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Extended Interview: Psychiatrist Explains Assertive Community Treatment

Psychiatrist J. Steven Lamberti is the director of the Severe Mental Disorders Program at the University of Rochester Medical Center. In 1995 he founded Project Link, a program that aims to provide continuing health care for people with serious mental illnesses who end up in the criminal justice system.

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  • SUSAN DENTZER:

    Project Link has been in existence now since 1995, and just recently you looked at all of the patients who have been treated under the program. What did you find?

  • J. STEVEN LAMBERTI:

    We found that Project Link cut involvement in the criminal justice system in half — about half as many arrests, half as many incarcerations. And we found even a more dramatic effect with hospitalizations and emergency room stays.

    We also found less substance abuse, which we think is driving a lot of the problems, and we found increased functioning. Now, I have to say that this research is early. We didn't have a control group, so our findings are preliminary. So we're doing a follow-up study that we're going to be presenting this week in Ottawa where we looked at every patient that's ever been through Project Link, and we confirmed the original results, that we cut the criminal justice involvement in half, and had even more dramatic results with reducing hospital stays and emergency room stays.

    But we were also interested in finding who didn't do well in Project Link. So we were looking at those factors that predicted not only success but failure.

  • SUSAN DENTZER:

    And what did you find there?

  • J. STEVEN LAMBERTI:

    We found that a lot of the factors that lead people with severe mental illness to getting into trouble with the criminal justice system are the same factors that lead other people to getting in trouble with the criminal justice system. These are established crime risk factors that are well known in the criminology literature — things like substance abuse, anti-social personality, having family problems, not being engaged in work or school. Those factors played quite a part.

  • SUSAN DENTZER:

    So that for people who were seriously mentally ill, but also had a lot of family issues or what-have-you, that would tend to have them not do as well in the Project Link environment?

  • J. STEVEN LAMBERTI:

    Yes, in a sense they have double trouble. Within Project Link we've probably seen all of our patients have problems with school, and problems with work, and most of them have problems with family, but there are different extremes.

    We found that the most strong predictor was a strong criminal history, because many people with schizophrenia, they get in trouble with the law simply because they're in the wrong place at the wrong time, or they get arrested for some type of petty charge. But there are some individuals who had antisocial personality traits before they developed psychotic disorders, and we found that those individuals with the strongest criminal histories, that was most predictive of continued criminal history.

  • SUSAN DENTZER:

    So one very simplistic way to say this is Project Link can't deal with every situation that you come across.

  • J. STEVEN LAMBERTI:

    That's absolutely correct. We're trying to take a bite out of the problem, but we definitely can't handle the whole problem. You know, when Rob [Robert Weisman, the director of Project Link] and I talk about people with mental illness who get involved with violent acts, we really don't think of it as a mental health issue. It really is a public health issue. So we've been working to get outside of the mental health system, to partner with the criminal justice system so that perhaps the whole will be greater than the sum of the parts.