New intervention strategies are needed to promote ongoing engagement in community-based treatment and support services among severely mentally ill adults diverted from the criminal justice system. Examples of two nationally recognized models are the Thresholds Jail Program in Chicago and Project Link in Rochester, N.Y. (Council of State Governments, 2002). Both programs use assertive community treatment (ACT) to engage clients in clinical, residential and social services through active outreach and around-the-clock availability. Each program coordinates with multiple components of the criminal justice system to promote continuity of care and to utilize legal leverage to promote adherence when necessary. Use of ACT to engage severely mentally ill offenders in partnership with criminal justice representatives is an increasingly common diversion strategy. A national survey conducted in conjunction with the National Association of County Behavioral Health Directors recently identified 16 such programs operating in nine states (Lamberti et al., 2003). This approach can be understood as representing a newly emerging Forensic Assertive Community Treatment or FACT model of care.
The Role of the Clinician
Beyond the emergence of promising new intervention strategies, everyday clinicians can make a substantial impact in reducing recidivism among people with severe mental illness by following six basic strategies.
Optimize pharmacotherapy. Control of psychotic symptoms and associated behaviors is the key to preventing unnecessary arrest and incarceration. Consider the use of long-acting decanoate medications and atypical antipsychotic drugs to promote adherence and maximize effectiveness.
Intervene early. Watch for early warning signs of impending psychotic relapse and intervene promptly whenever they occur.
Address substance use disorders. In addition to psychosis, drug use and drug-seeking behaviors are major risk factors for arrest and incarceration. Encourage involvement in combined substance use/mental health treatment interventions.
Use outreach techniques. Risk of arrest and incarceration increases in the absence of consistent treatment. Home visits, telephone calls and other measures should be used to promote ongoing engagement in care whenever possible.
Partner with family and community supports. They play a critical role in monitoring for signs of relapse and in intervening when disruptive behaviors occur. Make extra efforts to partner with residential service providers in order to prevent homelessness, another major risk factor for arrest.