Affordability of Forensic Assertive Community Treatment Programs: A Return-on-Investment Analysis

Area of Science:

• Forensic Psychiatry
• Health Economics
• Mental Health Services Research

Background:

• Severe mental illness in legal-involved populations presents significant public health and economic challenges.
• Forensic Assertive Community Treatment (FACT) is an intensive intervention designed to improve outcomes for this population.
• Understanding the economic impact, specifically the return on investment (ROI), of FACT programs is crucial for resource allocation and policy decisions.

Purpose of the Study:

• To assess the return on investment (ROI) associated with a forensic assertive community treatment (FACT) program.
• To quantify the economic benefits of FACT compared to standard outpatient psychiatric treatment for legal-involved individuals with severe mental illness.

Main Methods:

• Retrospective secondary data analysis of a randomized controlled trial involving 70 legal-involved patients with severe mental illness in Rochester, New York.
• Comparison of FACT intervention versus outpatient psychiatric treatment including intensive case management.
• Calculation of unit of service costs (emergency department visits, inpatient days, jail days) using New York State Medicaid and Department of Corrections data.

Main Results:

• The estimated return from FACT was $27,588 per-patient-per-year (PPPY), primarily driven by reduced psychiatric inpatient days.
• The estimated investment cost for FACT was $18,440 PPPY.
• This resulted in an estimated ROI of 1.50 (95% CI=0.35-2.97), indicating $1.50 return for every $1 invested.

Conclusions:

• The Rochester FACT program demonstrated a positive ROI, yielding approximately $1.50 for every $1 invested.
• This ROI was calculated excluding potential savings from reduced acute medical care, crime, and public safety costs.
• ROI estimates are sensitive to contextual factors, including Medicaid reimbursement rates for FACT and inpatient hospital stays.