People with severe mental illness are more than four times as likely to be arrested than other adults and account for nearly 20% of today's U.S. prison population. Behind bars, they often wait months to receive appropriate treatment, if any, studies show.

To tackle this growing national concern, varied approaches have been tried and tested in cities across the country, but results have been mixed at best.

Now, an intervention born in Rochester, N.Y., has been shown for the first time to reduce the population’s criminal convictions, jail time and hospitalizations by roughly 50 percent. Additionally, the model – which hinges on active collaboration and shared problem–solving between mental health and criminal justice systems – has proven to keep mentally ill individuals in treatment twice as long as the study’s comparison program.

In a three–year, randomized–control study conducted by clinical researchers at the University of Rochester Medical Center’s Department of Psychiatry, the Rochester Forensic Assertive Community Treatment model (R–FACT) withstood rigorous examination and now holds promise for cities across the United States. The peer–reviewed study, supported by a grant from the National Institute of Mental Health, was published online in the journal Psychiatric Services.

“Our research suggests that it’s possible to prevent criminal recidivism among people with even the most severe mental illnesses and substantial criminal histories." says study principal investigator, J. Steven Lamberti, MD, a professor of Psychiatry in URMC’s Department of Psychiatry. "We found that by combining the expertise of mental health and criminal justice professionals in a certain way, we can promote both individual health and public safety.”

Co–investigator, Robert L. Weisman, DO, professor of Psychiatry and forensic psychiatrist on the URMC study team, notes that R–FACT "promotes patient engagement in treatment and community tenure through collaboration with criminal justice partners. Such efforts will likely have large beneficial downstream effects for this population."

With the continued support of his Psychiatry Department chair and senior author Eric Caine, MD, and an equally dedicated team of colleagues, Lamberti has relentlessly devoted nearly 25 years to finding a way to keep mentally ill individuals from languishing in prisons—a trend that coincides with the downsizing of U.S. psychiatric hospitals in the 1980s. The Rochester Psychiatric Center (RPC), for example, once housed as many as 3,000 patients, but serves only about 100 today.

For many years, Lamberti believed the solution to the high rate of incarceration among the mentally ill (often involving the same individuals with repeated incarcerations in Rochester’s Monroe County Jail) was simply to provide better mental health treatment With county funding in 1995, he assembled what was then considered the “gold standard” of community mental health treatment – an assertive community treatment (ACT) team composed of culturally diverse psychiatric clinicians, social workers, and case managers who made “house calls” across the Rochester area.

Many other American cities, he would learn, developed similar outreach programs – which were later shown in studies to be effective at reducing hospitalizations, but not criminal involvement. In fact, to Lamberti’s dismay, ACT teams’ close monitoring of offenders and timelier reporting of criminal infractions to the justice system actually resulted in higher recidivism rates.