Forensic Mental Illness and Other Policy Misadventures. Commentary on “Extending Assertive Community Treatment to Criminal Justice Settings: Origins, Current Evidence, and Future Directions”

BackgroundHomelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed.AimsTo evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland.MethodsA total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed.ResultsCompared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0. 58 in favour of ACT. Patterns of care and costs varied according to race.ConclusionACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.

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Assertive community treatment for elderly people with severe mental illness

BMC Psychiatry ◽

10.1186/1471-244x-10-84 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 5

Author(s):

Jolanda Stobbe ◽

Niels CL Mulder ◽

Bert-Jan Roosenschoon ◽

Marja Depla ◽

Hans Kroon

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Elderly People ◽

Assertive Community Treatment ◽

Community Treatment

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Informal coercion: current evidence

10.1093/med/9780198788065.003.0006 ◽

2016 ◽

Author(s):

Ksenija Yeeles

Keyword(s):

Mental Health ◽

Criminal Justice ◽

Financial Incentives ◽

Community Treatment ◽

Current Evidence ◽

Future Research ◽

Perceived Coercion ◽

International Evidence ◽

Health Community ◽

Informal Coercion

This chapter considers non-legislative pressures in mental health community treatment, reviews the current body of evidence, and offers recommendations for future research. It attempts to clarify terminology on treatment pressures including different forms of ‘leverage’ such as housing, financial, criminal justice, childcare leverages, and perceived coercion. Based on a scoping review the chapter portrays current international evidence on prevalence, predictors, and outcomes of informal coercion (for example persuasion, interpersonal leverage, inducement, threats, and force) in both quantitative and qualitative studies with patients, with attention to the issues of the perception of fairness and the effectiveness of treatment, financial incentives to improve adherence, and sources of informal coercion. It also discusses common limitations and recommendations for future research.

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