Jessica Glass

Fortune’s BLC Meets A Dire Need

Monday, February 9, 2015

The Fortune Society’s Better Living Center (BLC), an Article 31 clinic operated by the New York State Office of Mental Health, opened in 2011 to specifically meet the mental health needs of individuals and families with current and previous criminal histories, and those in our alternatives to incarceration (ATI) program, to maximize their potential for recovery and promote successful reentry and reintegration into society and their communities.

The BLC is particularly innovative in that it exclusively addresses mental illness within a high-risk, often- neglected population – individuals with criminal histories.

Our clinic meets a dire need. According to the NYC Department of Health and Mental Hygiene (DOHMH), almost 15% of people who enter NYC jails self-report a history of treatment for mental illness. It is unknown how many individuals within that population have an undiagnosed or un-reported mental illness. There are estimates that claim over 90% of people who have been incarcerated have a mental illness if the definition of mental illness includes Axis I disorders of post-traumatic stress disorder, substance dependence, and adjustment disorder in addition to mood and psychotic disorders.

The BLC is the first outpatient mental health treatment clinic in the NYC area that almost exclusively caters to the needs of the reentry population. DOHMH confirms that there is a “great need” for mental health services tailored to meet the needs of this population. In addition to effectively serving clients diagnosed as having a serious mental illness (SMI), our clinic meets a previously unmet, significant need for mental health services among those who do not have a SMI diagnosis and therefore are not eligible for services provided by many other mental health providers. It is this population, many of whom we see through our Alternatives to Incarceration (ATI) programs, that is in critical need of mental health services offered in combination with a variety of other essential wrap-around services and supports.

A typical experience encountered by clients of the BLC involves being released from prison with a paper referral to a clinic that lacks experience both in the clinical sense and in the empathic sense of working with clients who have current or previous histories of incarceration/law involvement. They are often either blatantly rejected or dismissively encouraged to seek services elsewhere, and are given another paper referral to another agency lacking the experience and sensitivity they require. These poorly executed referrals compound an already marginalized population from receiving the care that they need. These vulnerable individuals are re-traumatized by the experience of rejection, abandonment, and stigma — feelings and experiences that are often part of their psychosocial makeup and that have factored into their current position in life.

At the BLC, professional staff is acutely aligned with the mission of The Fortune Society and eagerly treats this population with the care, dignity, integrity, and respect that they — and all clients — deserve. The initial point of engagement, if facilitated with quality clinical care, can often determine the difference between success and failure within the treatment dynamic.

The BLC assists to reintegrate clients into society by addressing their mental health needs and providing on-site benefit assistance to ensure that their insurance is active for prescription services. Clients receive a medical assessment and referral for physical primary care services, and are administered a comprehensive biopsychosocial assessment, including multiple evidenced-based symptom assessments that evaluate mental health symptoms, smoking cessation need, and co-occurring disorders. Clients are given a comprehensive psychiatric evaluation, including evaluation for medication needs, weekly therapy with the encouragement of family involvement in treatment, and monthly medication management sessions. Clients are also offered treatment within the group dynamic. BLC helps clients from the moment of their arrival as they are empowered as active agents of their own lives by collaboratively selecting their treatment — either weekly or bi-weekly, and with or without medication.

The clinic is staffed with licensed culturally competent professionals. The clinic focuses on addressing multiple prevalent areas that are critical to successful outcomes of treatment. Some of these areas include establishing economic stability, performing benefit evaluation, treatment of co-occurring disorders with a focus on relapse prevention, developing familial harmony, obtaining stable housing, pursuing education, resolving trauma, and processing grief and loss as well as developing insight into mental illness which is integral for collaborative care with clients acting as their own vehicles of progress. Most importantly, each client receives person centered care as well as collaborative treatment.

Although it’s difficult to choose from success stories, BLC is proud to mention the following case example that focuses on mental health stability and establishing sobriety:

Mr. G, a 63-year-old male now residing in Brooklyn who had been arrested for murder in the first degree, was referred to the program by his parole officer following his release from a long-term period of incarceration. He voluntarily enrolled in mental health treatment upon his release from incarceration after experiencing immediate challenges with adjusting to residing in his community after release. As part of the admissions process, Mr. G. was provided a comprehensive bio-psychosocial assessment by a clinical social worker and a psychiatric evaluation by a psychiatrist. These assessments determined that Mr. G met the medical criteria for treatment for panic disorder with agoraphobia, post-traumatic stress disorder, and mood disorder.

Mr. G agreed to treatment at the clinic receiving weekly psychotherapy and monthly psychiatric sessions. Therapy initially focused on psychoeducation and insight-oriented approaches to provide him with improved awareness and insight into his condition as this was his first interaction with the mental health treatment system. As the client engaged well in treatment, and significant trust and rapport was developed with his therapist, the clinic, and with The Fortune Society, psychotherapy interventions commenced to assist the client with understanding how his past behaviors affected his challenges with adapting to societal norms and for processing past trauma related to losses he suffered while incarcerated which were previously unaddressed. The client participated in cognitive behavioral therapy to manage panic attacks which enabled him to travel independently on public transportation throughout New York City. Lastly, the client completed a 12-week course of group therapy focused on anger management and assumed a mentorship role in this group to assist the younger members.

During his time at Fortune, Mr. G demonstrated successful recognition of the consequences of behavior, developed insight into his diagnosis, employed effective coping strategies for managing mood states and anxiety, maintained sobriety, and improved his overall mental health. Additionally, he overcame fears of addressing his general physical health and engaged with a PCP and specialist to treat conditions which had been largely neglected while incarcerated. Mr. G achieved significant stability in symptoms which enabled him to engage socially with family, improve his friendship network, and gain skills for managing activities for daily living. Through consistent progress with treatment, he obtained independent housing in a supportive living environment and is being considered for an early release from parole obligations in light of his general stability and good conduct while on parole. His reporting frequency to parole was steadily reduced, enabling the client to reduce a sense of institutionalization, and improved freedom from the criminal justice system.

As Mr. G.’s story notes, the stigma of “mental illness” is deeply woven into the communities, as are obstacles to treatment for issues/symptoms they believe are simply a type of weakness. The Fortune Society’s BLC program is often an individual’s first exposure to mental health treatment. A major challenge is encouraging patients to express their vulnerabilities, which in the past could result in dire consequences. The BLC has provided a community of support to a population that’s lacked a supportive environment for much of their lives. Often these individuals struggle to trust the process of treatment, presenting as guarded, evasive, and wary. They resist medication for a variety of reasons; for some it is a physical representation/evidence of them being “crazy” and for others the side-effects are a deterrent which is often not addressed by other treatment providers.

The challenge of overcoming stigma extends beyond our clients. Through the BLC, staff throughout the Agency has slowly begun to change how they view mental illness. As our staff has become more aware and sensitive to recognizing and responding to mental illness, we have been able to quickly identify clients in need in other Fortune Society programs — and facilitate immediate referrals to the BLC where they are offered quality clinical care.

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