Criminal Justice Involvement, Behavioral Health Service Use, and Costs of Forensic Assertive Community Treatment: A Randomized Trial

Abstract

Jail diversion and forensic community treatment programs have proliferated over the past decade, far outpacing evidence regarding their efficacy. The current study reports findings from a randomized clinical trial conducted in California for frequent jail users with serious mental illness that compares a forensic assertive community treatment (FACT) intervention with treatment as usual (TAU). Outcomes are reported at 12 and 24 months post-randomization for criminal justice outcomes, behavioral health services and costs. At 12 months, FACT vs. TAU participants had fewer jail bookings, greater outpatient contacts, and fewer hospital days than did TAU participants. Results of zero-inflated negative binomial regression found that FACT participants had a higher probability of avoiding jail, although once jailed, the number of jail days did not differ between groups. Increased outpatient costs resulting from FACT outpatient services were partially offset by decreased inpatient and jail costs. The findings for the 24 month period followed the same pattern. These findings provide additional support for the idea that providing appropriate behavioral health services can reduce criminal justice involvement.

A Systematic Review of Randomized Controlled Trials of Interventions to Improve the Health of Persons During Imprisonment and in the Year After Release

“…114 Case management-Four studies assessed the impact of case management on health care use, 56,78,112,142 2 of which had positive findings. 56, 78 A study of forensic assertive community treatment in persons with a major mental illness found that those who received assertive community treatment had more outpatient visits and fewer days of hospitalization over 2 years of follow-up compared with those who received treatment as usual, but there was no difference between groups in the rate of hospitalization. 78 In persons with severe mental illness, a Critical Time Intervention to identify and manage priority problems before release and to continue support after release did not affect mental health or alcohol or substance abuse service use, but did increase primary care access and medication adherence.…”

“…56, 78 A study of forensic assertive community treatment in persons with a major mental illness found that those who received assertive community treatment had more outpatient visits and fewer days of hospitalization over 2 years of follow-up compared with those who received treatment as usual, but there was no difference between groups in the rate of hospitalization. 78 In persons with severe mental illness, a Critical Time Intervention to identify and manage priority problems before release and to continue support after release did not affect mental health or alcohol or substance abuse service use, but did increase primary care access and medication adherence. 56 In adults infected with HIV, intensive case management before and after release compared with usual care did not affect clinic follow-up, hospitalization, or emergency room or urgent care visits in the year after release.…”

“…Persons with serious and pervasive mental illness Mental health treatment court with assertive community treatment (ACT) case management vs treatment as usual 77 Mental health, substance abuse Persons with a major mental disorder Forensic ACT vs treatment as usual 78 Health service utilization Adult men with anxiety or depression Group music therapy vs standard care (X. J. Chen, unpublished data, March 2014)…”

“…78,83,84 Thirty-five studies focused on substance abuse, 28 on mental health, 18 on infectious diseases, 12 on health service use, and 2 on chronic diseases, although some of these studies also reported outcomes in other categories. Details regarding interventions, outcomes, and results are provided as data available as a supplement to this article at http://www.ajph.org, categorized by the main outcome of interest.…”

The Cost of Incarceration: A Descriptive Analysis of Low-income Mentally Ill Misdemeanor Offenders in DeKalb County, Georgia (2012)

“…Studies have shown an association between mental health treatment and reduced rates of arrest and recidivism [10][11][12][13][14][15][16][17][18]. However, many Americans with mental health conditions who are at a higher risk of arrest, due to low income for example, go untreated [19].…”