New York City to Expand Diversion From Justice System

Prodded by continuing violence at the jail on Riker’s Island among inmates and between staff and inmates, the administration of New York City Mayor Bill deBlasio set up a task force to find a better way to manage prisoners.

Another incentive for the $130 million initiative was the expense of housing prisoners: $96,000 per person per year.

One of the greatest burdens on the system is housing and managing prisoners with mental illness, said Stephanie Lemelle, M.D., an associate clinical professor of psychiatry at Columbia University and co-director of public psychiatry education at the New York State Psychiatric Institute.

“In recent years, the total number of inmates in New York City jails has declined, but the number with a mental illness has not declined at the same rate,” said Lemelle at IPS: The Mental Health Services Conference last month in Washington, D.C. “The percentage has risen from 29 percent in 2010 to 38 percent in 2014.”

The task force’s approach was to look not just at the jail but more comprehensively at how people with mental illness got into the criminal justice system, what happened to them inside, and what goes on after they are released.

“A lot of people don’t need to be in the criminal justice system, and we can help,” said Lemelle.

Broadly speaking, the task force adopted the “sequential intercept” model that begins with the initial encounter between first responders and someone with a mental illness. That may mean an EMT doing an assessment in the field or a police officer with crisis-intervention training linking up with a behavioral health professional. Diverting the individual to an emergency department does not tie up the officer’s time as an arrest would.

For those brought into a jail, trained staff can screen for mental illness and choose diversion to a mental health setting or even to home, with appropriate follow-up until the court date.

Those convicted should receive better care, although that can be hampered by the frequently short stays in jail, said Lemelle. “Jails have a high turnover,” she said. “In prison, you can have a longer time to do real treatment.”

Planning for release is especially important for this population. “If individuals have had behavioral health services in jail, discharge planning needs to set up benefits, housing, and follow-up care and not just send them back to the streets,” she said. “The goal should be to expand employment opportunities and housing options, encourage family reunification, improve training and services linked to probation, and help them re-acculturate back into civilian life in the community.”

Part of the problem is that get-tough-on-crime laws often deprive ex-felons of just those benefits and services. In addition, basic community mental health services are too often inadequate.

Typically, ex-prisoners have difficulty reintegrating into society, so they drift back into crime and are rearrested, which leads to a higher burden on taxpayers, said Mardoche Sidor, M.D., medical director of the Center for Alternative Sentencing and Employment Services (CASES) in New York. The public health consequences of imprisonment also include the financial effects on families, pushing them into “an endless cycle of poverty, marginalization, and criminality.” CASES seeks to create alternatives to incarceration.

The Nathaniel Project, created by CASES, began in 2002 and provides 24 months of “extra-intensive supervision for indicted individuals with serious mental illness,” linking the justice and mental health systems.

Services include comprehensive mental health and integrated primary care treatment, rehabilitation, case management, court advocacy and reporting, and monitoring linkages to housing and social services.

The system has proven its worth, said Sidor, “but we need a new strategic plan because all services have so far been funded by grants.” ■

More information on the Center for Alter-native Sentencing and Employment Services can be accessed here.