Doctor Elizabeth Ford is a psychiatrist who has worked on and overseen the prison hospital psychiatric wards at Bellevue Hospital in New York since 2000. In this memoir, Dr. Ford describes the conditions, staff and patients in these wards as well as her own personal journey in working with them. Much of what she describes is frustrating and tragic: the lack of space and consistent treatment for those in need, seeing the same prisoners cycle back into her wards over and over, stories of individual prisoners (whose names have been changed) whose mental illnesses cause them and those around them pain and suffering. Yet even in these trying conditions, Ford sees within these men, as well within the department of corrections staff and medical staff, a reason to forge ahead, to stay committed to helping people whose crimes and physical demeanor are frightening to most others. Ford herself sometimes struggles with burnout, with individuals whom she cannot help as she wishes, with balancing family and work, and with natural disaster in the form of Hurricane Sandy. Nevertheless, she persists because she has a true calling to work with this population. As she writes,
I have come to see my success as a doctor not by how well I treat mental illness but by how well I respect and honor my patients’ humanity, no matter who they are or what they have done.
Ford begins with her internship in 2000 at Bellevue Hospital’s Comprehensive Psychiatric Emergency Program (CPEP), where she quickly establishes herself as someone who will speak up to authority on behalf of her patients. Ford later moves up to Bellevue’s 19th floor wards, which house the maximum security hospital ward and Riker’s Island’s inpatient unit. This is where most of Ford’s memoir takes place as, over the years, she becomes a resident psychiatrist and eventually director of the program there. While the 19th floor ward is part of Bellevue Hospital, its affiliation with the NYC jail system means that the ward also involves the Department of Corrections. Medical staff and DOC security staff work closely together, usually well but occasionally with friction. Ford notes a couple of incidents where she and officers on the ward butted heads over particular inmate patients, but for the most part Ford, the medical staff and the DOC staff function as a team. She notes a number of occasions in which officers on the ward demonstrate compassion and understanding of the inmates whose behaviors are out of control and frightening. The DOC officers also were instrumental in developing a program to get decent clothes to inmates for their court dates, and they did outstanding work in helping evacuate patients during Hurricane Sandy. Ford notes that the stresses of working with mental health inmate patients takes a toll on everyone and that burnout/turnover rates are high for both DOC and hospital staff. A number of medical staff express their own frustrations with inmate patients, urging Ford to just medicate them or ship off the extremely difficult ones — meaning just send them back to Riker’s where they’ll eventually be shunted back to Bellevue again in a game of human hot potato. Ford is quite honest and blunt about her own burnout, how she could see her attitude toward her patients spiraling downward to the point where she left the 19th ward around the time her second child was due. (She tells a couple of frightening stories of being pregnant on the ward and what the sight of a pregnant woman does to some of her patients, many of whom suffered abuse as children). Eventually, Ford finds herself back on the 19th ward, this time as a director for the program, which is where she will stay until leaving for a position on Riker’s Island itself.
Recent news stories have revealed that prisons today house large numbers of mentally ill inmates, that the US prison system has turned into a mental health system but is unprepared to function as such. Ford’s memoir provides a glimpse of how that looks in reality and it is a powerful and disheartening picture. Here are some of the facts Ford provides:
*Within the NYC jail system, some 40% of the population gets mental health treatment (about 5000 people) and of those, 1000 are “seriously mentally ill.”
*Those 1000 “seriously mentally ill” inmates in the NYC jail system are more than the number of patients in all of the inpatient psychiatric units in the NYC hospital system combined.
*The Bellevue Hospital maximum security wards, which handle the “seriously mentally ill” inmates, have a total of 68 beds.
The frustration, desperation and violence that results from this discrepancy is on full view in Ford’s memoir. Inmates at Riker’s who need help will not get it unless they have reached an extreme condition, such as threatening to commit suicide or repeatedly harming themselves and others. Some inmates know this and will attempt or threaten suicide just to get out of Riker’s for a while. Given the few beds at Bellevue, it’s essential that inmate patients’ length of stay be as short as possible. So as soon as someone makes some progress, he is out, even though he might need more help. And eventually, that same inmate might find his way back to Bellevue again or might die in jail at Riker’s. Ford’s descriptions of the conditions at Riker’s for mentally ill and behavioral problem inmates are horrific. Riker’s is understaffed in the psychiatric department, as no one really wants to work there (no surprise) and many of the staff are ‘per diem,’ meaning that consistency in care is pretty much non-existent.
So how do “amazing things happen” in such an environment? And what does that even look like? Well, it’s amazing when prisoner inmates at Bellevue express gratitude and appreciation for the work that Ford and the staff do to get them nice clothes for their court dates. It’s amazing when a group of inmates in a therapy session rally around to encourage another inmate. It’s amazing when a scared and violent inmate can be talked out of his fear and rage by Dr. Ford and go back to his cell without incident. It’s amazing when Ford encounters a former inmate on the street, a man suffering from schizophrenia, and he has been taking his medications and has put his life together. Amazing things happen because of amazing people like Dr. Elizabeth Ford and all of the staff who work with such dedication and purpose. At the end of this memoir, Ford has decided to leave Bellevue for Riker’s — out of the frying pan and into the fire. And she is enthusiastic about the challenges ahead. Despite that fact that she is just one woman facing a large and broken system, she forges ahead. That’s amazing.