For many years, public safety and public health officials have struggled to address the need for effective treatment services in the community for youth and adults who have mental illness and have become involved in the criminal justice system. In 2014, the NYC Mayor’s Task Force on Behavioral Health and the Criminal Justice System released a formal action plan calling for more community treatment options for this population.1 In recent years, as the number of people in CASES programs with behavioral health issues and specifically mental illness has progressively increased, our staff often struggled to find suitable treatment providers in the community due to factors including 1) the dual stigma of mental illness and serious justice involvement for our clients and 2) the lack of expertise among providers in working with this population.
Part of the challenge presented by justice-involved people with mental illness is their broad range of risks and needs. These include high rates of co-occurring substance abuse, barriers to housing and employment that can result from criminal justice involvement, and high rates of chronic physical health conditions. For the latter, researchers have found that people with serious mental illness and a history of incarceration are:
- 40% more likely to have a chronic medical problem than the general population
- 30% more likely to have multiple medical problems than individuals with serious mental illness who have no incarceration history2
Since 2000, CASES has operated multiple alternative-to-incarceration programs for justice-involved adults with mental illness and other behavioral health needs. The success of these programs, including State-licensed assertive community treatment (ACT) teams, led the NYS Office of Mental Health to encourage CASES to open a State-licensed outpatient mental health clinic in Central Harlem. CASES worked closely with experts in criminal/juvenile justice and behavioral health to design this new clinic, which we opened in 2014. The model—the Nathaniel Clinic—includes evidence-based mental health treatment integrated with onsite substance abuse services, legal services and benefits assistance, and primary health care. The latter is provided in partnership with the Institute for Family Health (IFH), one of New York's largest providers of health care for disadvantaged and at-risk people. CASES and IFH are providing primary care services co-located at the Nathaniel Clinic that are integrated with clients' ongoing mental health treatment. These services, called the Nathaniel Wellness Program, are part of the clinic's holistic approach designed to address the specific risks and needs experienced by justice-involved people who have mental illness.
The Nathaniel Clinic is a critical addition to the continuum of behavioral health services provided by CASES, a continuum that now includes:
- intensive mobile treatment in the community
- individual and group cognitive behavioral therapy
- substance abuse monitoring and counseling
- peer advocacy/support
- outpatient clinic services including integrated primary care
While the Nathaniel Clinic also serves eligible residents of the Harlem and surrounding communities, its specialization in clients who also have justice-involvement is helping to address a significant public health challenge. The Nathaniel Clinic is one of the only outpatient clinics operating in New York City with its specialization and the only one in Manhattan licensed to serve youth as young as age 13. In its first 18 months of operation, the clinic received more than 800 referrals from more than 40 distinct referral sources including probation and parole officers, illustrating the entrenched need for effective outpatient mental health services for the justice-involved who have mental illness.
The clinic’s inclusion of primary care services has also brought significant investment to the Harlem public health community. In 2015, CASES secured a four-year, $1.6 million grant from the U.S. Substance Abuse and Mental Health Services Administration to establish the Nathaniel Wellness Program, which provides integrated primary care services at the clinic. In partnership with the Institute for Family Health, one of New York’s largest non-profit providers of health services for indigent and at-risk people, CASES will establish a Federally-Qualified Health Center at the Nathaniel Clinic to help clinic clients improve their physical health while engaged in ongoing mental health treatment.