We all deal with mental health challenges in our lives. In New York State, we are doing everything in our power to guarantee that nobody has to face these challenges alone by expanding community-based services, supporting individuals during all stages of life, and promoting sustained recovery. For those who are involved in the criminal legal system, such efforts are even more essential. Thanks to specialized intensive services and a variety of diversion initiatives, we can often address justice-involved individuals’ mental health needs in a safe and supportive setting.
Diverting individuals from the criminal justice system begins with ensuring access to a wide array of behavioral health treatment and services and the availability of targeted diversion services for those individuals who intersect with the legal system. This article will focus on our efforts to expand the capacity of community-based services, strengthen diversion programs, and maintain the availability of forensic programs with a goal of assisting individuals in successfully maintaining their community tenure. We have consistently seen that well-timed interventions, diversion initiatives, and ongoing links to tailored care can minimize the need for law enforcement interaction, arrest, and incarceration when someone is experiencing mental health challenges.
Behavioral Health News readers are likely familiar with some of the New York State Office of Mental Health (OMH) programs that offer flexible, individualized support and care to individuals navigating vulnerable periods in their recovery journey. Thanks to the tremendous investments of Governor Hochul, we continue to expand the capacity of these community-based services. One such program is Intensive and Sustained Engagement Teams (INSET), a voluntary, peer-led, community-based engagement approach designed to support adults who have been historically marginalized, underserved, or unserved by the traditional mental health system. This 24/7 program also supports people who are at risk of involuntary treatment, hospitalization, or involvement in the criminal legal system. Building on this foundation, the new Forensic INSET (F-INSET) program uses the INSET approach while adding critical enhancements to support people impacted by the forensic mental health or criminal legal system. Both INSET and F-INSET programs are led by peer support workers who build trust and rapport with participants.
Another example of intensive supports is Assertive Community Treatment (ACT), which offers treatment and rehabilitation services in the community for individuals with Serious Mental Illness (SMI) whose needs have not been met in traditional service settings such as an outpatient clinic. ACT helps people gain independence, recover, and thrive in their communities.
Thanks to Governor Hochul’s record investments in our mental health system, we have significantly grown the reach of ACT, with 32 new and expanded adult teams, increasing statewide capacity by more than 1,600 slots. We have also enhanced and expanded the availability of Forensic ACT, to a total of 16 teams, with another four in development. Forensic ACT adapts the traditional ACT model to serve those involved in the criminal legal system by addressing risk and protective factors associated with arrest and incarceration. Along with investments in transitional housing, programs like these offer a supportive level of engagement for individuals who otherwise may find themselves in jails or prisons.
For a small number of individuals, the legal system can also be utilized to ensure that individuals access treatment to support their recovery. A recent independent evaluation of the state’s Assisted Outpatient Treatment (AOT) program was released, demonstrating that AOT can provide critical support for individuals who have not accessed needed services voluntarily. Individuals receiving AOT are at risk of further law enforcement interaction, incarceration, homelessness, hospitalization, and/or physical danger. AOT, when a judge orders mental health services to be provided to an individual who has not accessed them voluntarily, may be the necessary bridge between a need for intensive support and follow-through to recovery. The evaluation noted that court-ordered mental health services can improve outcomes for those who are at high risk of not being able to survive safely in their community otherwise. It also found that longer durations of participation in AOT were associated with better housing stability, stronger life skills, and reductions in hospitalization and further interaction with law enforcement. For individuals on an AOT order, a careful and intentional approach that supports individual autonomy and dignity, while also promoting personal and community safety, is needed. In this way, AOT, while employed rarely, can have a major positive impact on the lives of a select group of individuals.
OMH is also working in partnership with the Office of Addiction Services and Supports to strengthen the behavioral health crisis response system statewide, a priority for our state that has led to the establishment of new Crisis Stabilization Centers, Comprehensive Psychiatric Emergency Programs, further investments in the 988 Suicide & Crisis Lifeline, and the new Behavioral Health Technical Assistance Center (BHTAC). The BHTAC will develop and support the implementation of standardized protocols for a community-based, public health-led response to behavioral health emergencies and provide training and technical assistance to localities on their crisis plans.
Additionally, OMH is funding pilot programs in three communities across the state, with another four soon to follow, to ensure that crisis response systems prioritize a health-led response to behavioral health crises, providing safe, compassionate care. The funding supports multidisciplinary teams and requires peer support professionals to be deployed as part of their crisis response system. The resulting system will be trauma-informed, prioritizing racial equity, cultural humility, and harm reduction across the lifespan. By supporting a health-led response, we are reducing the reliance on law enforcement during a mental health crisis, enabling individuals to receive timely care and preventing unnecessary interactions with police and the criminal legal system.
Within OMH’s Division of Forensic Services, the Diversion Center plays a critical role in supporting both localities and individuals who can benefit from access to appropriate mental health services instead of incarceration. The Diversion Center, formally established in 2020, facilitates, evaluates, and promotes local initiatives and programs to divert justice-involved individuals with serious mental illness from arrest, prosecution, and incarceration. Under the auspices of the Diversion Center, the Mental Health/Criminal Justice Collaboration Unit provides support and technical assistance, developing and training community and criminal justice professionals who interact with individuals experiencing emotional crisis or living with mental illness. When detention in county jails is unavoidable, the unit provides suicide prevention screening training for professionals working there.
Over the summer, the Office of Mental Health announced the awarding of $2.4 million to help four upstate counties grow their capacity to divert individuals with behavioral health needs from the criminal legal system by connecting them with timely treatment and services. This funding is part of years of concerted effort to help individuals receive support and services outside of the criminal legal system, so they can remain engaged and thriving in their communities. And it represents only a small slice of the programs that share a similar goal.
With Diversion Center funding, counties across the state are utilizing peer support specialists, clinicians, care managers, community services coordinators, mobile response teams, and more — improving outcomes for individuals diagnosed with severe mental illness who are involved in the criminal legal system. These efforts are helping to address the fact that an increasing number of admissions to OMH civil psychiatric centers are individuals with legal system history and close to 10,000 adults in the state prison system are receiving OMH prison-based services. Unfortunately, this demonstrates the all too often coexistence of mental health challenges and legal system involvement.
Another important new initiative is Court-Based Mental Health Navigators, who support justice-involved individuals with mental health needs in the community, working with local systems to coordinate voluntary care and promote wellness and recovery. Based within county government, Navigators have a strong understanding of the local mental health, social services, and criminal legal systems. Navigators work at courthouses and coordinate closely with peer specialists, fostering rapid connection to support and encouraging engagement and participation with services. While this program is still in its early stages, 71 Navigators, who can be caseworkers, certified peer specialists, or licensed mental health professionals, will be working across 40 counties including New York City. Early data shows that about three-quarters of those referred for Navigator services accepted them, remaining engaged for at least a month on average during a critical period.
Even given all of these efforts supporting diversion, we know that there are instances when law enforcement involvement is unavoidable. And it is during these times that the Mental Health/Criminal Justice Collaboration Unit is so vital. This unit oversees our Crisis Intervention Teams (CIT) training, which ensures officers understand how to use enhanced skills to interact appropriately with individuals experiencing emotional crisis. The CIT program also guides officers on how to effectively work with mental health programs and providers.
It is important to note that our services do not stop when an individual becomes incarcerated, as we continue our work to promote hope, wellness, and successful community integration through ready access to evidence-based mental health treatment. Mirroring the spectrum of services available in the community, prison-based services encompass both inpatient and on-site corrections-located treatment in programs staffed by OMH. This includes clinic services, residential programs for more vulnerable individuals, crisis treatment, and more. From telepsychiatry to gender-related therapeutic services, peer support to suicide prevention, incarcerated individuals take critical steps toward recovery and prepare for successful community reintegration by addressing mental health needs before release from prison and return to the community. These efforts are complemented by appropriate pre-release discharge planning, ensuring individuals are equipped for a successful reentry and are able to live safely and thrive once back home, in many cases working with the support of Forensic ACT or INSET teams and utilizing supportive housing.
Our goal for individuals living with mental health challenges who are involved in the criminal legal system is the same as our goal for all New Yorkers. We must provide the care, support, and services required to ensure that everyone can recover, maintain meaningful roots in their community, and lead fulfilling lives. Thanks to a broad array of intervention and diversion efforts, we are taking necessary steps to prevent individuals from entering the legal justice system while also providing the needed services and supports for those who unfortunately are justice-involved.
Dr. Ann M. Sullivan is Commissioner of the New York State Office of Mental Health.
