Outcomes from the Evaluation of New York City's Beyond the Bridge Program: An Intensive, Structured Treatment Model for Incarcerated, Mentally Ill Individuals

New York City (NYC) has the nation's second largest jail system, with over 80,000 new annual admissions, and an average daily census of 13,500 inmates, almost all of whom are housed on Rikers Island. One-third of these inmates are mentally ill and, of these, twenty percent are severely mentally ill. NYC's Departments of Health and Mental Hygiene (DOHMH) and Correction (DOC) have a collaborative relationship within the City's jail system; DOC oversees the security and manages all jail admissions, while DOHMH is responsible for medical, mental health, substance abuse, dental, discharge planning, and transitional health care services for all inmates. In late 2010, DOHMH and DOC implemented a pilot program, Beyond the Bridge, to provide residentially-based cognitive behavioral therapy through a highly structured, incentive-based program in three mental observation units in a jail facility on Rikers Island. An in-depth evaluation was undertaken, with data collection built into the program since its inception. Key outcome measures of the evaluation include: reduction in violent incidents and fights, reduction in uses of force by corrections officers, reduction in time spent on suicide watch and incidents of self-injurious behavior, engagement in post-release mental health treatment, and increased length of community survival. Data collection was challenging, given the scope and variety of sources, including: Medicaid claims data, the jail's Electronic Health Record (the first jail-wide EHR to be implemented in the country), hand-written logbooks, and program-generated data. Preliminary analyses are underway, and analyses of all outcome data will be completed in the summer of 2012.