People with severe mental illness are more than four times as likely to be arrested than other adults and account for nearly 20% of today's U.S. prison population. Behind bars, they often wait months to receive appropriate treatment, if any, studies show.

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To tackle this growing national concern, varied approaches have been tried and tested in cities across the country, but results have been mixed at best.

Now, an intervention born in Rochester, N.Y., has been shown for the first time to reduce the population鈥檚 criminal convictions, jail time and hospitalizations by roughly 50 percent. Additionally, the model鈥攚hich hinges on active collaboration and shared problem-solving between mental health and criminal justice systems鈥攈as proven to keep mentally ill individuals in treatment twice as long as the study鈥檚 comparison program.[i]

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In a three-year, randomized-control study conducted by clinical researchers at the 麻豆视频鈥檚 Department of Psychiatry, the withstood rigorous examination and now holds promise for cities across the United States. The peer-reviewed study, supported by a grant from the National Institute of Mental Health, was published online today in , a journal of the American Psychiatric Association.

鈥淥ur research suggests that it鈥檚 possible to prevent criminal recidivism among people with even the most severe mental illnesses and substantial criminal histories." 听says study principal investigator, J. Steven Lamberti, M.D., a professor of Psychiatry in URMC鈥檚 Department of Psychiatry. 听"We found that by combining the expertise of mental health and criminal justice professionals in a certain way, we can promote both individual health and public safety.鈥�

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Co-investigator, Robert L. Weisman, D.O., professor of Psychiatry and forensic psychiatrist on the 麻豆视频study team, notes that R-FACT "promotes patient engagement in treatment and community tenure through collaboration with criminal justice partners. Such efforts will likely have large beneficial downstream effects for this population."

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鈥攁 trend that coincides with the downsizing of U.S. psychiatric hospitals in the 1980s.[ii] The , for example, once housed as many as 3,000 patients, but serves only about 100 today.

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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 ) was simply to provide better mental health treatment 听With county funding in 1995, he assembled what was then considered the 鈥済old standard鈥� of community mental health treatment鈥攁n assertive community treatment (ACT) team composed of culturally diverse psychiatric clinicians, social workers, and case managers who made 鈥渉ouse calls鈥� across the Rochester area.

Many other American cities, he would learn, developed similar outreach programs鈥攚hich were later shown in studies to be effective at reducing hospitalizations, but not criminal involvement. In fact, to Lamberti鈥檚 dismay, ACT teams鈥� close monitoring of offenders and timelier reporting of criminal infractions to the justice system actually resulted in higher recidivism rates.听听听 听听听听听听

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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 鈥渃riminogenic risk factors鈥� of mentally ill individuals, such as antisocial personality, criminal thinking, social support for crime, and substance abuse鈥攃oupled with psychiatric issues like psychosis, paranoia, cognitive impairment and trauma鈥攁nd how this combination makes people more vulnerable and less responsive to standard correctional intervention.听听

鈥淚f we want to fix the problem, we have to understand it,鈥� says Lamberti.听 鈥淧eople with severe mental illness have much higher rates of criminogenic risk factors, along with other issues that affect how they relate to others.听 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.鈥澨�

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But engaging individuals in treatment鈥攅specially those resistant or fearful of it鈥攊s the hardest part, says Lamberti.

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

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Getting judges, lawyers, probation officers, and other criminal justice professionals to 鈥渂uy-in鈥� to the program is key, Lamberti says.

鈥淟egal leverage isn鈥檛 about making threats to force compliance, or simply reporting infractions,鈥� says Lamberti. 鈥淚t鈥檚 about the appropriate, respectful use of legal authority to guide people toward engagement. It also requires getting mental health and criminal justice professionals to problem-solve together, and to consider therapeutic alternatives to punishment. 听Our clients are 听men and women who feel demoralized and discouraged, they are at their very lowest point, and they need more rewards than sanctions.鈥�

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Rochester City Court judge (7^th Judicial District) 听one of two judges who participated in the study, says the key elements that made the program work were the intensive level of communication between him and the R-FACT team members, the program鈥檚 comprehensive approach, and the fact that individuals could be seen immediately by a mental health provider upon court recommendation.

鈥淧rior to that, so many people had to wait six weeks or more for an appointment,鈥� says Elliott, who now presides over the and the Rochester Drug Treatment Court. 鈥淭hat鈥檚 what they were used to. But with FACT, they鈥檙e in treatment within a week.听 The treatment provider was always there in court and they had a feeling that someone was actually looking out for them. I would meet with the treatment team before and after the court appearance and get straight information about how each person was doing. If they were doing well, I could reinforce that, give them praise, and if they were screwing up, I could really address them in a very factual way. I could hone in on it. But the big thing was getting them immediate access to the right treatment.鈥�

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Elliott, who was a public defender for several years before becoming a city court judge, says it will take a high level of trust and understanding between mental health and criminal justice systems for the program to be transplanted elsewhere successfully. Lamberti and his colleagues worked diligently with the Rochester court system for several years to develop that level of rapport.

鈥淲e have a totally different lingo,鈥� Elliott says. 鈥淚t took some time for them to get used to how the court system works, and vice versa. Mental health is very touchy-feely, and this is a court and you have to be accountable. I take a different tone in here. Which is why I think it works. Steve calls it therapeutic jurisprudence. It does come down to the judge in many cases. I don鈥檛 think what I do is all that special. Treat people decently, give them a chance, find humor when I can and try to be understanding. You have to get a judge who鈥檚 willing to do that. But with this type of work, I feel like you can really make a difference in changing people鈥檚 lives.鈥�

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