other side of that ceiling. This is the tension made visible in a bed count. 

So what happens to the other 1,300 desperately in need of treatment? The review names it exactly. “High prevalence combined with limited resources forces a triage approach in which clinicians must prioritize urgent cases, principally suicide risk and acute psychosis, which limits their ability to uphold the standard of equivalence at all.”7 Everyone below the threshold of emergency receives next to nothing that a clinician would call comprehensive treatment. 

This is why access to care is not a question of the intake threshold. It is not that people are insufficiently ill to qualify for PACE. It is that triage requires selecting only the most acute, and that people are moved out and sent back into the general population as soon as they stabilize, only to frequently decompensate and sometimes to be brought back to PACE again. The review describes carceral mental health care as prioritizing stabilization over recovery, because providers are forced to balance therapeutic goals against security demands. Stabilization without recovery, repeated, is the quintessential clinical definition of a revolving door. 

The revolving door is literal. In 2025, Bellevue admitted 410 of 713 mental health referrals from the jails, about 57 percent. Elmhurst admitted 40 of 102, just under 40 percent and down from about 51 percent the year before.8 For comparison, the national rate of admission from an emergency room to a hospital bed, across all conditions, is around 20 percent.9 These are not hospitals turning people away. They are hospitals that are actually admitting people from Rikers at nearly triple the ordinary rate, because of how sick people are by the time they arrive. Rikers refers people out because it cannot manage them and gets roughly half of them back. 

There is no middle, and there cannot be. 

In the community, the space between crisis and nothing is where most mental health treatment actually happens. Let’s consider one such example: a Continuing Day Treatment Program (CDTP). A CDTP helps a person improve their daily functioning, build coping skills, and avoid repeat hospitalization while living in the community. It is structured, voluntary, continuous, and confidential. It assumes a person has a life to return to at the end of the day. 

Rikers Island has no such equivalent and can have none. A step-down program requires exactly the conditions the review identifies as unavailable in custody: continuity across time, private clinical space, voluntary engagement, and a therapeutic relationship not mediated by a correctional officer. You cannot build a day program inside a facility organized around counts, lock-ins, slamming doors and other loud noises, blinding lights, shrill alarms, and escorts. The absence of a middle tier at Rikers is not an oversight in the service array. It is the shape a carceral institution takes. 

So the two options are either inpatient-adjacent care like PACE for the most acutely sick—a few hundred people—or warehousing, for the rest of those still in desperate need. And warehousing causes devastating harm and worsens a person’s mental health—people rapidly decompensate and they become more likely to cycle through systems again. Not to mention the added harm of warehousing in an dangerously overcrowded jail like Rikers. 

What this Council can do. 

Rikers cannot be a comprehensive mental health provider. The question is not how to improve treatment on the island. It is how to stop sending people with complex needs and desperately in need of treatment to Rikers, in the first place; and how to effectively divert them to community infrastructure that the city must make serious investments in. 

New York has a working answer and refuses to fund or standardize it. Mental health courts divert people with serious mental illness into community treatment, supportive housing, and services. Recent graduation rates at Brooklyn Mental Health Court have run between 73 and 87 percent, and an evaluation of the court found that participants see significant reductions in re-arrest.10 This is the type of door my two clients walked through. 

Now consider the scale. Roughly 1,700 people were active, compliant participants in mental health courts across the entire state last year. Brooklyn Mental Health Court has graduated 1,560 people in total from its opening in 2002 through the end of last year.11 The number of people who graduated from twenty-four years of the state's model diversion court is still smaller than the number of people designated to have serious mental illness over one month (December 2025) at Rikers. About half of New York's 62 counties have no mental health court at all, because unlike drug courts, they are not required by law.

And where the courts exist, access is slow and rationed. At Brooklyn Mental Health Court, the median time from arrest to a first contact with clinical staff was 265 days last year, followed by another 104 days to determine eligibility and 56 days more to begin the program.

One of my colleagues at NYCDS represented a young woman diagnosed with schizophrenia who spent roughly ten months on Rikers Island waiting to learn whether she could enter the Manhattan Mental Health Court, because leaving jail hinged on how the prosecutors evaluated her case. She was motivated. She wanted treatment. She wanted to be reunited with her young daughter. She said she felt hopeless because nothing appeared to be happening. She was admitted to the treatment court this past May and she has been consistently following her treatment plan since. Her daughter visits her in the community.14 She should not have needed many months of screening by the District Attorney to determine whether or not she should then be referred to the treatment court for the court to also then again determine whether or not to refer her to the community care that this state already knows how to deliver. 

My client Tom who has a schizophrenia diagnosis got into treatment court because a judge overruled a District Attorney. That should be the rule, not the exception that proves that the system works by accident. 

The Treatment Court Expansion Act, S.4547/A.4869, would standardize treatment courts statewide, expand eligibility, reduce plea requirements, and end the prosecutorial gatekeeping that determines who gets treatment and who gets Rikers. Mayor Mamdani has described it as "one part of what it can look like to ensure that we are closing Rikers Island."15 Chief Judge Wilson and Chief Administrative Judge Zayas support it.16It has stalled in Albany for years. 

I am asking this Council to make the TCEA an explicit part of its Albany agenda, and to say plainly what today's oversight hearing makes clear: that every month this bill sits without passing is a another month the City spends in frenetic efforts to operate the largest psychiatric facility in New York State from within a carceral setting, at a site that—by its own clinicians' account—can only be therapeutic for 334 people at a time. In this regard, not only could mental health care in jails never be a solution, but also every month the bill sits, is another month of misallocation of the city’s taxpayer dollars, priorities, and values away from building out the kind of sustained community infrastructure that truly promote public safety for all.