Meeting the Needs of Justice-Involved People With Serious Mental Illness: In Reply

IN REPLY: As admirers of their work, we thank Drs. Lamberti and Weisman for their comments on our article (1). We agree that the evolution of forensic assertive community treatment (FACT) they describe is exactly the type of community-based, multipronged, comprehensive service approach needed to address the high rates of justice involvement among people with serious mental illness. We also agree that the FACT service delivery model as described by the Substance Abuse and Mental Health Services Administration (SAMHSA) is one example of how our proposed vision can be put into action.

The evidence for the effectiveness of the FACT model that Drs. Lamberti and Weisman have developed is promising. That said, we have a couple points of clarification. Neither our critique of the criminalization hypothesis nor our discussion of the research that has consistently shown that mental illness is not a strong predictor of criminal justice involvement is new (2, 3). With the recent adaptations that have been made to standardize FACT, the authors appear to agree with us on the basic premise of our article, which is that we need to expand existing community-based mental health services to include new approaches to addressing involvement of forensically involved people with serious mental illness. For us, that is the call to action.

To that end, we note that while the emerging research on FACT is promising, there is much yet to be learned about how FACT works best, for whom, and under what circumstances (4). It could well be that much of the mixed findings of prior research is related to the high degree of variability found in the structure and operating procedures of FACT teams across the country (4, 5). The recent SAMHSA guidelines mentioned by Drs. Lamberti and Weisman offer programs sound direction on how to standardize FACT programs. However, more research is needed before the evidence for this standardized FACT model’s impact on recidivism is clear (6). We also have far to go to ensure the dissemination and uptake of this standardized version of FACT. As it stands now, FACT programs are an expensive resource with limited availability, and local demand for such specialized services can outpace the community’s ability to provide them (5).

FACT is a program that straddles the border of specialized forensic services and what we hope will be mainstream criminogenically informed community mental health services. On the basis of the available evidence, we consider the standardized FACT program to be one key component of the continuum of community-based services that is needed to create the “intercept 0” we describe in the article. But, like most of the services on this continuum, there are many questions that remain about how best to use FACT to intervene as early as possible in the trajectory of criminal justice system involvement for people with serious mental illness. We are heartened by the commitment that Drs. Lamberti and Weisman demonstrate toward our shared goal and look forward to working with them and others to find the answers.