Treatment to Keep Chronically Mentally Ill Out of Jail

For Immediate Release: Monday, March 01, 2010

"Washington County recognizes that the corrections system is not the best way to get needed treatment for people with mental health issues," says Kristin Burke, Program Coordinator for Washington County Mental Health Division. Burke worked with representatives of the Sheriff's Office, Community Corrections and service providers for people with severe and persistent mental illness. They wanted to reach people who have been in and out of jail multiple times, people who are hard to get into treatment where traditional treatment hasn't been able to help. With some funding for "jail diversion" from the State of Oregon, a design team researched approaches that are evidence based – it's already proven elsewhere that they work with this challenging population – and that could be used in Washington County.

The result of that research is the FACT Program. The acronym stands for Forensic Assertive Community Treatment: forensic, because the clients they want to work with have been to jail often; assertive, because the model is that the treatment comes to the person who is ill rather than expecting them to show up to appointments at an agency; and community, because the treatment happens in a supported living environment outside of jail rather than in jail.

"The folks coming in are fresh out of jail, homeless, not psychiatrically stable and have no benefits. Nothing is in order in their lives," says Miranda Powell, MSW, who is the supervisor of the program, which is contracted to Sequoia Mental Health, a non-profit agency. Participants may have committed a variety of crimes, many of them "nuisance crimes" such as trespass, abuse of the 911 medical system, or other minor crimes and found their way into the jail.

Powell leads a team that includes a physician, a Washington County probation officer, two M.A. level therapists, two B.A. level mental health associates, a nurse, a substance abuse professional and herself. What makes this team unique is that they alone provide all the treatment a client needs to become a stable resident of the community, so the client needs to interact with fewer people in order to get better. Treatment is provided to each client according to their individual needs. Each of the team members are committed to being available 24 hours a day (they take turns taking calls at night) and willing to go to the client to help them de-escalate when they are in crisis.

"It's more humane to help a person with supported housing, daily contact with team members, supported employment, benefits assistance, dual diagnosis treatment, assistance with medications, mental health counseling, case management and other miscellaneous services. These are very helpful to people who have previously been treated as a 'management problem,'" according to Powell.

Powell, who ran a similar program in Washington, D.C., before moving back to her home state, says, "The program isn't 'rocket science,' but it uses common sense, support in the natural community, it brings services to them, and is available 24 hours a day."

The program is expensive, but not nearly as expensive as it would cost to house these people in a jail or hospital. It more than pays for itself in terms of money saved. The program has been taking clients, who are referred exclusively by corrections and mental health, for four weeks. Already, 13 are started with "engagement and assessment." "Over the next six to nine months, we'll bring the program up to a maximum of 50 clients," says Powell.

Not all the clients will succeed, according to Powell. She expects that some will go back to jail or to prison. Some clients will need this high level of service for the rest of their lives, but some will "graduate" to lower levels of care and be enrolled in other less structured mental health programs. About 70% will be men, 30%, women.

The FACT Program will be continually evaluated, according to outcomes: the number of jail bed days used before the program and after, and successful housing and employment.

"FACT is a program that is built on collaboration," says Kristin Burke. "If it wasn't for the willingness of Community Corrections to participate and the cooperation of the Sheriff's Office, this program wouldn't be possible." Burke looks forward to other types of community collaboration in the future.

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