New York City’s extraordinary drop in crime—best evidenced by murders plummeting from 2,245 in 1990 to 332 last year and jail incarceration being reduced by nearly half since 1991—is certainly something to be proud of, yet we still face challenges in effectively addressing the needs of New Yorkers with behavioral illness. Even as the jail population declined, the absolute numbers of those with mental health issues in jail has remained steady, taking up a larger and larger proportion of the total population behind bars.
Today, the seriously mentally ill account for 7 percent of the city’s jail population, those with some mental health disorders make up 38 percent of the total jail population, and those with substance use problems, more than 85 percent of the total jail population. Individuals with behavioral health needs are more likely to be detained after arrest, to stay in jail longer, and to return to jail repeatedly. A study by the city’s Department of Health and Mental Hygiene found that 400 individuals with behavioral health issues accounted for 300,000 jail days during a five-year period. Without smart intervention, these “frequent flyers” serve a life sentence a few days at a time.
Despite our successes, we must hold ourselves accountable for our failure to provide appropriate responses for the behaviorally ill who enter the criminal justice system, to identify who presents a danger and who does not, and to provide options other than jail or hospitalization.
Last year, Mayor Bill de Blasio convened a task force that I co-chaired with the deputy mayor for health and human services to reduce the number of people with behavioral health needs cycling through NYC’s criminal justice and health systems. Recognizing that the systems are interrelated, the task force took a first-ever stem-to-stern look at what works and what doesn’t. Over 100 days, the task force engaged more than 400 leaders and justice practitioners from across the city and nation and proposed reforms—systemic where possible and pilots where not. Several of those reforms are listed below.
Before arrest – Creating options and providing expertise
We are providing first responders with training to identify the range of behavioral health issues, and creating community drop-off centers—which police can utilize when they come into contact with an individual with behavioral health needs—as alternatives to arrest or hospitalization.
In the courts – Controlling risk with programming, not jail
We are creating risk assessment instruments that will help service providers and other system players identify where programming can interrupt cycles of reoffending, and we will be keeping people out of jail where appropriate by tripling the number of options for supervised release.
In jail – Changing culture
We are training crisis intervention teams—staffed by specially trained corrections officers and health workers—to de-escalate conflicts, as well as implementing policies to reduce punitive segregation. We have also taken steps to enhance programming, including increasing vocational training, expanding programs that help individuals to plan for their life after returning to the community, and convening substance use disorder education and support groups.
Back in the neighborhood
Teams of correctional and health workers are focusing on ensuring that every person leaving jail is connected to Medicaid, Health Homes, and social service benefits. And—with the aim to address the “frequent flyers”—we are creating supportive housing options, which are proven to reduce jail, hospitalization, and shelter stays.
Critically, the task force is now turning its attention to ensuring that we are as focused as possible in identifying both risks and needs and in matching the right services to the right people at the right time. Science needs to replace fear when addressing those with mental health issues, and we are committed to reforming our criminal justice system so that it both reduces crime and meets the needs of vulnerable New Yorkers more effectively and more efficiently.