Abstract
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.
Highlights
The United States has the highest rate of incarceration in the world, with approximately11.6 million people cycling through jails and prisons annually [1]
We have previously identified both solitary confinement and serious mental illness as risk factors for self-harm and one of the goals of this analysis was to identify whether the Clinical Alternative to Punitive Segregation (CAPS) unit is associated with lower rates of self-harm
CAPS-enrolled patients spent an average of 70 days in the program, with an average of 255 days in jail, while those in Restrictive Housing Unit (RHU) spent an average of 46 days in the program and an average of 367 days in jail, and those in both programs spent an average of 46 days in CAPS
Summary
The United States has the highest rate of incarceration in the world, with approximately. 11.6 million people cycling through jails (in New York State: locally operated, short-term facilities that hold people awaiting trial and/or sentencing, as well as those found guilty and sentenced to a term of one year or less) and prisons (long-term facilities run by a State or the Federal government that hold people serving sentences of longer than one year) annually [1]. 95% of these incarcerations occur in jails, which are chaotic settings given the short stay of the incarcerated and the lack of established programs that exist in most prisons [2,3]. The New York City (NYC) jail system is the. Res. Public Health 2016, 13, 182; doi:10.3390/ijerph13020182 www.mdpi.com/journal/ijerph
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