The Challenge

Approximately 20% of people held in jails and 15% of people held in state prisons have a serious mental illness.1 It is estimated that 17% of people incarcerated (15% of males and 31% of females) in New York City jails have symptoms of a serious mental illness.2 Mostly poor people of color, justice-involved people with mental illness often struggle with the burdens of homelessness and drug addiction, chronic physical health problems, and social isolation. While incarcerated, people with mental illness receive limited and often inappropriate psychiatric care. Moreover, they are frequently released without any plan for ongoing care in the community, leading to a revolving door of arrest, confinement, release, and rearrest.

The FACT Approach

In 2016, CASES was selected to operate three of the City’s five new Forensic Assertive Community Treatment (FACT) teams. FACT provides coordinated behavioral health and social support services to people with recent justice-involvement using an adapted version of the Assertive Community Treatment model—a multidisciplinary, community-based treatment model designed specifically for difficult-to-engage individuals who have a history of serious dysfunction and high usage of mental health emergency services. FACT staff include experts in psychiatry, mental health, nursing, social work, substance use treatment, peer support, housing, employment, family, and criminal justice. FACT is structured to provide the holistic, wraparound services central to the ACT model while also focusing on close coordination with criminal justice agencies to help clients adhere to ongoing system requirements (e.g., parole or probation supervision) and avoid further justice involvement. Available 24 hours a day, seven days a week, and delivered primarily in clients’ living settings, FACT services include:

• Comprehensive clinical assessment and treatment planning
• Nursing services including to support management of psychiatric medication
• Specialist services including family, housing, substance use, and employment services
• Crisis intervention
• Peer advocacy services
• Ongoing individual and group services
• Ongoing advocacy and support with managing requirements related to involvement in the criminal justice system

The Impact

CASES’ FACT teams–Brooklyn FACT, Manhattan FACT I, and Manhattan FACT II–began admitting clients in October 2016. Over their first four months of operation, the programs enrolled a total of nearly 60 individuals with serious mental illness and recent justice -involvement. As these programs complete their initial startup phases, CASES will report on outcomes established by the NYS Office of Mental Health for F/ACT teams statewide.