In recent times, this conversation has tended to focus on Rikers Island. And with good reason. As Alisa Roth chronicles in her book “Insane: America’s Criminal Treatment of Mental Illness,” Rikers and huge jails like it have become the country’s de facto psychiatric hospitals. As officials prepare to close Rikers in 2026, advocates are asking: Where are the seriously mentally ill patients that fill many Rikers jail cells going to go?

This is a good moment to look also at how the mentally ill are shuffled among city jails like Rikers and state-run forensic facilities such as Kirby.

Kirby is generally mentioned in connection with the lurid crimes of its “criminally insane” patients. But its other patients, those who have been found “incompetent to stand trial,” make up the bulk of the population these days, according to staff.

These patients stay at Kirby — or its sister facility, Mid-Hudson — until they can be “restored to competency” and then stand trial. They watch videos and attend counseling sessions to understand the nature of the charges they are facing; some receive medication under court order. But they can remain there for months or even years before they are able to pass the required test and appear in court. In some cases, they go back to jail but mentally decline before their trial date, landing back at Kirby for another stint.

The dust-up over the planned move is a call to examine this piece of a broken system. The mentally-ill inmates who often travel between city jails and state-run forensic centers are subjected to a process that is plagued by delays and dysfunction. The patients may also face the threat of violence at Kirby, just as the staff does.

This threat could grow worse if the move takes place, Kirby employees said. In addition to the disruption of the move itself, employees warn the new unit has unaddressed structural issues: nooks where patients can hide, and low ceilings with metal frames that can be torn out and weaponized.

While they acknowledged that only a small percentage of patients presented a serious threat, several employees expressed concern about the new unit’s bedrooms. At Kirby, most patients sleep in large areas, with beds separated by partitions, where they can be easily monitored. In their new quarters, most will be in pairs in small hospital-style rooms, with no windows on the doors. This could endanger patients’ lives, I was told.