When someone is experiencing a mental health crisis, often the only alternatives are jail or an emergency room. Neither of those alternatives is particularly helpful, and sometimes they can make a person’s condition worse. Nationwide, cities and counties are searching for cheaper and more therapeutic options.
Some are turning to Forensic Assertive Community Treatment, or FACT, teams — a way to provide a range of support services designed to keep people with serious mental illness out of the hospital and out of the criminal justice system.
I went along with Michael Falck, who’s the program director for a FACT team in Hennepin County, to meet one of his clients, Kentrell Lamberson.
He was at his mother’s apartment that day because he needed a place for his kids to go. So, we sat at a picnic table in the backyard, where Lamberson gave Falck an update on his last psychiatrist visit.
Lamberson reported the doctor was going to give him a blood pressure medication and probably lower his antidepressant dosage to help him “balance a little bit.”
The backyard of an affordable housing complex is not the most traditional place to meet with a mental health worker, but FACT teams are all about meeting people literally where they are.
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The idea comes from ACT, or Assertive Community Treatment teams, which were developed in the 1970s, as states had shut down large numbers of psychiatric institutions. People who had been living in hospitals were now living in their communities, and the mental health field realized quickly that some of those patients were having a really hard time with the transition.
So, a group of mental health workers in Wisconsin came up with the idea of ACT teams, which were designed to serve as ”hospitals without walls.” A team would make sure patients had all the services they’d had in the hospital to keep them on track: doctors, nurses, social workers, and housing and employment help. They found that these ACT teams worked pretty well at keeping those people out of the hospital.
They didn’t work so well at keeping people out of the criminal justice system, people like Kentrell Lamberson. He’s on probation for a drug charge. He kept getting sent back to jail on probation violations. He counts at least seven such times before he started with the FACT team.
Lamberson has a serious mental illness, which complicates everything he does. He has children, no job and has been homeless on and off for years.
He knows he could end up in jail again if he doesn’t meet his probation requirements. But meeting them can be hard because of everything else that’s going on in his life.
“When I’m in this type of situation, being homeless,” he said, “I have to put probation as … a priority. And like my kids, I have to make sure they have somewhere to sleep and somewhere to go.”
But because the FACT team works with the probation department, when the going gets tough, Falck or one of the other team members can make sure the department knows what Lamberson is dealing with. And they can help him deal with his current challenges.
Caseworkers come over, Falck said, and “we’d work on housing. We’d work on vocational stuff. We’d work on just organizing all the daily stressors. What do I need to focus on this week?”
FACT teams go further than that, trying to keep people out of trouble with the law generally. To do that, they focus on things that may increase someone’s risk of committing crimes, such as hanging out with the wrong people.
It sounds complicated, but a lot of it is just being available to the clients. Lamberson remembers when the team first started working with him.
“These guys, I mean, they followed me around everywhere,” he said. “I was homeless for a long time with my family. And they followed me from hotel to motel to Holiday Inn.”
He can call them anytime he wants, he said, “call them, text them, if I had their Facebook page, I’d be on there, too.” And for all kinds of things: “I call them for advice,” he said. “I call them for, if I’m low on food, I call them for a Cub Foods gift card sometimes. Or they take me to the food shelf. They take me to hospital visits. I call them for a friendly voice.”
It’s pretty obvious that for Lamberson, the program is working. But there are FACT teams all over the country and no there’s no real way to know whether they’re statistically effective at keeping people like Lamberson out of jail.
Researchers at the University of Rochester set up a similar program years ago in their upstate New York community and their data suggests it works pretty well. They helped design the program in Hennepin County — and another one in Ramsey County — to see if they can replicate the results.
Gary Cuddeback, a professor at the University of North Carolina’s social work school, said the available research suggests FACT teams are no magic bullet. Like a lot of things, he said, FACT programs work really well for some clients, but not for others.
“It works for some people under some circumstances some of the time,” he said. “But to say it cures or addresses, keeps folks out of the criminal justice system completely and it does that completely, is not where we are with the evidence.”
And so far, that seems to be the case for the Hennepin County team. Of the 60 or so people in the program, about half returned to jail after they started. (The probation officer who works with the team said the people probably got lesser punishments, thanks to the program, than they would have otherwise.)
It’ll be a few years before the Rochester team has results from its study in Minnesota. In the meantime, the FACT team will keep working with its clients, including Lamberson, who has a few more months on probation. Perhaps the best result for him is that he can stay in the program even when he’s completed his probation.
This reporting is part of Call to Mind, our MPR initiative to foster new conversations about mental health.