NYAPRS Note: Forensic Assertive Community Treatment (FACT) teams, like the one described below from Maricopa County in Arizona, are demonstrated to reduce recidivism for people struggling with mental health and other complications. In this year’s NYS 2015-16 Executive Budget, money was allocated for community based services to assist people transitioning out of prison and possibly to afford ACT teams and housing to reduce the likelihood they will have further experiences with the criminal justice system. This model, which incorporates peer specialists as team members and leaders, is also reliant on a high proportion of outreach and engagement.
New Phoenix Team Tackles Recidivism of Those with Mental Illness
The Republic; Megan Cassidy, 1/27/2015
Jeremy Reed’s client isn’t where he said he would be.
Not five minutes before this became apparent, Reed had spoken to him on the phone while driving south toward downtown Phoenix.
“What’s up man, it’s Jeremy. … What’s up, what are you doing? … You’re on 24th Street and Van Buren? … Hey, do you mind if I come get you so I can take you in to see the nurse so you can get your injection? … All right.”
After a scan of the McDonald’s at the prearranged cross streets, it’s clear that Reed’s client was mistaken about his location, left the restaurant in a hurry or lied about being there in the first place. But for Reed’s purposes, it really doesn’t really matter. He just needs to find him.
Reed, a case manager at Community Bridges, is part of a 13-person team that provides what’s known as “assertive community treatment” to those with serious mental illness.
The outreach-centered programs have become an industry standard for treating those with persistent and severe mental illnesses such as schizophrenia, major depression, panic disorder and bipolar disorder.
Focus on catalysts
Reed’s ACT team narrows its scope even further. He’s part of a forensic ACT team (FACT), which works with seriously mentally ill clients with recurring run-ins with police.
Prisons and jails around the country often operate as de facto mental-health facilities, treating a disproportionately high number of offenders with mental illnesses.
A 2006 U.S. Department of Justice report estimated that 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of jail inmates had a mental-health problem.
FACT teams, like those in Maricopa County, aim to halt the revolving door of incarceration and hospitalization by focusing on the catalysts.
“One of the first questions that I ask (potential clients) when I’m doing a screening is, ‘Why do you get incarcerated? Why do you have police interaction?’ ” said Liz DaCosta, clinical coordinator for Community Bridges’ FACT team.
Often, she said, it’s a volatile mix of homelessness, mental illness, drugs and a will to survive.
“The outdoors becomes their home, and their behavior and the mental illness is a lot more apparent than someone who has an apartment,” she said.
The group operates on a 90/10 philosophy, DaCosta said. In the beginning, the team is doing about 90 percent of the heavy lifting and the client is partaking in about 10 percent.
But over time, she said, the clients realize the changes are benefiting their lives — there’s a roof over their head, food in the refrigerator and a bed to sleep in. Gradually, the life changes inspire the clients to do more on their own.
The Community Bridges’ FACT team began accepting clients in August, and it is one of eight ACT teams that will be added to Maricopa County’s previous roster of 15 in the next two years. It is the second FACT team in Maricopa County, joining the People of Color Network’s existing team. Each team caps at 100 clients.
The FACT team has so far accepted 60 clients, 11 of whom are still awaiting release from incarceration. The team works with the Maricopa County Sheriff’s Office when screening for potential patients.
Since its inception, the team has experienced an 85 percent success rate in preventing its 49 clients from returning to jail or prison.
Experts say assertive community treatment enhances the quality of life for those involved while stemming the high price tag of recidivism and hospitalization.
Although it’s too soon to gauge what effect the team will have on local taxpayer dollars, some reports from FACT teams throughout the country have indicated promising results.
According to a report published by the National Alliance on Mental Illness, one FACT team reported 85 percent fewer hospital days for their clients, saving $917,000 in one year and an 83 percent reduction in jail days.
The expansion is a product of the Arnold vs. Sarn lawsuit against the state of Arizona, which for more than three decades alleged inadequate treatment of seriously mentally ill residents by Arizona’s Department of Health Services and Maricopa County. A landmark settlement was reached last year that included provisions for additional housing, job training, family and peer support and life-skills training.
Tad Gary, chief clinical officer at Mercy Maricopa Integrated Care, said the settlement has helped renew the interest in community-based, rather than inpatient, practices for the county’s seriously mentally ill. Mercy Maricopa manages the public behavioral health care in Maricopa County.
“We’re talking about services in the community for people to really become as independent as possible,” Gary said.
It’s personal
For Reed and many of his co-workers, the job is personal. Eight of his 13-member FACT team are currently in recovery or have experienced a history of mental illness.
If Reed had suffered a serious mental illness, he would have been a prime candidate for the program in the late 2000s.
Reed’s addiction to heroin, cocaine and crack helped him to burn all family ties in New Jersey, and in 2006 his parents sent him to a treatment center in Phoenix.
For a few weeks, Reed believed he was gaming the system. He secured a job at the center while receiving treatment.
But, he said simply, “they frown upon staff members doing drugs. So I was asked to leave, and that began my homelessness.”
Reed estimated that he’s been arrested about 20 times — mostly for shoplifting and trespassing charges — and two of the charges landed him in prison.
Reed, who has been clean since May 9, 2011, said he draws from his dark history when reaching out to clients.
For one, he said, simple logistics can be a setback.
Reed believes one of the key components of the program’s success is a ride home from jail. He never dreaded incarcerations when he was homeless — his living conditions improved. Fear set in as his release date approached.
“When we go to the jails and meet them … and we tell people we will pick them up, there’s such a huge sigh of relief coming,” he said.
Reed and the other case managers each assume specialty positions such as housing or employment services, and each oversees a handful of clients.
But the team members rotate throughout the clients, regularly stopping by to make sure they’ve taken their medication, shuttling them to court appearances, helping them to sign up for Social Security benefits or simply making sure their apartment is clean.
Checking in
On a recent Thursday morning, Reed was checking in with an animated man in his mid-50s who was living at a transitional men’s facility in Mesa.
Upon hearing there was a female reporter accompanying Reed that day, the client disappeared for 10 minutes to comb his hair and change clothes.
He gets sidetracked at the presence of a new face.
“Megan? I love that name,” he says. “The Megan on TV is such a doll — she’s with that “Family Guy”? With the mean baby!”
“Yeah, Stewie!” Reed chimes in.
It continues like this for a few minutes until Reed patiently interrupts.
“We have to make sure we stay on track here,” he says, holding up a sleeve of green capsules.
“We’re taking one in the morning, right? So you see how we’re doing it, right?”
Reed watches as the client swallows and checks on the battery power of his ankle monitor before heading off to the next client.
Not every interaction runs so smoothly. It’s not unusual for Reed to spend hours of his workday in light-rail stations, bus stops, back alleys and other transient haunts tracking down a client.
The next client he’s to visit in central Phoenix is missing from his apartment. The next, the one he’s supposed to meet at McDonald’s, answers his phone and tells Reed that he’s now at Community Bridges down the street, where he’s scheduled to receive an injection.
Reed finally spots him across the street, lounging outside a check-cashing center. The client, a quiet man in his mid-20s, freely follows Reed back to the facility.
“Were you able to get the dishes done in your sink?” Reed asks as the two cross the street.
Unlike some rehabilitation facilities, patients can receive the FACT team’s services indefinitely. They can graduate after two years of avoiding an arrest or hospitalization.
“You see the light come on for somebody and you can’t describe it,” Reed said. “I used up everything so it’s like payback time for me.