The intervention: Alternative to incarceration (ATI) case management services for people living with serious mental illness that emphasizes engagement in community treatment
Who is served: People ages 18 and above who are living with serious mental illness facing nonviolent felony charges and, on a case-by-case basis, violent felony charges in the Manhattan Supreme Court
In the past decades, the proportion of people with mental illness—and serious mental illness—in the criminal legal system has accelerated. That includes in New York City, where more than 43% of people incarcerated in City jails have a mental health need, and 15-20% have a serious mental illness. While there have been strides made to increase services both in and out of jail for these populations, traditional courts often do not have the resources, the capacity, or the knowledge base to appropriately assess and divert eligible participants into relevant programming as an alternative to incarceration.1 Once incarcerated, these individuals are more likely to stay in jail longer than the general population,2 keeping them removed from family, employment, and access to comprehensive treatment in a community—as opposed to a correctional—setting.
The MMHC Approach
The Manhattan Mental Health Court (MMHC) was created in 2011 with the goal of reducing recidivism among people living with serious mental illness (SMI) by addressing their mental health diagnoses. A problem-solving court, the MMHC provides supervision and case management for people living with SMI who are facing felony convictions. As a partner in MMHC, CASES has provided case management for people participating in the Court since 2015. The CASES team works with clients and Court stakeholders to create highly individualized program plans that address the clients’ mental health needs and supports them to achieve stability in the community. This process prioritizes collaboration between the judge, prosecutor, defense attorney, and client. All MMHC case management program plans address:
- Mental health
- Care coordination
- Substance use
- Primary care/medical needs
- Vocational, education, and other needs
MMHC features four program phases: Adjustment, Engagement, Progress and Treatment, and Preparation for Graduation. These phases call for intensive initial engagement to ensure clients have support as they transition from jail back to the community, establish rapport with the CASES team, become acclimated to the MMHC process, and make initial contact with community-based treatment providers. Given the highly individualized nature of the program, behavioral health treatment referrals can range from short-term, 28-day rehabilitation programs to long-term, inpatient programs spanning a year or more.
As appropriate, participants can also be connected with CASES’ menu of programming, including mental health treatment and primary care at the Nathaniel Clinic, group counseling sessions at our community offices, or Assertive Community Treatment (ACT) team services. The assigned CASES MMHC Case Manager meets regularly with participants, maintains communication with treatment providers, and discusses updates with Court stakeholders—including the judge, MMHC Resource Coordinator, defense, and prosecution—during weekly case conferences in the judge’s chambers. Contingent upon these updates and the potentially evolving needs of participants, the program’s mandated services are subject to change throughout the participant’s tenure with the MMHC. After successful completion of services, the participant is often able to have their plea vacated and charges dismissed or dropped to a lesser charge. Over the past three fiscal years, two-thirds of MMHC clients have successfully completed mandated requirements and graduated from MMHC.