Last week, New York City opened an innovative housing unit that will provide mental health treatment for roughly 100 detainees from the notorious Rikers Island jail. complex.
The 104-bed facility is the city’s first Outposted Therapeutic Housing Unit, and it’s operated by NYC Health + Hospitals/Bellevue. The facility will serve detainees who have complex medical needs and are “clinically vulnerable.”
The detainees will be transferred from the notorious complex. Opening this first of three therapeutic units is part of Mayor Zohran Mamdani’s campaign promise to close the problematic correctional facility at Riker’s Island.
The facility is one of the largest jails in the world, but it also functions as a mental institution. The complex logs roughly 100,000 admissions per year, and has an average daily population of nearly 7,000 inmates. Although Black people make up about 20% of New York City’s population, around 6 in 10 Rikers detainees are Black.
System Overhaul
“Opening this new clinical facility at Bellevue Hospital is how we begin to close Rikers Island — not with promises, but with action,” Mamdani said at an April 7 press event. “For too long, people with serious medical needs have been left to suffer in a system that was never designed to care for them.”
Opening this new clinical facility at Bellevue Hospital is how we begin to close Rikers Island — not with promises, but with action.
New York Mayor Zohran Mamdani
Now, “we are building something different: a system that delivers real care, treats people with dignity and makes our city safer for everyone—incarcerated people, corrections officers and all New Yorkers,” Mamdani said.
The U.S. has the world’s largest incarcerated population, and most of the people behind bars have chronic illnesses. Conditions linked to poverty, limited healthcare access before incarceration, and high rates of smoking, substance use, and trauma are prevalent.
Stretched to Breaking Point
Roughly 60% of incarcerated persons have at least one chronic condition such as hypertension, cardiovascular disease, diabetes, asthma and chronic lung disease, arthritis, or cancer.
At the Rikers Island complex — where all detainees are awaiting trial — a daily churn of health emergencies exposes a system strained by neglect, thin staffing, and delayed medical care.
Reform advocates describe missed responses to overdoses, asthma attacks, and mental health crises, with violence and disrepair intensifying the misery. Deaths tied to suicide and suspected overdoses underscore what families say is a place where help too often comes too late — if at all.
Over the past five years, as many as 50 people have died in or shortly after spending time at Rikers, a toll that advocates say reflects systemic failures in medical care, safety, and staffing.
High Rates of Chronic Illnesses
In 2019, the New York City Council voted to close Rikers Island by August 2027 and replace it with four jails featuring therapeutic centers across the city. But delays under Mamdani’s predecessor, Mayor Eric Adams, mean the city probably won’t meet that deadline.
The new therapeutic units will provide direct access to a full range of specialty services, including oncology, cardiology, and neurology. Clinicians from the city’s Correctional Health Services unit will deliver care on-site “in a therapeutic environment designed to improve health outcomes.”
Patients with serious conditions, such as cancer and congestive heart failure, who don’t need to be hospitalized but are too high-risk to live in a traditional jail will be treated.
CHS will remain the primary provider of clinical care, working closely with Bellevue specialists. The NYC Department of Correction will provide security, custody management, programming and other services.
More Clinics to Come
The city plans to open two more therapeutic housing units for CHS patients. Those will serve detainees who have significant mental health needs.
Roughly 37% of inmates in state and federal prisons and 44% being held local jails have been diagnosed with a mental health condition. This is twice that of the overall adult population.
Approximately 40 states require incarcerated individuals to meet medical co-pays to see a doctor or other health professional. Roughly one-third of inmates required to meet a medical co-pay have a co-payment that is higher than one week’s prison wages.