Treatments
ACT: Assertive Community Treatment
ACT, or Assertive Community Treatment has been called Intensive Case Management, but it is much more than that. It involves a dedicated team of providers that bring treatment, support and rehabilitation to the patient, whenever and wherever it is needed. Services are available 24 hours a day, 7 days a week, 365 days a year. These teams consist of a psychiatrist, nurses, social workers, addiction specialists, occupational therapists and vocational counselors, all of which function as case managers.
While it was originally designed for chronically ill patients with schizophrenia and is especially relevant for individuals with co-morbid substance abuse, it can be and is used for other people who are at high risk for relapse and hospitalization.
It is also much more than a program to insure medication compliance by coercion. It addresses all of the factors that can lead to decompensation, including the stresses that homelessness and poverty introduce into the lives of people suffering from mental illness.
Because ACT teams provide continuous monitoring and support, problems are identified early, when members of the team can more easily assist patients in their efforts to resolve these problems.
Team members come to know the people they serve better than any other providers can and they share this knowledge freely with one another. Recipients of these services can receive visits in their homes or wherever they may be. They can be seen daily if required.
As part of the ACT model, even the psychiatrist can participate in home visits and is always able to see patients as often as is necessary. He or she can provide individual or couples therapy or be involved in group therapy sessions. Because patients are closely monitored, medications can be changed frequently if symptoms worsen or side effects develop.
Clients do not require the attention of multiple of separate agencies. They receive medication management, housing services, vocational guidance, supportive therapy, living skills training, and assistance with money management from a single cooperative source. Services are delivered based upon “evidence based practices”.
The following features characterize the ACT model:1
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Multidisciplinary treatment teams with low client to case manager ratio (eg, 10 to 1 rather than 30 to 1 or more) -
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Shared caseloads among clinicians (rather than individual caseloads)
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Direct provision of services, rather than brokering services to other providers
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24-hour coverage, including emergencies
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Close attention to illness management
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Most services provided in the community, rather than at the clinic
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High frequency of contact with clients; and assistance with practical problems in living
The ACT model effectively compensates for what private insurance companies and public assistance have done to the delivery of medical care, especially for people with chronic mental illnesses.
Working as a member of an ACT team often provides the most gratifying clinical experience of a career in the field of mental health treatment. With ACT, the client clearly comes first.
To read what one grateful recipient of the ACT experience had to say, visit: www.chovil.com/act.html
Minnesota Assertive Community Treatment Standards can be reviewed at: www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs_id_019807.pdf
NAMI/Assertive Community Treatment (ACT) provides general information about this model at: www.nami.org/Template.cfm?Section=ACT-TA_Center
1 Medscape General Medicine 3(1), 2001
(Sources: The author's knowledge base, unless otherwise noted.)
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