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New Yorkers Involved with the Criminal Justice System Get Needed Mental Health Care

Having spent the majority of her adolescence on the streets and involved in the criminal justice system, Teisha battled depression and a growing sense of hopelessness at the age of 18. In an effort to establish some stability and support in her life, she rushed into a marriage with a man she met at a homeless shelter. The relationship soon turned abusive, however—forcing Teisha back onto the streets and into renewed encounters with the justice system. After one particular arrest, Teisha was mandated to the Center for Alternative Sentencing and Employment Services (CASES), an innovative alternative sentencing program in New York City.

Although vivacious and remarkably resilient, Teisha struggled with undiagnosed mental illness. CASES staff identified symptoms in Teisha and referred her to the Nathaniel Clinic for treatment. The first of its kind in New York State, the Nathaniel Clinic is uniquely designed to serve youth and adults who have mental illness and are involved with the criminal justice system. Operated by CASES, this State-licensed clinic, located in Central Harlem, began offering services in September 2014 with support from an NYSHealth grant.

Prior to visiting the Nathaniel Clinic, Teisha had never received any mental health treatment. Once at the clinic, she underwent a comprehensive clinical screening and began attending regular therapy sessions to help work through the feelings of hopelessness and anxiety she had developed through years of uncertain, transient living. The Nathaniel Clinic staff also helped Teisha pursue one of her long-time dreams: going to college. A year later, Teisha—now age 20—is a student at the Borough of Manhattan Community College, where she is working toward an associate degree in science.

The Nathaniel Clinic provides services—typically unavailable at traditional clinics—that specifically address the risks faced by and needs of people involved with the criminal justice system. The clinic developed a treatment model that integrates mental health, substance use, and physical health treatment with criminal justice-related coordination and rehabilitation services to improve health outcomes and reduce recidivism. It accepts clients ages 13 years old and up from all five New York City boroughs and provides a range of services, including individual and group counseling/therapy; psychiatric evaluations; medication management; health physicals and monitoring; integrated treatment for substance use; and crisis intervention.

Despite experiencing significantly higher rates of medical, behavioral health, and substance use problems than the general population, most people involved with the criminal justice system have had extremely limited access to effective mental health treatment in the community. For many years, New York City and State officials have grappled with how to address the intersection between mental illness and criminal justice involvement.

While CASES’ primary focus is on alternatives to incarceration, it is ramping up efforts to provide its participants with greater access to evidence-based behavioral health services—a measure strongly endorsed by policymakers in both the health care and criminal justice fields.

“We have seen such a great need for mental health services every day since opening the clinic,” says Ann-Marie Louison, director of adult behavioral health programs, CASES. “The youth and adults we are treating have experienced many difficulties and present with complex histories. Many have been long disconnected from school or work and reside in neighborhoods disproportionately impacted by poverty and violence. Many also have difficult family backgrounds, struggle with substance use, and have significant past experiences of trauma—including the trauma that comes with being incarcerated,” says Ms. Louison. “Our approach to treatment not only helps clients recover, but also allows them to learn different responses when faced with challenges so as to help them avoid new crimes and other poor outcomes.”

Since opening its doors, Nathaniel Clinic has seen a growing demand for services—in its first six months of operation, the clinic has served more than 160 clients, including more than 50 young people ages 13–24. As it reaches capacity, the clinic expects to serve 400 clients annually, offering a much-needed resource for Teisha and others as they work to regain their emotional and physical health and reconnect with the community.

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