New York's de Blasio to spend $130 million to help mentally ill

Behavioral health and criminal justice advocates are praising New York City Mayor Bill de Blasio's attempt to help mentally ill people caught in a cycle of arrests and incarceration get treatment instead.

This week, de Blasio unveiled a $130 million, four-year project to address the problem. According to a report from a task force (PDF) de Blasio appointed to study the issue, about 400 people accounted for more than 10,000 jail admissions over a five-year span, with 67% of that group in need of mental health services and almost all identified as having issues with substance abuse.

“For years, the criminal justice system has been the default for dealing with behavioral and mental health issues, but that approach alone does not best serve public health or public safety,” de Blasio said in a statement.

De Blasio's task force, formed in June, included law enforcement, district attorneys, defense lawyers, judges and academics, as well as commissioners from city and state agencies and representatives from the private sector and behavioral health agencies.

“I think if it's fully implemented, it could have a big impact on the criminalization of mental illness,” said Jennifer Parish, director of criminal justice advocacy at the New York-based Urban Justice Center. “I think it's an approach that many advocates have asked for of moving away from just using the criminal justice system as a response to people with mental health issues who are not being well served in the public mental health system and instead looking at a public health response to these problems.”

The effort has been deemed one of the most comprehensive initiatives to deal with the increasing number of mentally ill who have made up the city's jail population in recent years, which has risen from 24% in fiscal 2010 to 38% in fiscal 2014 despite a 12% decrease in the overall jail population during that same period.

“The task force really focused on the entire criminal justice spectrum,” said David Cloud, a senior program associate with the New York-based, Vera Institute of Justice, a not-for profit policy and research center focused on criminal justice system reform. “They tried to identify all the different points where we can do a better job as city government, as community and behavioral health providers, to identify people that eight shouldn't be in the system or that could benefit from a different approach to care.”

Under the plan, the city would provide special training for as many as 5,500 police officers to assess non-threatening suspects who display symptoms of mental illness and substance abuse. Those displaying such symptoms would be taken to a clinical drop-off center in Manhattan as an alternative to jail or a hospital emergency department. A second drop-off center is scheduled to open in another borough in 2016.

The concept of training police to assess those with mental illness has been carried in a number of cities over the years. One of the first programs was developed in Memphis in 1988 when the police department worked with mental health providers and advocates to form their Crisis Intervention Teams. Officers undergo 40 hours of training to learn how to diffuse crisis situations involving those with mental illness, and can divert people to a mental health treatment facility.

In addition to officer training, the plan calls for an expansion of the court-ordered supervised release program for those awaiting trial that do not pose a risk of re-offending and are not a high flight risk. Efforts are also underway to reform the bail system from one that is still heavily bases the decision on whether to release a person waiting for trial back into the community on their ability to pay a monetary amount.

“Cash bail keeps people in (jail) for longer than they need to be,” Parish said. “I think trying to revise that piece of the system could keep people out of jail.”

For those already incarcerated, the plan would call for crisis intervention teams made up corrections officers and health workers to be deployed to diffuse potentially volatile situations. It would also expand access to substance abuse treatment and create preventive service units for inmates with mental health disorders.

Upon release from incarceration, the city would provide planning teams before inmates were discharged to connect them with social service programs and Medicaid coverage. More than 260 permanent housing units through the city's Department of Homeless Services will be created.

Parish said she was not sure whether the funding proposed for the project would be sufficient given the overwhelming need for services, calling the plan a “building block.”

“Whether it will have the kind of significant impact that we want to have to really reduce the numbers will depend on how it's carried out,” she said.

Follow Steven Ross Johnson on Twitter: @MHsjohnson