MedicalExpress.com
Rochester FACT Proto-Type
Forensic Assertive Community Treatment -- Recidivism Reduction

Excerpt:
​With the continued support of his Psychiatry Department chair and senior author Eric Caine, MD, and an equally dedicated team of colleagues, Lamberti has relentlessly devoted nearly 25 years to finding a way to keep mentally ill individuals from languishing in prisons—a trend that coincides with the downsizing of U.S. psychiatric hospitals in the 1980s.

The Rochester Psychiatric Center (RPC), for example, once housed as many as 3,000 patients, but serves only about 100 today.

​For many years, Lamberti believed the solution to the high rate of incarceration among the mentally ill (often involving the same individuals with repeated incarcerations in Rochester's Monroe County Jail) was simply to provide better mental health treatment 

 With county funding in 1995, he assembled what was then considered the "gold standard" of community mental health treatment—an assertive community treatment (ACT) team composed of culturally diverse psychiatric clinicians, social workers, and  case managers who made "house calls" across the Rochester area.

Many other American cities, he would learn, developed similar outreach programs—which were later shown in studies to be effective at reducing hospitalizations, but not criminal involvement.

In fact, to Lamberti's dismay, ACT teams' close monitoring of offenders and timelier reporting of criminal infractions to the justice system actually resulted in higher recidivism rates.

It was a talk given by a criminologist at a national conference that caused Lamberti to channel his energies in a new direction.

His attention turned toward understanding the multiple and unique "criminogenic risk factors" of mentally ill individuals, such as antisocial personality [We believe the vague & unscientific antisocial personality diagnosis is extremely  harmful & we appreciate what they are trying to do], criminal thinking, social support for crime, and substance abuse—coupled with psychiatric issues like psychosis, paranoia, cognitive impairment and trauma—and how this combination makes people more vulnerable and less responsive to standard correctional intervention.  

"If we want to fix the problem, we have to understand it," says Lamberti.  "People with severe mental illness have much higher rates of criminogenic risk factors, along with other issues that affect how they relate to others. 

The key to preventing recidivism is to engage these individuals in specific interventions that target the things driving their involvement with the criminal justice system." 

But engaging individuals in treatment—especially those resistant or fearful of it—is the hardest part, says Lamberti.

After several years of research, trial-and error, multiple studies and focus groups, what evolved under Lamberti's direction was the Rochester FACT prototype which uses legal leverage to engage individuals in mental health treatment that systematically targets their criminogenic risk factors.

Getting judges, lawyers, probation officers, and other criminal justice professionals to "buy-in" to the program is key, Lamberti says.
"Legal leverage isn't about making threats to force compliance, or simply reporting infractions," says Lamberti.

"It's about the appropriate, respectful use of legal authority to guide people toward engagement. {Unless that "legal authority" is reined in most people are going to be in a world of hurt  in our opinion]  It also requires getting mental health and criminal justice professionals to problem-solve together, and to consider therapeutic alternatives to punishment.

" Our clients are  men and women who feel demoralized and discouraged, they are at their very lowest point, and they need more rewards than sanctions."


Read more at: https://medicalxpress.com/news/2017-06-mentally-ill-treatmentmodel-shown-breakthrough.html#jCp
Hmm . . . Well, the video we had displayed on the Rochester FACT model seems to have been taken down from YouTube -- maybe we are incorrect.

In any case, below we had tried to show the harshness of some of the comments in the video when we quite accurately applied them to the Mental Health & Criminal Justice Systems. 

Val's Take 

    This has a lot of implications.  Of course, ACT can mean a lot of things.  It has to be INDIVIDUALIZED & STRENGTH-BASED & PERSON-CENTERED  --- NOT Court-Centered.

       Ideally, it is not being administered with the threat of "legal authority."

         Already in Colorado Springs we have seen the de-funding of a Mental Health Court.  It takes a lot of time, energy and money to "educate" the Criminal Justice System around these issues -- and where  there is no other choice -- we do that.

           But it seems to us it makes a lot more sense to pull people off and out of the Criminal Justice System where possible and provide necessary housing and services.

             The Rochester FACT Prototype poses some challenging questions to our preferred solution.

                The traditional ACT Teams in Rochester actually seemed to be making things worse with their close monitoring of offenders and reporting of criminal infractions to the justice system leading to higher recidivism rates.

                Further, we talk a lot about "mixed bags" -- not just people, but systems, all kinds of things.  If we just focus on "fixing"/punishing/whatever the person as the Criminal Justice System does -- we are going to have limited success.

               The Criminal Justice System is likely going to find it "irrelevant" the words of Dr. Thomas Insel, former Director of the National Institute of Mental Health:

New approaches to mental illness are especially important since “we’re not doing very well either on the diagnostic or therapeutic side,” Insel says.

                               ------Scientific American, quoting Thomas Insel former Director of the National Institute of Mental Health

               So to paraphrase the Judge in the video above, how does one say to the Mental Health Profession and the Criminal Justice System  -- "You're Failing" without demoralizing these hard-working systems.
 
               We think the question  with respect to ACT and people with mental illness is whether the Rochester FACT Prototype could be adopted to a non-court involved model or there is another service program that is equally successful.


​Bottom Line:  State We Really Need that ACT/FACT Work Group
​

        With respect to the Rochester FACT Proto-Type one of the telling quotes from one of the Rochester Team:

 "It's about the appropriate, respectful use of legal authority to guide people toward engagement. "

Well getting the "appropriate, respectful use of legal authority" is no given as this quote subtlely implies.
​
             AND we are going right back to our "MIXED BAGS."

             So from the Mental Health Professionals standpoint, they need legal authority to "guide people toward engagement" because:
  • Some people with mental illness have anasognosia (don't have insight into their illness).  Some mental health advocates feel this is very subject to abuse.  
  • We believe some people do have anasognosia and that this can be subject to abuse, it's complicated.  [Query:  If this is so bad why are people falling into the criminal justice system as opposed  to civil commitment under "Gravely Disabled?"]
  • The Rochester FACT Proto-Type argues that "mental illness" is just one of many criminogenic factors AND that's why it's appropriate to have this in the criminal justice system -- AND basically they feel they can't handle it outside the criminal justice system.
  • Well, if someone says they can't handle it, they can't handle it.
  • On the other hand, as Caltech neuro-scientist David Anderson observes  in the TedxTalk  -- some of these medications don't work so well and in some cases can even even do more harm than good. 
  • If there was ever a time for NOTHING ABOUT US, WITHOUT US -- THIS IS IT.  AND It is Making Our Call For An ACT/FACT Group Even More Pressing.
  • One thought is to bifurcate questions of treatment for FACT involved defendants to the civil commitment courts and give them additional duties & funding as opposed to trying to create a mental health court in each jurisdiction.
  • A lot of this stuff does get rubber-stamped in the civil commitment courts BUT -- there is much more expertise there,  and  these issues are just going to become more complex in the years to come -- NOT less.  We really need to figure out where is the best place to develop the expertise we need.
  • Finally, the issues go beyond people with "mental Illness" and substance use issues and include traumatic brain injury, developmental disabilities, other neurological disorders, and people with physical disabilities such as someone who is deaf and may be startled and find themselves with an assault  on an officer charge.  
  • We need systems that have the time, energy and patience to deal with often complex situations and people.
  • We need Colorado State Government to comply with Olmstead and provide the housing and services people need to prevent their institutionalization or great risk of institutionalization  caused by homelessness.
 Adopt and Apply an Inclusive Definition of Mental Health.   JHSO endorses a positive definition of mental health; mental health is not simply the absence of signs or symptoms of mental illness or addictions, as noted at the opening of this report.

Accordingly, JHSO recommends that the province of Ontario adopt a similarly inclusive and broad definition of mental health across all of its Ministries and that this definition infuse service paradigms, to ensure that all Ontarians with mental health issues are being treated appropriately and sensitively.

http://www.johnhoward.on.ca/wp-content/uploads/2015/07/Unlocking-Change-Final-August-2015.pdf