(Oct. 17, 2017) Forensic assertive community treatment (FACT) is found to reduce criminal justice involvement and increase outpatient treatment use in newly-released results from a randomized control trial.
FACT is an emerging model of outpatient treatment for justice-involved individuals with serious mental illness. Previous studies have been mixed on its effectiveness to reduce criminal justice contact among program participants, however, that has been shown to be due to the wide variability in FACT program structure and treatment availability.
J. Steven Lamberti and colleagues conducted a randomized control trial of a standardized FACT program, the Rochester FACT model, for individuals involved in the criminal justice system. Seventy adults with a diagnosis of a psychotic disorder and who had been arrested for a misdemeanor crime were enrolled in the study.
The Rochester FACT model is a high-fidelity ACT program that utilizes legal leverage to engage individuals into treatment in the community. In addition, program staff are specially trained in criminal justice and there is significant collaboration between the mental health and criminal justice system.
Outcomes of FACT Evaluation
The study, published in Psychiatric Services, found that the FACT model had significant effects in improving outcomes for individuals with serious mental illness compared to usual treatment controls. Individuals enrolled in the FACT program on average had fewer:
- number of arrests (0.8 compared to 1.3 arrests),
- days in jail (21.5 compared to 43.5 days),
- emergency department visits (0.8 compared to 1.9 visits) and
- hospitalization days (4.4 compared to 23.8 days).
In addition, compared to individuals in the control group, people in the FACT program on average had greater:
- days in treatment (305.5 compared to 169.4 days) and
- outpatient treatment contacts (112.0 compared to 14.1 contacts).
The authors conclude that individuals with serious mental illness who have committed misdemeanor crimes and who were enrolled in the Rochester FACT model had less criminal justice involvement and more engagement in community treatment than individuals who were in traditional treatment.
For the control group, treatment consisted of outpatient case management by treatment teams including a psychiatrist and social worker. Because the outpatient mental health clinics used in the study had waiting lists for more than three months, control participants were given priority preference as a service enhancement to better match FACT participation.
Providing treatment for individuals with serious mental illness involved in the criminal justice system is challenging. The authors conclude that "by targeting the drivers of crime, emphasizing shared problem solving, and avoiding overreliance on punishment, the Rochester FACT model represents a criminologically informed hybrid of ACT."
Elizabeth Sinclair
Research Associate
References:
- Lamberti, J. S. et al. (October 2017). A randomized controlled trial of the Rochester forensic assertive community treatment model. Psychiatric Services.