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From Punishment to Treatment: The “Clinical Alternative to Punitive Segregation” (CAPS) Program in New York City Jails

Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA
Author to whom correspondence should be addressed.
Academic Editor: Deborah Shelton
Int. J. Environ. Res. Public Health 2016, 13(2), 182;
Received: 10 August 2015 / Revised: 21 January 2016 / Accepted: 26 January 2016 / Published: 2 February 2016
(This article belongs to the Special Issue Correctional Health)
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. View Full-Text
Keywords: jail; solitary confinement; mental health; self-harm jail; solitary confinement; mental health; self-harm
MDPI and ACS Style

Glowa-Kollisch, S.; Kaba, F.; Waters, A.; Leung, Y.J.; Ford, E.; Venters, H. From Punishment to Treatment: The “Clinical Alternative to Punitive Segregation” (CAPS) Program in New York City Jails. Int. J. Environ. Res. Public Health 2016, 13, 182.

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