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QUEENS, N.Y. — Dr. Nichole Adams, a clinical psychologist who oversees the mental health programs for the New York City Department of Correction with Correctional Health Services, knew she had her work cut out for her when she took the position.

But she told PIX11 the DOC has implemented effective programs, due to a close collaboration with Dr. Elizabeth Ford, a psychiatrist with the city’s Health and Hospitals Corporation.

“We’ve actually trained over 4,000 officers in mental health ‘first aid,’ Dr. Adams said recently from the Department of Correction’s Executive Offices in Queens. “They learn what are symptoms of mental illness.”

And the symptoms are many.

At least 11 percent of the inmates in the jail system have severe mental illness like schizophrenia, bipolar disorder, or PTSD—post-traumatic stress syndrome.

“There are more individuals who are in the New York City jail system with serious mental illness than in all the hospitals [in the five boroughs],” Dr. Ford told PIX11. “Many of the people in our service are arrested for behaviors that somehow relate to their illness.”

One of them is 20-year-old Saul Nunez, who was arrested last June for beating a 91-year-old man over the head with a cane.

Saul had told his mother, Rosa, he needed the cane, because he needed to suck demons out of the air.

“Saul has schizophrenia, and he’s been in jail almost eight months,” his mom, Rosa Nazar, told PIX11 in a courthouse hallway. “Jail is not treatment for the mentally ill.”

Nazar said her son is in a unit with another inmate who screams at night, “I want to kill, I want to kill,” and he’s suffering from sleep deprivation, along with nose bleeds.

He gets medicine for his condition, along with an injection once a month, “and when he starts shaking, he gets another pill for shaking,” Saul’s mother noted.

Unfortunately, psychiatric medication is known for having side effects and Dr. Ford told us that’s the reality of these serious disorders. It’s a reason why many people stop taking their medicine.

“Unfortunately, adherence with psychiatric medications is not great in this country,” Dr. Ford said.

Former Correction Commissioner Martin Horn—now a professor with John Jay College of Criminal Justice—said experience with the system has taught him the side effects of psychiatric medication can be so unpleasant, that “individuals would prefer to quiet the voices in their heads or alleviate depression by using heroin or cocaine or alcohol.”

Horn added, “It’s really a very shameful commentary on New York City in the 21st Century that our first line of treatment for the acutely, mentally ill is the jails.”

About 700 to 800 inmates in the city’s jail population have serious mental illness.

Some have families who tried to get them a psychiatric bed in a mental hospital without success.

“There are not enough hospital beds to take care of mentally ill patients,” said Dr. Lewis Nelson of Rutgers University School of Emergency Medicine.

“In the late 1970s, early 1980s, the mental health laws changed. We went from institutionalizing people long term to allowing them to be quote/unquote free.”

He said hospitals make difficult decisions every day about psychiatric admissions.

“There’s not one hospital that’s guilty of this. It’s every hospital.”

The New York City Department of Correction has two, key programs for housing inmates with serious mental illness. One is a high intensity, mental health unit called PACE, which has officers embedded in it. Another program, CAPS, was started in 2013 and excludes people with serious mental illness from punitive segregation, commonly called solitary confinement. Both were developed by Correctional Health Services in collaboration with the Department of Correction.

“In those structured settings, medication adherence is very high,” Dr. Ford said. “These units have been extraordinarily effective.”

Yet, the grind of going to court has been tough for Rosa Nazar, who still hopes her son will be placed in a psychiatric facility one day.

James Toner, Saul’s defense lawyer, was upset the prosecution wanted Saul Nunez to plead guilty and potentially get a 7-year sentence.

Juan Llorens, the elderly victim, made a good recovery, forgave Saul, and offered the suspect’s mother a hug on Broadway in upper Manhattan last July.

“She’s a good woman,” Llorens said at the time.

“It’s very painful, very painful” Nazar said of her son’s condition.

“Saul’s been sick for a long time, and the system failed him.”

Editor’s Note: Changes have been made to this article at the request of the Department of Correction (DOC) to clarify a few points. Rikers and city jails have more mental patients than all hospitals in NYC, not more than all hospitals in NYS as originally noted. This has also been updated to note that oversight of mental health programs falls under Correctional Health Services (CHS) and that CAPS and PACE were developed by CHS in collaboration with DOC.