The Nathaniel Project is a unique alternative-to-incarceration program for seriously mentally ill felony offenders in New York City. By bridging the gap between the criminal justice and mental health systems, the program helps participants avoid the downward spiral of psychiatric deterioration and re-arrest.

It is designed to achieve three aims: to promote public safety; to help mentally ill felony offenders live productive, law-abiding lives in the community; and to provide cost savings to city and state government.

The Project offers comprehensive community-based case management services and intensive supervision and support. Our staff assist participants in obtaining and engaging in treatment, supportive housing, and benefits - all crucial elements in establishing stability and avoiding criminal involvement. The Project monitors participant progress and offers guidance and supportive counseling for a two-year period.

The Nathaniel Project will consider any prison-bound defendant who has been indicted on a felony charge, has a serious mental illness, and requires on-going psychiatric treatment and supportive services to function in the community. Referrals can be made by anyone, but typically come through court personnel. Candidates undergo a multi-step screening and risk-assessment process to assess their current situation, psychiatric and criminal history, and potential for success in the program.

Screening and Risk Assessment
Upon referral, Nathaniel staff conduct a psycho-social assessment of the individual as well as an evaluation of the circumstances in the pending criminal case. This allows staff to determine whether he or she meets the program's basic criteria: that he or she has a serious and persistent mental illness (including Mentally Ill Chemically Addicted) and is jail- or prison-bound. The screening also determines whether the individual is stable enough to make use of program services and whether staff can develop a reasonable, individualized plan for consideration by the court and the District Attorney's Office.

Project staff carefully assess the level of risk posed to the community should the participant relapse through failure to comply with treatment. Examining the prospective participant's psychiatric and criminal history for evidence of aggressive behavior, staff balance these factors against the individual's level of insight and motivation to avoid incarceration and succeed in treatment.

Intake Assessment
During the intake assessment process, prospective clients are interviewed at least twice to gauge their motivation level and determine their risk of further involvement in criminal activity. The assessment also evaluates the level of support that will be required for them to return to the community and successfully adjust to the demands of crime-free living. They are informed that the Nathaniel Project is not an easy way to get out of jail, requiring a lengthy investment, hard work, and commitment.

To develop an individualized service plan, the Nathaniel Project also gathers a great deal of information from potential participants' families, along with mental health service providers both in the community and jail. These plans detail the type of housing and benefits the participant would need, the level of psychiatric intervention and supervision required to achieve stability, and which additional programs the client will participate in, such as day treatment, a psychosocial clubhouse, or vocational training/job placement. All participants review and sign a service plan contract, which also explains the consequences of missing appointments with staff and in the community.

Program Services - First Year
The Nathaniel Project offers an unprecedented level of service intensity during the critical first weeks of a participant's transition from incarceration to the community. Project staff make arrangements for temporary or transitional housing prior to a client's release from custody; staff then meet with each client at the time of their release and escort them to their housing provider. During the first year of the program participants receive intensive case management and supervision services as follows:

• A three-visit minimum per week during the first two months
• A two-visit minimum per week during the following two months
• A one-visit minimum for the next eight months to complete the
  first year

During the first year, the case management focus is to help clients successfully apply for Medicaid and other public benefits, obtain stable housing or enter a residential treatment program, become engaged in community based psychiatric treatment, and develop other community-based links that will help them achieve stability. In the first 90 days, when the risk of relapse is greatest, Project staff directly administer treatment so that there is continuity during the transition to new housing and treatment providers. Our budget also includes a "subsistence" allowance for medication and basic needs such as food, clothing, and temporary housing, and for any gap in benefits.

Project staff meet regularly with the participant and various service providers to monitor progress, collect information for the court, intervene as an advocate for the participant with providers, assist providers in treatment planning and working with the participant. Above all, staff foster a close relationship with the participant to reinforce treatment compliance. This relationship is the critical element to compliance and helps participants achieve the goals and objectives outlined in their service plan contract. If the participant does not fulfill his or her program obligations, Nathaniel Project staff will inform the court and/or probation promptly. Nathaniel Staff also escort clients to all court dates and present progress reports to the court as requested.

Program Services - Second Year
During the second year, case management shifts to a monthly monitoring and supervision model. Participants are expected to have a stable living situation, to be engaged in treatment, and to have developed a community-based support network. Frequency of contact is determined in coordination with other mental health treatment providers and by court requests for continued progress reports.