The proliferation of jails
and prisons as places of institutionalization for persons with serious mental
illness (SMI) has resulted in many of these patients receiving jail-based
punishments, including solitary confinement.
Starting in 2013, the New York
City (NYC) jail system developed a new treatment unit for persons with SMI who
were judged to have violated jail rules (and previously would have been
punished with solitary confinement) called the Clinical Alternative to Punitive
Segregation (CAPS) unit. CAPS is designed to offer a full range of therapeutic
activities and interventions for these patients, including individual and group
therapy, art therapy, medication counseling and community meetings.
Each CAPS
unit requires approximately $1.5 million more investment per year, largely in
additional staff as compared to existing mental health units, and can house
approximately 30 patients. Patients with less serious mental illness who
received infractions were housed on units that combined solitary confinement
with some clinical programming, called Restrictive Housing Units (RHU).
Between
1 December 2013 and 31 March 2015, a total of 195 and 1433 patients passed
through the CAPS and RHU units, respectively. A small cohort of patients
experienced both CAPS and RHU (n = 90). For these patients, their rates of
self-harm and injury were significantly lower while on the CAPS unit than when
on the RHU units. Improvements in clinical outcomes are possible for
incarcerated patients with mental illness with investment in new alternatives
to solitary confinement. We have started to adapt the CAPS approach to existing
mental health units as a means to promote better clinical outcomes and also
help prevent jail-based infractions.
The cost of these programs and the
dramatic differences in length of stay for patients who earn these jail-based
infractions highlight the need for alternatives to incarceration, some of which
have recently been announced in NYC.
Full article at: http://goo.gl/jCSAJB
- 1Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. sglowakollisch@nychhc.org.
- 2Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. fkaba@nychhc.org.
- 3Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. awaters1@nychhc.org.
- 4Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. yleung2@nychhc.org.
- 5Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. eford@nychhc.org.
- 6Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA. hventer1@nychhc.org.
- Int J Environ Res Public Health. 2016 Feb 2;13(2). pii: E182. doi: 10.3390/ijerph13020182
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