{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:08:19Z","timestamp":1777615699686,"version":"3.51.4"},"reference-count":11,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2016,2,2]],"date-time":"2016-02-02T00:00:00Z","timestamp":1454371200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/ijerph13020182","type":"journal-article","created":{"date-parts":[[2016,2,3]],"date-time":"2016-02-03T01:48:18Z","timestamp":1454464098000},"page":"182","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["From Punishment to Treatment: The \u201cClinical Alternative to Punitive Segregation\u201d (CAPS) Program in New York City Jails"],"prefix":"10.3390","volume":"13","author":[{"given":"Sarah","family":"Glowa-Kollisch","sequence":"first","affiliation":[{"name":"Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatos","family":"Kaba","sequence":"additional","affiliation":[{"name":"Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Waters","sequence":"additional","affiliation":[{"name":"Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Leung","sequence":"additional","affiliation":[{"name":"Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Ford","sequence":"additional","affiliation":[{"name":"Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Homer","family":"Venters","sequence":"additional","affiliation":[{"name":"Correctional Health Services, New York City Health + Hospitals, New York, NY 11101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2016,2,2]]},"reference":[{"key":"ref_1","unstructured":"International Center for Prison Studies Entire World Prison Population Rates per 100,000 of the National Population (2010). Available online: http:\/\/www.prisonstudies.org\/info\/worldbrief\/wpb_stats.php."},{"key":"ref_2","unstructured":"Todd, D.M. (2013). Jail Inmates at Midyear 2012\u2014Statistical Tables (NCJ 241264), Available online: http:\/\/www.bjs.gov\/content\/pub\/pdf\/jim12st.pdf."},{"key":"ref_3","unstructured":"Carson, E.A., and Golinelli, D. (2013). Prisoners in 2012: Trends in Admissions and Releases, 1991\u20132012 (NCJ 243920), Available online: http:\/\/www.bjs.gov\/content\/pub\/pdf\/p12tar9112.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1136\/jech.2009.090662","article-title":"Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the generation population","volume":"63","author":"Binswanger","year":"2009","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_5","unstructured":"Todd, D.M. (2012). Jail Inmates at Midyear 2011 (NCJ 237961), Available online: www.bjs.gov\/content\/pub\/pdf\/jim11st.pdf."},{"key":"ref_6","first-page":"104","article-title":"Solitary confinement and mental illness in U.S. prisons: A challenge for medical ethics","volume":"38","author":"Metzner","year":"2010","journal-title":"J. Am. Acad. Psychiatry Law"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Morriss, R.G. (2015). Exploring the effect of exposure to short-term solitary confinement among violent prison inmates. J. Quant. Criminol.","DOI":"10.1007\/s10940-015-9250-0"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1353\/hpu.2013.0142","article-title":"The triple aims of correctional health: Patient safety, population health and human rights","volume":"24","author":"MacDonald","year":"2013","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"442","DOI":"10.2105\/AJPH.2013.301742","article-title":"Solitary confinement and risk of self-harm among jail inmates","volume":"104","author":"Kaba","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_10","unstructured":"New York State Office of Mental Health, Available online: http:\/\/www.omh.ny.gov\/omhweb\/pcs\/portal\/faq.html."},{"key":"ref_11","unstructured":"Mayor\u2019s Task Force on Behavioral Health and the Criminal Justice System, Available online: http:\/\/www1.nyc.gov\/assets\/criminaljustice\/downloads\/pdf\/annual-report-complete.pdf."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/2\/182\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:18:38Z","timestamp":1760210318000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/2\/182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,2,2]]},"references-count":11,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2016,2]]}},"alternative-id":["ijerph13020182"],"URL":"https:\/\/doi.org\/10.3390\/ijerph13020182","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,2,2]]}}}