Assertive Community Treatment (ACT) is an evidenced based program designed for individuals with serious mental health disorders. A team of professionals, including: nurses; psychiatrists; case managers; substance abuse counselors; and social workers oversees the client’s care (Assertive Community Treatment, 2011). Clients can reach a member of the team twenty-four hours a day. The team helps the clients overcome obstacles in their everyday lives. For example: housing; education; paying bills; appointments; food shopping and many more (Assertive Community Treatment. 2011). This paper will discuss: the development of ACT; the target population; structure and components of the program; barriers to implementing; and how ACT can aid in recovery. …show more content…
Individuals with mental disorders were let out into the community without a specific plan or system in place (Drake, 1998). Many individuals, with mental illness, did not have the knowledge or understanding how to navigate the broken mental health system outside of institutions and ended up incarcerated or homeless (Furlong, Leddy, Ferguson, & Heart, 2009). As a result, the need for case management, diverse practitioners, and integrated services in the 1970’s led to the development of Program of Assertive Community Treatment (PACT) in Madison, Wisconsin by Test and Stein (Drake, 1998). Test and Stein realized that community based services lacked the effectiveness of inpatient care services. Frequently, client’s mental health would decline with out- patient care leading to re-hospitalizations (SAMSHA, 2008). They wanted clients to have a better quality of life and be able to integrate into the community (SAMSHA, 2008). For this reason, the PACT team implemented low caseload to be shared by providers from different disciplines (SAMSHA, 2008). PACT’s objective was to help reduce high rates of hospitalization and homelessness of individuals with serious mental illness (Furlong, et al., 2009). The ACT model is the derivation of PACT (Drake, …show more content…
According to Furlong, et al., 2009, in 2006, 49% of clients engaged with an ACT team at Thresholds lived independently, 87% of members had no hospitalizations, and over seven percent were employed (Furlong, et al., 2009). Fidelity of five of the ACT teams at Thresholds was measured by the Dartmouth Assertive Community Scale (DACTS), a 28 item instrument, which measures a team’s adherence to the ACT model on a rating scale of one through five (1 = not
The fight for improved health care for those with mental illness has been an ongoing and important struggle for advocates in the United States who are aware of the difficulties faced by the mentally ill and those who take care of them. People unfortunate enough to be inflicted with the burden of having a severe mental illness experience dramatic changes in their behavior and go through psychotic episodes severe enough to the point where they are a burden to not only themselves but also to people in their society. Mental institutions are equipped to provide specialized treatment and rehabilitative services to severely mentally ill patients, with the help of these institutions the mentally ill are able to get the care needed for them to control their illness and be rehabilitated to the point where they can become a functional part of our society. Deinstitutionalization has led to the closing down and reduction of mental institutions, which means the thousands of patients who relied on these mental institutions have now been thrown out into society on their own without any support system to help them treat their mental illness. Years after the beginning of deinstitutionalization and after observing the numerous effects of deinstitutionalization it has become very obvious as to why our nation needs to be re-institutionalized.
Each year, 52 million Americans have some form of mental health problem and out of those patients 60% are members of a managed care group. (Madonna, 2000, ¶ 8) Managed mental health care’s successes and failures now bear directly on the mental wellbeing of 32 million particularly vulnerable Americans. Initially managed care was intended to be a “comprehensive approach to healthcare that included balancing cost, quality, utilization, and access.” (Madonna, 2000, ¶ 23) In theory, this is an optimal approach to the delivery of health care and it has proven somewhat successful in the area of physical health, but it has not provided the same success in the area of mental health. Mental health is still being treated as a separate and less important aspect of health care despite the fact that some mental health disorders, such as schizophrenia, have shown higher success rates than those of common medical procedure, such as angioplasty. (Etheredge, 2002, ¶ 6)
States obtain many services that fall under mental health care, and that treat the mentally ill population. These range from acute and long-term hospital treatment, to supportive housing. Other effective services utilized include crisis intervention teams, case management, Assertive Community Treatment programs, clinic services, and access to psychiatric medications (Honberg at al. 6). These services support the growing population of people living in the...
Rather than preparing graduates in education or consulting as previous graduate nursing programs had done, this program educated psychiatric-mental health nurses as therapists with the ability to assess and diagnose mental health issues as well as psychiatric disorders and treat them via individual, group, and family therapy (ANA, 2014). Thus, the Psychiatric Mental Health Clinical Nurse Specialist (PMH-CNS), one of the initial advanced practice nursing roles (Schmidt, 2013), was born. After Community Mental Health Centers Act of 1963 led to deinstitutionalization of individuals with mental illness, PMH-CNSs played a crucial role in reintegrating formerly institutionalized individuals back into community life (ANA, 2014). PMH-CNSs have been providing care in a wide range of setting and obtaining third-party reimbursement since the late 1960’s. In 1974 a national certification for PMH-CNSs was created (APNA, 2010). Subsequently, PMH-CNSs began to be granted prescriptive privileges in the Pacific Northwest in the late 1970s, that practice has now spread to 37 states and the District of Columbia (APNA,
Until the middle of the last century, public mental health in the United States had been the responsibility, for the most part, of individual states, who chose to deal with their most profoundly mentally-ill by housing them safely and with almost total asylum in large state mental hospitals. Free of the stresses we all face in our lives, the mentally-ill faced much better prospects for peaceful lives and even recovery than they would in their conditions in ordinary society. In the hospitals, doctors were always accessible for help, patients were assured food and care, and they could be monitored to insure they never became a danger to themselves or others. Our nation’s state hospital system was a stable, efficient way to help improve the lives of our mentally disabled.
“During the 1970’s and 1980’s mental hospitals had a fiscal crisis and thousands of people with schizophrenia and other mental illnesses who had been institutionalized for years had been released by the courts. These individuals no longer met the standard for forcible incarceration because they were not dangerous or in need of supervisory treatment any longer. As a result a large amount of people with mental illnesses or were socially fragile were let go from hospitals lacking psychiatric and social work follow up, and many stopped taking their medications” (Shapiro & Wizner, 2011, p.2-3). In 2002, New York City along with New York’s mental health and parole supervision agencies based a nonprofit organization called Project Renewal. This program assisted ex-offenders that had ment...
ACT is based around the idea that people receive better care when their mental health care providers work together. ACT team members help the person address every aspect of their life, whether it be medication, therapy, social support, employment or housing.
Perkins, R. Repper, J. (1998) Dilemmas in Community Mental Health. Oxon: Radcliff Medical Press Ltd.
In 1955, over 559,000 individuals resided in inpatient psychiatric hospitals. By 1995, however, the number had drastically diminished to 69,000, (National Health Policy Forum, 2000). This drastic reduction was largely due to the discovery of antipsychotic medications in the 1950s, and the deinstitutionalization movement of the 1960s, wherein several thousands of mentally ill individuals were released from psychiatric institutions to return to their communities for treatment. Mental health centers (MHCs) were conceptualized during deinstitutionalization to provide treatment to these newly-released mentally ill persons in their communities. Although efforts were well-intended, the MHCs failed to serve the neediest subset of individuals. Instead, they served those who had minor psychiatric diagnoses and needed little treatment. As a result, the United States experienced an increase in the number of homeless individuals, most of whom still exhibited psychotic symptoms. Involuntary Outpatient Commitment (IOC) was created to serve those “forgotten” mentally ill individuals without placing them back in institutions. Ideally, IOC will increase community tenure for the severely mentally ill, decrease the likelihood of decompensation, and provide the necessary treatment by means less restrictive than hospitalization, (Borum et al., 1999).
On October 31, 1963, President Kennedy signed the Community Mental Health Act into law with the aim to change the delivery method of mental health care (National Council for Behavioral Health, 2013). The primary aim was to release the mentally ill from institutions and allow them to successfully integrate into functional members of society. In an effort to achieve this goal, delivery of care would be a coordination of effort from a network of outpatient clinics, community services, partial hospitalizations, and when needed emergency services. The funding for these services was to be from a combination of government, private programs and self-pay sources. However, due to the recent recession government sources reduced funds available for mental health services (Thomas). This economic reality coupled with an already fragmented health care system has left mental ill vulnerable. Patients that fall into the cracks in the system often end up in homeless shelters, jails/prisons or the morgue (Szabo, 2012).
NASMHPD. (2014, Accessed April 27). Retrieved from NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS: http://www.nasmhpd.org/About/AOMultiStateDisaster.aspx
The largest function of the Housing First program is to ensure that people with mental illness have somewhere to stay on a permanent basis. This will help the government to take better care of their health since they can easily be accessed. The program helps deal with the senior demographic in the country and helps ensure that medical care can be provided in the comfort of a home. In most cases, service participants that are suppo...
Those with mental illness would live in the community with an array of services and be able to be free from the constraints of confinement. In the early 1960’s the United States began an initiative to reduce and close publicly-operated mental hospitals. This became known as deinstitutionalization. The goal of deinstitutionalization was to allow people suffering from mental illness to live more independently in the community with treatments provided through community health programs. Unfortunately, the federal government did not provide sufficient ongoing funding for the programs to meet the growing demand. States reduced their budgets for mental hospitals but failed to increase funding for on-going community-based mental health programs. As a result of deinstitutionalization hundreds of thousands of mentally ill people were released into the community without the proper resources they needed for their treatment. (Harcourt,
It helps to strengthen social support systems and strives to improve functional abilities and overall quality of life. Case Management is beneficial in reducing the number of hospital admissions, while also preventing relapse as clients partake in assertive community treatment, rather than seeking episodic care. Community based mental health care not only helps to improve individual quality of life, but also helps to improve the welfare of the community at large. Case management is implemented in nearly every community within the United States as a means to provide services to individuals with severe psychiatric disabilities, especially for those who are unable to access quality care for their own mental
One of the first major steps that began the development of community health centers was the Community Mental Health Act of 1963, signed by President John F. Kennedy (Moran, 2013). Under this law, mental health needs shifted from institutions to community-based programs that helps prevents, identifies and treats mental illnesses (Moran, 2013). Many people realized how institutions were not responding to the higher rates of patients appropriately and questioned its overall effectiveness and lack of holistic practices (Moran, 2013). Since the Community Mental Health Act of 1963, the United States worked on deinstitutionalization so communities can get the health care they needed