Behavioral Health Services

The Challenge

The rate of mental illness and other behavioral health needs among the daily population at Rikers Island has significantly increased in recent years, from 29% in 2010 to 42% in 2016.1 If this increase continues, within a few years roughly half of those detained at Rikers will have mental illness. Already, 11 of every 100 people at Rikers have serious mental illness.2 Because many jails and prisons are poorly equipped to provide quality behavioral health treatment, inmates with mental illness rarely make progress toward recovery and rehabilitation while incarcerated. On the contrary, studies indicate that many people with behavioral health needs experience a decline in their overall wellness while incarcerated, including due to the various forms of emotional and physical abuse commonly sustained by people with mental illness in correctional facilities including Rikers Island.3

Following release from jail or prison, people with behavioral health needs often struggle to successfully manage the transition back to life in the community. Treatment providers based in the community are often reluctant to serve these individuals either due to a lack of expertise or the dual stigma of criminal histories and behavioral health needs. As a result, justice-involved people with mental illness are particularly vulnerable to a revolving door of arrest, incarceration, release, re-arrest, incarceration, etc.

Our Approach

CASES adult behavioral health services include court-based alternatives to detention and to incarceration along with community programs that include intensive mobile treatment services. All of these programs incorporate the evidence-based principles of

  • Risk-need-responsivity: tailoring service intensity to an individual’s unique risks and needs as documented in validated screening and assessment
  • Motivational interviewing: helping participants to overcome ambivalence and/or resistance to change and promoting their commitment to engaging in support and treatment services
  • Trauma-informed care: delivering services within a framework that recognizes and addresses the likelihood that clients have experienced and/or are currently experiencing trauma

As detailed in the links below, CASES’ specific adult behavioral health services include:

Court-based Programs

  • Short-term alternatives to incarceration for individuals with behavioral health treatment needs and histories of chronic low-level criminal involvement
  • Gender-responsive services for women with behavioral health needs including significant histories of trauma
  • Supervised release as an alternative to monetary bail and pre-trial detention for low-risk people awaiting trail

Community Programs

  • State-licensed assertive community treatment (ACT), including an alternative to incarceration for adults with serious mental illness facing incarceration as the result of felony charges
  • Reentry services for adults with serious mental illness returning from Rikers Island
  • Intensive mobile treatment for adults with untreated serious mental illness identified by City agencies as posing a significant risk for violence

All of the above programs include psychiatric and nursing services as needed and provide seamless referrals to CASES' Nathaniel Clinic, our State-licensed outpatient mental health clinic.

Outcomes

CASES launched its first adult behavioral health program in 2000. This program, the Nathaniel Project, provided New York City’s first alternative to incarceration for adults with serious mental illness facing prison as the result of felony charges. At the time, it was uncertain that a program could safely supervise this population in the community while helping them to engage in treatment and avoid recidivism. As documented at right, the Nathaniel Project won national recognition for its ability to achieve these goals and was subsequently converted into the first of CASES’ three State-licensed, Medicaid-reimbursable mental health treatment programs.

Over the past 15 years, we have built on the Nathaniel Project approach, providing effective alternatives to incarceration for adults with a variety of behavioral health needs and a variety of criminal justice involvement. Based on the success of these programs in reducing recidivism and promoting positive life improvements among clients, CASES in recent years has begun providing reentry and intensive community treatment programs for high-risk adults with serious mental illness.

For specific program information including outcomes, please see links below.

References

1 The City of New York. (2016). Preliminary fiscal 2016 mayor's management report. NYC: City of New York. Retrieved from http://www1.nyc.gov/assets/operations/downloads/pdf/pmmr2016/2016_pmmr.pdf ^

2 Ibid. ^

3 U.S. Department of Justice (2014, August 4). CRIPA investigation of the New York City Department of Correction jails on Rikers Island. NYC: United States Attorney's Office for the Southern District of New York. Retrieved from https://www.justice.gov/sites/default/files/usao-sdny/legacy/2015/03/25/SDNY%20Rikers%20Report.pdf ^

4 Winerip, M., & Schwirtz, M. (2015, April 10). For mentally ill inmates at Rikers Island, a cycle of jail and hospitals. The New York Times. Retrieved from http://www.nytimes.com/2015/04/12/nyregion/for-mentally-ill-inmates-at-rikers-a-cycle-of-jail-and-hospitals.html ^