MENTAL HEALTH AND SUBSTANCE MISUSE

Over two million people with serious mental health challenges are incarcerated each year, making prisons and jails the largest psychiatric care providers in the nation. Even this number, high as it is, cannot begin to capture the full picture of human suffering brought about by our failure to adequately address mental health needs. Statistics show that once they have been incarcerated, people with mental challenges stay behind bars longer, end up in solitary confinment much more often, and commit suicide at significantly higher rates. Upon release, a disproportionate number cycle through the system repeatedly, never receiving treatment for the mental health challenges that led to their imprisonment in the first place.

As District Attorney, Lucy will be committed to fundamentally reshaping the way our criminal justice system interacts at every level with people suffering from mental health disorders, including reducing the frequency of — and eliminating — those interactions altogether. Lucy’s approach will be guided by principles of minimization: minimize system contact as much as possible and minimize the harm of that contact when it does occur by training staff in trauma-informed responses and cultural humility. In cases where there has been serious harm, Lucy will promote a public health approach by converting Manhattan’s anemic Mental Health Court into a fully-funded and fully- equipped institution, capable of addressing the unique challenges of justice-involved people with mental illnesses while promoting public safety.

In pursuit of proactive interventions that keep people out of the legal system, Lucy will:

Decline to prosecute cases of substance possession for personal use. Where possession constitutes a danger to the user or others, divert that case into public health and community-based care.

• Convene an advisory board of behavioral health experts — clinical and medical experts, community-based advocates, service providers, people with lived experience — among others — to ensure that current procedures within the District Attorney’s Office are informed by public health approaches.

• Collaborate with public health officials and community-based advocates to build prevention strategies for keeping people with mental health and substance misuse needs out of the criminal justice system. including early identification through programs like Screening, Brief Intervention, and Referral to Treatment (SBIRT).

• Create early intervention opportunities, including the use of peers (people who have previously experienced a mental health challenge).

• Adopt an explicit policy of diverting people with behavioral health or mental health needs who commit low level offenses or petit theft crimes.

• Promote the use of pre-arrest or pre-arraignment diversion wherever possible.

• Use bully pulpit to push for new public safety paradigm based on cross sector partnerships — aligning policy, practices, and funding.

• Support clinical responses — such as Co-Response, Mobile Crisis units and CAHOOTS (Crisis Assistance Helping Out on the Streets) — to mental health 911 calls.

• Advocate for rapid expansion of NYC’s recently announced Mental Health Teams of Emergency Medical Services pilot.

• Leverage relationships with community organizations and actors — including non-profits, faith leaders, and support groups — who are already working within their communities to catalog initiatives and formalize relationships and referral programs.

• Develop messaging in close consultation with with community groups and leaders to cultivate buy-in from all stakeholders. Public health responses to mental health disorders and addiction are effective, but require increased outreach and education to secure broad community support.

• Push the New York State Department of Corrections’ medical facilities to adopt the same accreditation process as non-prison medical facilities and to adopt the Medications for Opioid use Disorder protocol to safely accommodate the health needs of incarcerated people suffering from addiction and withdrawal, thereby decreasing the likelihood of relapse upon release.

• Actively enroll New Yorkers returning home from prison in Medicaid through a warm hand-off and referral during which a trusted person will connect the returning citizen to community-based treatment resources.

Mental Health Courts

When serious harm does occur, Mental Health Courts have been proven to better tailor treatment, ensure genuine accountability, and facilitate rehabilitation programs for those living with behavioral health disorders. Yet, Manhattan’s mental health court is under-utilized and under-resourced.

Nationally, uptake looks similarly grim. With nearly every mental health court across the U.S. focusing primarily on low-level nonviolent offenses, eligibility is far too restrictive for these courts to make a significant difference. Manhattan has the opportunity to lead the nation on policy at the intersection of mental health and criminal justice reform. As DA, Lucy will ensure Mental Health Courts no longer exclude people solely because of the nature of their crime — we must tailor approaches so that those living with mental health issues who commit violence can receive the treatment they need, not be automatically shunted into the prison system.

In order to safely and thoughtfully expand the Mental Health Court to further serve residents of Manhattan, Lucy will:

Review the terms of participation and eligibility with an eye toward expanding Mental Health Court practices to further promote public safety and community well-being; this includes:

• Reassessing eligibility criteria to be more inclusive regardless of the type of crime committed.

• Expanding treatment and support services.

• Introducing a pre-adjudication option for some lower level offenses.

• Encouraging ADAs — through concrete incentives — to refer eligible people to the Mental Health Court.

• Ensuring that all Mental Health Court staff receive training on the unique needs and circumstances of people living with mental illnesses.

• Convene a multidisciplinary roundtable to outline best practices for the expansion of mental health courts.

• Increase uptake by working collaboratively with the defense bar to identify eligible candidates and require that ADAs refer appropriate candidates for screening.

• Measure impact using proven performance metrics, such as:

  • In-program reoffending.

  • Attendance at judicial hearings and treatment sessions.

  • Progress towards stable living conditions.

  • Need-basis of treatment and supervision.

  • Individual satisfaction and perceived fairness.

  • Participant preparation for transition out of program.

  • Post-program recidivism.