Washington State Institute for Public Policy
Forensic Assertive Community Treatment (FACT)
Adult Mental Health: Serious Mental Illness
Benefit-cost estimates updated May 2017.  Literature review updated May 2014.
Forensic Assertive Community Treatment (FACT) is an adaptation of Assertive Community Treatment (ACT) for individuals with involvement in the criminal justice system. In this analysis the study population included individuals with serious mental illness who were identified as candidates for FACT in jail.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $549 Benefits minus costs ($18,200)
Participants $6 Benefit to cost ratio ($0.41)
Others $364 Chance the program will produce
Indirect ($6,192) benefits greater than the costs 0 %
Total benefits ($5,274)
Net program cost ($12,926)
Benefits minus cost ($18,200)
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Crime $143 $0 $272 $72 $487
Health care associated with psychiatric hospitalization $406 $6 $91 $204 $707
Adjustment for deadweight cost of program $0 $0 $0 ($6,468) ($6,468)
Totals $549 $6 $364 ($6,192) ($5,274)
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $14,000 2013 Present value of net program costs (in 2016 dollars) ($12,926)
Comparison costs $4,482 2013 Cost range (+ or -) 10 %
Specific cost data are not available for FACT. We estimated the cost of FACT using the annual per-patient costs of ACT in Washington State (Washington State Department of Social & Health Services, 2013). We also assumed that the comparison group in the FACT study would have similar costs to the comparison group in the ACT studies that we reviewed. The cost of the comparison group in these studies was estimated by reducing the cost of the ACT intervention by a factor of 3.12 because the comparison group caseloads were higher than ACT caseloads by this factor in the ACT studies that we reviewed. Washington State Department of Social & Health Services. (2013). 2013 program description, Washington Program for Assertive Community Treatment. Retrieved from https://fortress.wa.gov/dshs/adsaapps/about/programs/MH%20Program%20for%20Assertive%20Community%20Treatment.docx.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Crime 1 72 -0.111 0.173 41 0.000 0.000 42 -0.111 0.524
Hospitalization (psychiatric) 1 72 -0.211 0.174 41 0.000 0.000 42 -0.211 0.226
Citations Used in the Meta-Analysis

Cusack, K.J., Morrissey, J.P., Cuddeback, G.S., Prins, A., & Williams, D.M. (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: a randomized trial. Community Mental Health Journal, 46(4), 356-363.

Dodge, K.A., &The Conduct Problems Prevention Research Group. (1993). Effects of intervention on children at high risk for conduct problems. Paper presented at the biennial meeting of the Society for Research in Child Development, New Orleans.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov