The Challenge

Even as the number of individuals incarcerated in New York City facilities has declined in recent years, City jails continue to operate as a treatment facility of last resort for many individuals with mental illness. In 2017, more than 40% of the people on Rikers Island were flagged for possible mental health needs,[1] up from 33% in 2011.[2] Twenty percent of those incarcerated in City jails were estimated to have serious mental illness (SMI), such as schizophrenia and major depression.[3]

While incarcerated, people who have mental health needs face greater challenges to attaining justice than other detainees. They are less likely than others to make bail and thus more likely to be held pretrial. Compared to those facing similar charges, they are more likely to be sentenced to incarceration and, upon release, are more likely to return to jail faster.[4] Clearly, the cycle of arrest and incarceration signals a failure of public health services for these individuals, with the typical issues people face during incarceration—separation from family; disruption of social services, housing, and employment; and high-stress, traumatic jail and prison settings—compounded by worsening mental health needs that can lead to punitive, harmful responses including extended periods in isolation.

The NCS Approach

In 2014, the Mayor’s Office for Criminal Justice (MOCJ)—in collaboration with the NYC Departments of Correction and of Health and Mental Hygiene—created Court-based Intervention and Resource Teams (CIRTs) operating in each borough. CIRT was structured both as an alternative to detention for people awaiting trial and as an alternative to incarceration (ATI) for those otherwise facing jail or prison sentences. CASES was selected by the City to operate CIRT in Manhattan.

In 2020, CASES implemented a significant enhancement of CIRT, now called the Nathaniel Community Success (NCS) program. NCS provides an ATI for individuals with mental health needs and/or co-occurring mental health and substance use disorders, serving youth and adults age 16 and over who would otherwise be jail- or prison-bound and have mental illness, including those who have co-occurring substance use disorders. NCS services include:

• Specialized clinical assessments using the evidence-based Short-Term Assessment of Risk & Treatability (START) to guiding nuanced, comprehensive treatment and success planning that considers participant strengths and goals along with risks and needs while emphasizing motivation and resilience
• Intensive initial services that gradually taper to encourage client skill building, independence, and linkages to ongoing services in the community
• Close coordination 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
• Ongoing mobile, in-community outreach to clients to ensure engagement in services and progress toward personal and program goals
• Evidence-based approaches including Motivational Interviewing, Seeking Safety, and Dialectical Behavioral Therapy (the latter at CASES Nathaniel Clinic)
• Post-program linkage to CASES Health Home Care Coordination program for clients with serious mental illness and/or other serious/complex health needs