Report from the Field: Mental Health

Last February, Bronx Community Solutions began screening all of its clients, as part of the assessment that each individual receives after they've been sentenced to the program, to identify possible mental health issues for which assistance might be needed.

We're hopeful that we can assist many individuals who otherwise would fall through the cracks, and also excited that we may be uniquely able to learn important information about the mental health issues of low-level offenders who are being cycled in and out of the justice system. We've learned some very interesting things so far. Click Here to read more.

From Case Manager Amber Pettit:

Beginning February 24, 2009, a brief mental health screening tool was added to the Bronx Community Solutions intake assessment for the purpose of identifying clients with mental illnesses. The tool consists of a set of questions pertaining to a client’s history of mental health treatment, currently utilized by the Bronx TASC program, and the GAINS Brief Jail Mental Health Screen to assess the client’s current mental health status.

Our pilot project is a result of recommendations made by a joint City/State panel on the issue of mental health in the justice system and announced at a press conference by Mayor Bloomberg. The June 2008 Report of the New York State/New York City Mental Health-Criminal Justice Panel recommended that New York City should introduce mental health screening in the Bronx Criminal Court to identify individuals sentenced to brief community-based programs who may benefit from mental health assessments, intensive engagement, and voluntary case management.

The goal of this pilot initiative is to use Bronx Community Solutions’ brief period of mandatory engagement to promote longer-term voluntary participation in mental health services that may help the individual to not re-offend.

Every individual whose responses to the screening indicate that they may be dealing with a mental health issue is scheduled to participate in group or individual mental health counseling as part of their mandate. In some cases, if a client appears to be in crisis, they will be escorted directly to meet with a case manager at our on-site social service department for immediate assistance.

During this initial implementation period (February 2009-July 2009), Bronx Community Solutions has identified 367 clients with current or past mental health problems. Of these 367 clients, 246 completed the mental health treatment readiness group and 138 individual counseling sessions were conducted.

The preliminary data that we've gathered and analyzed indicates that compared to Bronx Community Solutions’ clients as a whole, the individuals who are responding as possibly having mental health issues are more likely to be women, more likely to be older, less likely to be black and more likely to be white or Hispanic, more likely to admit to substance abuse, and more likely to be currently or previously homeless.

What we’ve learned during our individual counseling sessions suggest that a majority of these clients are, in fact, suffering from co-occurring substance abuse and mental health disorders. Most clients are aware of their psychiatric diagnoses and have extensive, albeit sporadic, treatment histories. Many are unable to distinguish mental health symptoms from substance abuse problems and lump both into their “illness.” The clients tend to be frustrated with the level of care they have received in the past and the accessibility of services within the Bronx. Many have no medical insurance or have let their Medicaid lapse and lack the proper documents needed to re-apply.

The good news is that in many cases, with encouragement and assistance from Bronx Community Solutions' case managers, these individuals have been able to successfully re-connect with treatment and other services. They may experience future setbacks, but in each of these cases an arrest that might have otherwise led to a short stay in jail or a few days spend cleaning up a local park have been leveraged into a re-engagement with services and a break from the pattern of minor arrests and short jail sentences that is common for many of these individuals.

A case study of one of our clients (their name has been changed), tells part of the story about mental health issues affecting the low-level offenders in the criminal justice system:

Ms. Perez has a history of almost a dozen arrests over the past two decades for prostitution, drug possession, petty larceny and trespassing. Most recently she was arrested for prostitution and sentenced to two days of social service with Bronx Community Solutions. After he intake assessment was completed and her responses to questions about mental health indicated that she was dealing with significant mental health issues, she was scheduled to attend a group session on mental health treatment readiness and an individual counseling session with a case manager.

During her individual counseling session, Ms. Perez disclosed that she has suffered from mental illness since early childhood when she was diagnosed with Tourettes Syndrome. She endured ridicule from family and friends which eventually led to self-mutilating behavior, for which she was hospitalized in her late teens. As an adult she has been treated sporadically for various anxiety and mood disorders. She admits she is often non-compliant with her medication regime and finds it difficult to maintain a consistent therapy schedule. Even more difficult for her is establishing a relationship with new treatment providers as feelings of anxiety and apprehension often overwhelm her in unfamiliar settings. Recently, Ms. Perez had been receiving therapeutic and psychiatric services from a community based service provider but she was recently discharged due to missing two consecutive appointments which violated a condition stipulated in a “contract” that was created to address her poor attendance. The case manager and the client spoke at length about the importance of therapy and together created a list of strategies to improve her attendance. As one of her absences was a result of her recent arrest, the case manager provided Ms. Perez with car-fare and documentation to bring to her program in hopes of being re-admitted.

When Ms. Perez returned to Bronx Community Solutions for her group counseling session the following week she provided documentation that she was indeed re-dmitted to her program and will see a therapist next week. She was also informed that her Medicaid was no longer active and that she must take steps to remedy this before her appointment. The Bronx Community Solutions case manager provided Ms. Perez with car-fare and directions to the appropriate Medicaid office in order to facilitate this process. At this time, Ms. Cruz is still receiving services at her program and has not been rearrested.