Clinical & Community Alternatives

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 [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 [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 [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.

4 [4]

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 [5], our State-licensed outpatient mental health clinic.

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 [6] 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.

The Challenge

Incarceration takes both an emotional and physical toll on all New Yorkers. In addition to costing New York City taxpayers around $1.4 billion annually, incarceration disrupts families, employment, access to medication, and community ties. These disruptions disproportionately impacts individuals who are Black and Latine, who make up about 90% of those currently incarcerated in New York jails, even as incarceration continues to do little to improve community safety: nationwide, almost 70% of individuals released from incarceration are rearrested within three years, 40% within the first year of reentry. Individuals who have mental illness are also disproportionately impacted by chronic cycles of arrest and incarceration. These individuals, who account for nearly half of those currently detained at Rikers Island, are jailed more frequently and for longer periods than those facing similar charges, indicative of New York City’s continuing reliance on incarceration as a response to unmet mental health needs.

In the summer of 2017, New York City Mayor Bill de Blasio announced a plan to close Rikers Island and replace it with smaller, borough-based jails. This groundbreaking policy relies on community-based strategies focused on recovery, healing, and wellness—a new approach to justice that includes rapid access to individually-tailored, evidence-informed clinical services attentive to trauma and focused on strengths-based principles that build motivation and resilience. CASES’ Clinical & Community Alternatives (CCA) Department builds on this new approach to provide holistic, community-based services.

Our Approach

CASES has offices in the Bronx, Brooklyn, and Manhattan courts that facilitate a range of cost-effective alternative-to-detention (ATD) and alternative-to-incarceration (ATI) programs, including for youth and for people living with serious mental illness. Our team of assessment and intake specialists work with court-involved persons, collaborate with public defenders, and advocate to prosecutors and judges to secure the diversion of appropriate individuals to a CASES ATI tailored to clients’ needs and goals, including avoiding  recidivism.

The ATI advocacy process is led by CASES ATI Intake Unit, a team featuring psychologists and licensed clinicians who provide rapid, person-centered screening and assessment for court-involved persons potentially appropriate for a community-based jail or prison alternative. Our ATI Intake Unit screens for ATI eligibility while also more comprehensively assessing an individuals strengths, needs, challenges, and goals. This assessment process—for most of the below programs utilizing the evidence-based Short-Term Assessment of Risk & Treatability (START) or START-Adolescent Version (START-AV)—guides robust treatment and success planning for program clients as they transition from court to community. CASES ATI programs include:

  • newSTART: Provides a 1-, 3-, or 5-day ATI for individuals facing short-term jail sentences—usually 30 days or less—many of whom have a history of low-level criminal legal system involvement. Beginning directly in the courthouse, the newSTART ATI features a rapid intake and assessment process that identifies a client’s needs and connects them with community-based mental health, substance use, employment, housing, and/or other services that facilitate self-sufficiency and can help them avoid further involvement with the legal system. See the newSTART page for more information.
  • Nathaniel Community Success (NCS): NCS is an innovative ATD and ATI program for people 16 and over who have mental health needs. The program emphasizes intensive initial services that gradually taper to encourage client skill building, independence, and linkages to ongoing services in the community, as As appropriate, NCS services are closely coordinated with treatment at CASES State-licensed Nathaniel Clinic in Central Harlem, which includes onsite mental health, substance use, primary care, case management, peer, and family services along with crisis intervention as needed. NCS features mobile, in-community outreach to clients to ensure their ongoing engagement in services and progress toward personal and program goals. See the NCS page for more information.
  • Nathaniel ACT (NACT): NACT is an award-winning ATI providing intensive, mobile treatment for individuals living with serious mental illness (SMI) facing incarceration for felony charges. The program implements the evidence-based, State-licensed Assertive Community Treatment (ACT) model encompassing psychiatric, nursing, clinical, housing, family, employment, and peer support. See the NACT page for more information.
  • Manhattan Mental Health Court (MMHC): MMHC is a specialized ATI operating in the Manhattan Mental Health Court that engages individuals age 16 and older with SMI in ATI services. CASES MMHC staff conduct comprehensive assessments, make treatment recommendations, coordinate appropriate treatment, provide ongoing case management and support in the community, and provide continuous updates to the Court. See the MMHC page for more information.
  • Reframing Opportunity, Alternatives & Resilience (ROAR): Building on decades of experience providing alternative sentencing options for youth and young adults in New York City courts, Reframing Opportunity, Alternatives & Resilience (ROAR) provides individualized and developmentally-appropriate support to young people (age 16-27) who would otherwise face jail or prison sentences as the result of a felony or misdemeanor charge. ROAR operates in courtrooms and at CASES’ offices in the Bronx, Brooklyn, and Manhattan, with program staff working as a team to deliver coordinated services addressing each young person’s unique needs and goals, including related to mental health, substance use, education, employment, and family. See the ROAR page for more information.

Outcomes