The Nathaniel Clinic

The Intervention: State-licensed, Article 31 outpatient mental health clinic

Who is Served: Youth and adults with indications of mental illness, including those with current or previous involvement in the criminal justice system

The Challenge

Responding to the comprehensive treatment needs of youth and adults with mental illness who become involved in the criminal justice system continues to be a major challenge for public safety and public health officials. Individuals with mental illness who become justice-involved often face significant challenges upon return to the community even compared with those who are justice-involved but do not have mental illness. Currently, more than 40% of inmates at Rikers Island experience mental health issues, an increase from 29% in FY 2010.1 Further, at any given time there are thousands of individuals with mental illness in the community under probation supervision.

In 2014, the NYC Mayor’s Task Force on Behavioral Health and the Criminal Justice System released a formal action plan, stating that “the criminal justice system has become the default for addressing the problems presented by people with behavioral health issues.”2 Consistent with rates at Rikers Island, CASES programs in recent years have served an increasing rate of youth and adult clients with mental health needs. However, due to factors including 1) the dual stigma of mental illness and serious justice involvement and 2) lack of expertise among providers, CASES staff have found it difficult to help our clients access effective treatment in the community. This is also consistent with findings by the Mayor’s Task Force, which noted the need for more community treatment options for justice-involved people with mental illness.

The Nathaniel Clinic Approach

In 2012, to help address the lack of community treatment options, the NYS Office of Mental Health encouraged CASES to open a State-licensed, outpatient mental health clinic. CASES opened this clinic in 2014 in Central Harlem. Designed with experts in criminal/juvenile justice and behavioral health, the Nathaniel Clinic specializes in serving justice-involved youth and adults who have mental illness and co-occurring substance use disorders. The program model includes mental health treatment integrated with onsite addiction services, primary health care, and legal services including assistance obtaining public benefits. Guided by evidence-based approaches including motivational interviewing and trauma-informed care, specific clinic services include:

  • Comprehensive clinical assessment
  • Individual and group counseling (including evidence-based therapies and interventions)
  • Psychiatric services including medication management
  • Integrated dual disorder treatment
  • Integrated primary health care services (see more details here)
  • Legal services including assistance obtaining public benefits and with navigating the consequences of justice involvement (provided in partnership with the Mental Health Project of the Urban Justice Center)
  • Specialty legal assistance for justice-involved youth (provided in partnership with Youth Represent and including support by a Skadden Fellow)
  • Ongoing care coordination with other service providers including criminal justice agencies (e.g., nonprofit alternative-to-incarceration programs, probation officers, and jail discharge planners, etc.)

The Impact

Since opening in October 2014, the clinic has seen a significant demand for services. To date, more than 800 referrals have been made to the clinic from more than 40 distinct sources, including hospitals, community-based organizations, and probation and parole officers. Clinic staff have seen a high level of need among clients, with nearly half assessed with at least three Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses and more than half with co-occurring substance use. The clinic has thus far promoted

  • significant reductions in depression scores among clients (assessed via the Patient Health Questionnaire-9)
  • high rates of client satisfaction (assessed through the Working Alliance Inventory)

In June 2015, CASES’ Director of Adult Behavioral Health Programs Ann-Marie Louison was awarded the Joan H. Tisch Community Health Prize for Excellence in Urban Public Health by the Roosevelt House Public Policy Institute at Hunter College. The award included recognition of the Nathaniel Clinic as a significant addition to New York City’s public health landscape.

References

1 The City of New York (2016). Preliminary fiscal 2016 Mayor's management report. NYC: City of New York. Retrieved from http://www1.nyc.gov/assets/operations/downloads/pdf/pmmr2016/doc.pdf ^

2The City of New York (2014). Mayor’s Task Force on Behavioral Health and the Criminal Justice System: Action plan. NYC: City of New York. https://www1.nyc.gov/assets/criminaljustice/downloads/pdfs/annual-report-complete^