From Punishment to Treatment: The "Clinical Alternative to Punitive Segregation" (CAPS) Program in New York City Jails

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

By:  Glowa-Kollisch S1, Kaba F2, Waters A3, Leung YJ4, Ford E5, Venters H6.

• 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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Doing Time in Solitary Is Unimaginably Hard. Getting Out Might Be Harder

Via:  http://goo.gl/ry6YTn

Disparities in Mental Health Referral and Diagnosis in the New York City Jail Mental Health Service

To better understand jail mental health services entry, we analyzed diagnosis timing relative to solitary confinement, nature of diagnosis, age, and race/ethnicity.

We analyzed 2011 to 2013 medical records on 45,189 New York City jail first-time admissions.

Of this cohort, 21.2% were aged 21 years or younger, 46.0% were Hispanic, 40.6% were non-Hispanic Black, 8.8% were non-Hispanic White, and 3.9% experienced solitary confinement. Overall, 14.8% received a mental health diagnosis, which was associated with longer average jail stays (120 vs 48 days), higher rates of solitary confinement (13.1% vs 3.9%), and injury (25.4% vs 7.1%). Individuals aged 21 years or younger were less likely than older individuals to receive a mental health diagnosis and more likely to experience solitary confinement. Blacks and Hispanics were less likely than Whites to enter the mental health service, but more likely to experience solitary confinement.

More consideration is needed of race/ethnicity and age in understanding and addressing the punishment and treatment balance in jails.

Below:  Timing of entry into mental health services (n = 6673): New York City jail, 2011–2013. Note. Mean = 24.62 days; SD = 65.929 days. The sample size was n = 6673.

Below:  Timing of mental health service entry with respect to the first solitary confinement episode (n = 876): New York City jail, 2011–2013. Note. 0 = service entry on the first day of solitary confinement. Mean = –43.82 days; SD = 168.822 days. The sample size was n = 876.

Full article at: http://goo.gl/QOV8nq

By: Fatos Kaba, MA, Angela Solimo, MA, Jasmine Graves, MPH, Sarah Glowa-Kollisch, MPH, Allison Vise, BA, Ross MacDonald, MD, Anthony Waters, PsyD, Zachary Rosner, MD, Nathaniel Dickey, MA, MPH, Sonia Angell, MD, MPH, and Homer Venters, MD, MS

Fatos Kaba, Angela Solimo, Jasmine Graves, Sarah Glowa-Kollisch, Allison Vise, Ross MacDonald, Anthony Waters, Zachary Rosner, Nathaniel Dickey, and Homer Venters are with the Bureau of Correctional Health Services, New York City Department of Health and Mental Hygiene, Queens, NY. Sonia Angell is with the Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene.

Corresponding author.

Correspondence should be sent to Homer Venters, MD, MS, Bureau of Correctional Health Services, New York City Department of Health and Mental Hygiene. 42-09 28th St, WS 10-84, Queens, NY 11101 (e-mail: vog.cyn.htlaeh@1retnevh). Reprints can be ordered athttp://www.ajph.org by clicking the “Reprints” link.

  

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