A Conversation with Elizabeth Ford, MD, Deputy Director of New York State Psychiatric Institute

Criticism and distrust in the ability of America’s criminal justice system to protect those in its custody, fueled by increasing transparency about racism and health inequities revealed by the Covid-19 pandemic, have highlighted an emerging field straddling public and forensic psychiatry focused on caring for individuals who have become involved in the juvenile or criminal juvenile justice systems.

In February 2023, Columbia Psychiatry (Columbia Department of Psychiatry and New York State Psychiatric Institute) named Elizabeth Ford, MD as Deputy Director and Clinical Director of the New York State Psychiatric Institute.

Dr. Ford brings over 20 years of experience to justice psychiatry. She began her work as an NYU psychiatry resident at Bellevue Hospital, served as Director of Forensic Psychiatry for NYU/Bellevue, Chief of Psychiatry for NYC Health + Hospitals’ Correctional Health Services at Rikers Island, and provided psychiatric care for people on probation and parole as Chief Medical Officer for a social service agency in Harlem before joining the Columbia faculty.

In collaboration with Columbia faculty already working at the intersection of psychiatry and justice (Michael Compton, MD, Kate Elkington,PhD, and Leah Pope, PhD), Dr. Ford co-founded and chairs the Workgroup for Justice-Involved Behavioral Health. The Workgroup is an evolving collective of researchers, educators, clinicians, administrators, students, and people directly impacted by justice systems seeking to fill gaps in knowledge and clinical best practices.

Columbia Psychiatry spoke with Dr. Ford about her role, her vision for justice psychiatry, , and her critically acclaimed 2017 memoir, an account of her experiences at Bellevue Hospital treating men from Rikers Island.

In your book, Sometimes Amazing Things Happen: Heartbreak and Hope on the Bellevue Hospital Prison Ward, you share some very personal anecdotes about your experiences. What did writing the book teach you about where you wanted to take your career?

I had a specific goal for the book: to highlight the humanity, strength, and resilience of the patients. I was tired of reading headlines describing them as monsters; my experience was much the opposite. They were honest, insightful, afraid, and in pain. They helped me become a better doctor more than any formal education I received. While initially hesitant, I am grateful to my publisher for encouraging me to speak openly about my struggles. Feedback I continue to receive indicates that being honest about my work has helped others in the field feel less alone and has even inspired some medical students to enter psychiatry.

The process of writing each day helped me to integrate day-to-day situations with what I was learning about the health and justice systems, and the pervasive individual, institutional, and systemic biases that exist toward justice-involved individuals. It prompted me to value the importance of working both inside and alongside these complex and intertwined systems.

Based on your experience working within the New York City jail system, including Rikers Island, what do you hope to accomplish?

My career choices have been driven by the patients and a dedication to keeping them at the heart of my professional decision making. Each new role has introduced me to another facet of the criminal justice system, through which many thousands of people with mental illness traverse each year. My passion is to increase psychiatry’s engagement in the understanding and care of people who are involved with the criminal and/or juvenile justice systems, as well as those who have been involved and those at risk of becoming involved. I am grateful that the New York State Psychiatric Institute and Columbia Department of Psychiatry recognized how critical this work is to their public psychiatry mission.

You’ve already been leading conversations with colleagues interested in addressing mental health within justice systems. What are your most excited about?

A core principle of the Workgroup’s mission is to ensure that projects are driven by people who are most affected by justice systems. For example, instead of relying on funding agencies to decide research priorities, we aim to prioritize projects generated in collaboration with justice-involved peers, service providers, family members, and law enforcement. My experience running challenging clinical services within complex and counter-therapeutic environments is that meaningful change starts with individual conversations, includes all opinions, and then expands organically to institutions and systems. I am fortunate to work here with people dedicated to that mission.

I am also thrilled to be involved in residency training again. We have hosted guest speakers who have been incarcerated and expanded education about “justice psychiatry” in the forensic residency curriculum.  A site visit to Rikers Island and weekly supervision about caring for people under arrest in the CPEP have been added to the PGY2 year.

How do you and the Workgroup coordinate with and complement the work of the New York State Office of Mental Health Division of Forensic Services?

The Division of Forensic Services (DFS) provides mental health services to a wide range of justice-involved individuals, including people incarcerated in New York State prisons and individuals hospitalized in state forensic facilities. DFS also provides training for first responders and supports county jail diversion efforts. DFS is helping to find common areas to address community needs as the Workgroup shapes our priorities and projects.

Criminal justice reform has gotten the attention of policymakers. Are you hopeful about progress in this area?

I am indeed hopeful, especially about conversations that are starting to happen not just about reform, which sometimes just makes a bad system less bad, but about transformation, which to me means upending the very structures and principles upon which a system is built. I have seen that individuals directly affected by the criminal justice system are starting to be included in the policymaking process; I am hopeful that this will disrupt the typical “top-down” approach. There is increasing attention to the social determinants of mental health, all of which also happen to be social determinants of justice-system involvement.

As we address those determinants to improve mental health—increasing access to things like housing, food security, employment, education, and health care—justice involvement and the reliance on places like jail for shelter and treatment, will decline as well. Criminal justice issues haven’t only gotten the attention of policymakers. Medical and residency education across the country is recognizing the importance of caring for and learning about justice-involved individuals. I am hopeful that this will result in more active engagement by the medical and behavioral health systems in transforming the justice systems.