Working Across Systems to Secure Jail Alternatives for Individuals with Serious Mental Illness

For an individual with serious mental illness (SMI) jailed following a felony arrest, the wait for trial can last as long as 9-12 months. This period of pretrial incarceration often includes transfers between Rikers Island and the Kirby Forensic Psychiatric Center on Wards Island, as individuals struggle to maintain wellness while in jail and require hospitalization for mental health treatment. CASES’ Nathaniel Assertive Community Treatment (NACT) is specifically designed to intervene in this cycle, shorten periods of pretrial detention, and provide an effective alternative to jail and prison stays for people with SMI. 

“I know of CASES because they serve a very specific population of people who are incredibly vulnerable, even before the pandemic,” said Patricia Kim, a social worker at Rikers Island. “They’re always one of the first providers we look to call because we need a group who know how to address a lot of systemic issues that [jailed individuals with serious mental illness] face. That knowledge is really important to [addressing] these individuals’ mental health and medical care.” 

The process of securing the release of a client to NACT can take months of advocacy to judges and prosecutors, comprehensive clinical assessment and release planning, and coordination with other providers in the community to support an individual’s return to the community. Nearly a year ago, in fall 2019, Patricia began working with Laura DazianoCASES’ Clinical Supervisor on our Manhattan Court Intake Team, to help an individual initially referred to CASES by a Kirby social worker. This individual, Nicholas*, was facing a serious charge and lacked stable connections in the community, conditions that can make securing a jail alternative difficult. However, when Laura screened Nicholas in the Kirby hospital setting, she found him to be psychiatrically stable and enthusiastic for treatment.   

After stabilizing at Kirby, Nicholas was transferred back to the 730 unit at Rikers. The return to jail after experiencing improvement in mental health can be particularly fraught for an individual living with SMI. Together, Laura and Patricia worked with Nicholas’s attorney to have his case transferred to a specialty mental health court that could speed his release from jail to CASES’ supervision and treatment servicesThough the court agreed to mandate Nicholas to NACT, his case then hit an all too frequent barrier: housing.  

“Supportive housing providers will not interview people while they are incarcerated,” Patricia said, “and that’s extraordinarily problematic because the waitlists, once you are interviewed, are 3-9 months on average. If you can’t start that process until you’re already discharged, that’s an interminable amount of time to wait for housing, [usually] living in a shelter or on the street.” 

Working with the Nathaniel ACT Evaluator Brittni Adekoya, Patricia was able to arrange an interview for Nicholas for a short-term crisis respite accommodation that might satisfy the court’s concernsUnfortunately, it was then early April. Before the interview could happen, Rikers halted most visits due to the COVID-19 outbreak in the jail and, despite being approved for release to a CASES ATI, Nicholas remained incarcerated and became infected with the virus.  

Fortunately, after being quarantined in a special unit at Rikers, Nicholas recovered without complication. With the support of a court-based mobile crisis team, he then applied for supportive housing offered through the Fortune Society. In late April, his housing application was approved. The court then agreed, with Nicholas’s enrollment in the intensive, mobile treatment provided by CASES’ NACT program, to release Nicholas to the community. Engagement in NACT was especially critical due to the pandemic.  

Nicholas depends on a medication that needs to be managed very closely by in-person blood draws,” Laura explained about why Nicholas needed the level of care provided by NACT. “He couldn’t be released to just any type of treatment. He needed an ACT program, where even with the pandemic, they would actually see him in person to do those blood draws to monitor his medication.”  

A State-identified essential service, NACT has comprehensive safety protocols to ensure client and staff safety during in-person services delivered in the context of the pandemic. Nicholas’s return to the community and engagement in comprehensive, ongoing support tailored to his illness and related needs speaks to the persistence and coordination required to help individuals with SMI access community alternatives.  

“It took months,” Laura said. “There was a real effort from all parties. The discharge planning social worker and clinical staff on the AMKC PACE Unit, the Fortune Society supportive housing staff, the Brooklyn Mental Health Court, our team—we were all in an email thread with Nicholas’s attorney. Everyone collaborated to help him. We were all thanking each other at the end because his release was long time coming.” 


To learn more about the comprehensive services provided by NACT, please visit our website [1]. Note that while this article was being prepared, Patricia Kim became a whistleblower at Rikers Island, related to the spread of COVID-19 at the jail.  

*To protect this client’s identity, we have used a pseudonym.