National Alliance on Mental Illness
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Treatment, not Jail: Forensic Assertive Community Treatment
People living with mental illness deserve effective treatment, not to be warehoused in jails and prisons. But exactly which treatments help keep people out of the criminal justice system? A promising intervention, forensic assertive community treatment (FACT), may be one of the services that best meets the needs of people who are already involved with the justice system to prevent incarceration and reduce recidivism.
Dr. Steve Lamberti, at the University of Rochester Medical Center, says FACT is successful because the treatment team works closely with criminal justice partners–often the public defender—and comes to the individual with an array of services.
This approach is based on the assertive community treatment (ACT) model, an intervention that is proven effective at meeting the needs of people with serious mental illness who need intensive services. ACT provides a variety of supportive services around the clock to people in their homes and communities. ACT teams provide mental health and substance abuse treatment as well as employment and education support, housing assistance, crisis services, and rehabilitation to people with serious mental illness.
FACT is different from ACT because it includes coordination with the criminal justice system. According to Lamberti, one of the keys to the success of FACT is what he calls “legal leverage.” Receiving FACT services can be a condition of probation or parole, or paired with a mental health court, a way to avoid jail time. Individuals leaving forensic hospitals may also be referred to FACT. Public defenders often play a role in recommending an individual for participation in FACT and help advise individuals about whether participation in the program is in their best interests. It also helps that the individual, provider and criminal justice representative meet and agree on a plan, which includes information-sharing, roles and responsibilities and the consequences of dropping out of treatment.
Working with FACT provider teams, attorneys, judges and others in the criminal justice system have to reach an agreement about the importance of diversion. While criminal justice professionals tend to be concerned about saving money and protecting public safety, Lamberti says they also need to believe that treatment is a worthwhile alternative to jail or prison.
Is FACT Effective?
The first study of FACT teams was published by Dr. Lamberti and colleagues in 2004, and there are currently dozens of programs. Lamberti says it’s hard to know an exact number because there is not yet a standard model for FACT and there is no national organization that keeps track of programs. Lamberti and his colleagues are working with the National Institute of Mental Health (NIMH) to develop a standard model and test it, to prove that FACT is successful.
However, results from individual programs are very promising. Project Link in Rochester, one of the first FACT teams, reports several positive outcomes including decreased hospitals days, decreased jail days, high consumer satisfaction and decreased substance use. Studies of Project Link and Thresholds, another FACT program in Chicago, also show cost savings. Project Link reports cost savings of more than $59,000 per person per year.
The programs save money because they reduce the amount of time individuals spend in jails and psychiatric hospitals.
Role for NAMI
Although FACT is growing, most communities do not yet have a program. NAMI Affiliate and State Organization leaders can advocate for FACT services by making the case that money reinvested in intensive services for people at risk of involvement with the justice system will save money in the future in reduced incarceration and hospitalization. FACT can also help to break the costly cycle of jails, homelessness and crisis care that many people with serious untreated mental illness experience.
Local criminal justice leaders can make good allies in the fight for FACT and other services by making the case that services reduce the burden on the criminal justice system and allow police to focus on public safety.
While NAMI Affiliates have not typically provided services as part of FACT programs, there may be a lot that NAMI can offer once the programs are up and running. According to Lamberti, ACT teams often include a peer counselor, and this may a good addition to FACT teams. In addition, FACT teams can help connect clients and their families with a variety of NAMI services such as peer and family education and support groups.
To find out whether there is a FACT program in your community, contact your local NAMI Affiliate or your county mental health department. Click here for more information about ACT. For technical assistance in starting a FACT program, contact Dr. Lamberti at Steve_Lamberti@URMC.Rochester.edu.