In the Courts: Supporting New Yorkers Experiencing Behavioral Health Needs

Behind bars at the Manhattan Criminal Court, Mr. Harris1 stood with his arms tucked in his shirt. He rocked back and forth then paced back and forth. Emily Smith from CASES’ Court Services Team introduced herself, explaining that she was meeting with him on behalf of the Manhattan Supervised Release Program (MSRP). Pulling up the intake form on her tablet, Emily mentally noted the signs of Mr. Harris’s distress. She had already reviewed his criminal legal history and his current drug-related charges prior to the pre-arraignment interview.  

“I’m going to ask you a few questions, is that okay?” 

Mr. Harris leaned against the wall, his head against the cinderblock, and said, “Yes.”  

Having met many clients in active withdrawal, Emily asked softly, “Mr. Harris, have you taken any substances in the last 24 hours prior to being arrested?”  

Mr. Harris, still leaning against the wall, nodded his head. “Yes,” he said.  

“Okay,” Emily replied. “What is your home address?”  

Mr. Harris replied that he does not have one. Sometimes he stays with his grandmother. Mr. Harris provided Emily with his grandmother’s phone number.  

Emily could see Mr. Harris was suffering; she understood the potential harm that pushing forward with the questions in the MSRP intake form could cause to his current physical and mental status as well as to his long-term relationship with CASES. “Mr. Harris, would you be interested in a treatment program?”  

“Yes,” he replied.  

“Okay, we can help you with that. I have Gatorade for you and sugar packets. It helps sometimes.”  

Before ending the interview, Emily stressed that the MSRP team would work with Mr. Harris to get him connected to the help he needs and would support him in attending his court appointments. After the interview, Emily next saw Mr. Harris when he appeared for arraignment before the judge. After over 24 hours in custody, Mr. Harris was arraigned and released to MSRP.  


The largest Pretrial Services program in the city, MSRP serves thousands of New Yorkers each year. This includes residents of all five boroughs. The program grew rapidly after the passing of the New York State 2019 Bail Elimination Act—growth that continued during the pandemic, with CASES Court Services Team being the first Pretrial Court Services team in New York City to return to in-person work in July 2020.  

The CASES Court Services team functions seamlessly in a fast-paced environment, covering all arraignment shifts every day, including holidays. The team reviews collateral materials (e.g., rap sheet, correctional health services records) prior to meeting clients, arranges for pre-arraignment interviews whenever possible, advocates for clients to be released to MSRP instead of receiving bail or pretrial detention, and connects clients to their intake appointment at a CASES community office located in their preferred borough.  

Due to limited space in the courthouse, the CASES team has developed the practice of conducting immediate post-arraignment meetings in courthouse hallways or directly outside the courthouse. During these meetings, staff help clients understand court mandates, assess for and address emergency needs through referrals, and provide information regarding the community intake appointment. This appointment at the client’s assigned CASES borough office is a critical step in beginning to build trust with clients by developing a comprehensive understanding of their needs and, when possible, immediately addressing them while meeting court requirements, including attending court appointments and initiating long-term service planning around the client’s goals.  


The growth of MSRP has coincided with the COVID-19 pandemic and correlated mental health and opioid overdose crises in New York City. Emily’s experience with Mr. Harris is not novel—our Court Services Team meets with clients in active withdrawal on a daily basis. About one in five of MSRP clients have histories of serious mental illness and/or substance use disorders. About half of these clients are experiencing homelessness, one of the primary factors linked with elevated vulnerability to adverse MSRP outcomes including failure to appear for court appointments.  

In an interview with CASES staff, Ashley Dills, Team Leader of MSRP Court Services, shared some of the challenges experienced by MSRP clients with substance use disorders.  

“Clients who get arrested and brought to arraignments have been in custody, on average, for 24 hours. By the time we talk to them, it’s been an entire day without substances, and they are really going through it,” explained Ashley. “Typically, clients just want to go as quickly as they possibly can. 

“Sometimes a client reports they are going straight to a methadone treatment program; however, most of those programs close around 2pm, so timing is important. If we are interviewing a client in the morning, we are trying to get them out as soon as possible. If a client is arraigned at night, their program isn’t going to be open; they have missed their dose for the day, or even the day before, and they have to wait until the next day to get it. That’s a big problem as well.”  

Ms. Dills explained that her team regularly makes 911 calls for clients in withdrawal who are having trouble functioning, always with client permission.  

“Clients in withdrawal have said yes because they know that once the EMTs arrive, they will get some relief through medications such as benzodiazepines.”  

In such cases, the Court Services Team serves as a critical liaison, providing EMT information on the client’s status and background, as well as collecting pertinent information to support future engagement with the MSRP Community Services Team. However, Ms. Dills stressed that there is not a designated staff member who can accompany the client to the hospital, or to a substance use facility, since Court Services staff must remain in the Court to continue to provide coverage throughout arraignments for additional clients moving through the courts.  

“Sometimes the person goes into the ambulance and then we may never see them again,” Ashley explained. “I tend to give the paperwork to the EMTs and hope that they give it to them, but I don’t know what happens when the client goes out of our sight. I can’t be sure if they get the address or documentation of where to report for their community intake appointment.” 


As currently resourced, MSRP is limited in its capacity to coordinate with hospitals and treatment programs, especially when clients seek emergency care immediately upon release from arraignment. An area of growing investment at CASES is supporting clients in making it to their community intake appointment, attendance at which greatly predicts success in MSRP according to CASES data. Currently, the MSRP team leverages its Outreach Specialist Team, which follows up with clients who miss their community intake and helps navigate barriers to attending their appointment, such as transportation or childcare. MSRP staff also leverage mobile crisis teams operating out of CASES Nathaniel Clinic. The latter teams meet clients in crisis in the community, provide behavioral health support, and establish connections to both treatment options and MSRP Case Coordinators to ensure clients are getting the help they need while navigating the conditions of their Supervised Release.  

To better meet the needs of MSRP clients with behavioral health needs, the Court Services Team is currently completing additional training in crisis intervention; five staff members are being trained on administering naloxone and dispensing Narcan for clients at risk of opioid overdose. The MSRP team is committed to ensuring individuals like Mr. Harris are not lost to the system—that they are engaged in services and feel supported by a dedicated staff, both increasing their chances of success in MSRP and recovery in the community. 

1 A pseudonym