The Challenge

Jail and prison have become facilities of last resort for many people with serious mental illness (SMI), contributing to a cycle of crime, incarceration, release, and recidivism worsened by ineffective treatment and the traumatic conditions of correctional facilities. While the total New York City jail population has decreased in recent years, the rate of individuals with mental illness has steadily grown. In 2017, more than 40% of inmates at Rikers Island had symptoms of mental illness, and approximately 20% in City jails overall were estimated to have SMI, such as schizophrenia or major depressive disorder.1

Once in the system, those with mental illness tend to cycle again and again through the courtroom, jail, and prison.2 In recent years, media such as the New York Times have described the violent treatment of inmates with mental illness at Rikers Island, where “brutal attacks by correction officers on inmates—particularly those with mental health issues—are common occurrences.”3 These conditions likely contribute to poor outcomes upon return to the community, with people with mental illness returning to jail twice as fast compared to individuals without mental illness who are charged with similar crimes.4

The Nathaniel ACT Approach

In 2000, CASES launched the Nathaniel Project, the city’s first alternative-to-incarceration (ATI) program for adults with SMI facing incarceration as the result of felony charges including violent arrests. Named for a man whose schizophrenia went untreated as he cycled in and out of jail and prison for 15 years, the Nathaniel Project earned national recognition for safely supervising people with felony legal histories and SMI in the community and helping them to engage in treatment. This recognition included the American Psychiatric Association’s Significant Achievement Award and the American Probation and Parole Association’s President’s Award.

In 2003, CASES transitioned the program to a State-licensed Assertive Community Treatment (ACT) team. Nathaniel ACT is a two-year ATI that provides intensive, mobile team treatment 24/7 in the community to adults who have SMI, high service needs, and felony legal histories. Nathaniel ACT staff include experts in psychiatry, mental health, nursing, social work, substance use treatment, peer support, housing, and employment. Key program features include:

• Immediate subsistence services to support the transition from jail to the community
• Comprehensive clinical assessment and treatment planning
• Nursing services including to support management of psychiatric medication
• Specialist services including family, housing, substance use, and employment services
• Crisis intervention
• Peer advocacy services
• Ongoing individual and group services
• Ongoing advocacy and support with managing requirements related to involvement in the criminal legal system