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What
is ACT?
ACT is a service-delivery model that provides comprehensive,
locally based treatment to people with serious and persistent
mental illnesses. Unlike other community-based programs, ACT
is not a linkage or brokerage case-management program that
connects individuals to mental health, housing, or rehabilitation
agencies or services. Rather, it provides highly individualized
services directly to consumers. ACT recipients receive the
multidisciplinary, round-the-clock staffing of a psychiatric
unit, but within the comfort of their own home and community.
To have the competencies and skills to meet a client's multiple
treatment, rehabilitation, and support needs, ACT team members
are trained in the areas of psychiatry, social work, nursing,
substance abuse, and vocational rehabilitation. The ACT team
provides these necessary services 24 hours a day, seven days
a week, 365 days a year.
How
did ACT begin?
Now in its 26th year, the ACT model evolved out of work led
by Arnold Marx, M.D., Leonard Stein, M.D., and Mary Ann Test,
Ph.D., on an inpatient research unit of Mendota State Hospital,
Madison, Wisconsin, in the late 1960s. Noting that the gains
made by clients in the hospital were often lost when they
moved back into the community, they hypothesized that the
hospital's round-the-clock care helped alleviate clients'
symptoms and that this ongoing support and treatment was just
as important - if not more so - following discharge. In 1972,
the researchers moved hospital-ward treatment staff into the
community to test their assumption and, thus, launched ACT.
What
are the primary goals of ACT?
ACT strives to lessen or eliminate the debilitating symptoms
of mental illness each individual client experiences and to
minimize or prevent recurrent acute episodes of the illness,
to meet basic needs and enhance quality of life, to improve
functioning in adult social and employment roles, to enhance
an individual's ability to live independently in his or her
own community, and to lessen the family's burden of providing
care.
What
are the key features of ACT?
Treatment:
-
psychopharmacologic treatment, including new atypical antispyschotic
and antidepressant medications
- individual
supportive therapy
- mobile
crisis intervention
- hospitalization
- substance
abuse treatment, including group therapy (for clients with
a dual diagnosis of substance abuse and mental illness)
Rehabilitation:
-
behaviorally oriented skill teaching (supportive and cognitive-behavioral
therapy), including structuring time and handling activities
of daily living
- supported
employment, both paid and volunteer work
- support
for resuming education
Support
services:
-
support, education, and skill-teaching to family members
- collaboration
with families and assistance to clients with children
- direct
support to help clients obtain legal and advocacy services,
financial support, supported housing, money-management services,
and transportation
Who
benefits from the ACT model?
The ACT model is indicated for individuals in their late teens
to their elderly years who have a severe and persistent mental
illness causing symptoms and impairments that produce distress
and major disability in adult functioning (e.g., employment,
self-care, and social and interpersonal relationships). ACT
participants usually are people with schizophrenia, other
psychotic disorders (e.g., schizoaffective disorder), and
bipolar disorder (manic-depressive illness); those who experience
significant disability from other mental illnesses and are
not helped by traditional outpatient models; those who have
difficulty getting to appointments on their own as in the
traditional model of case management; those who have had bad
experiences in the traditional system; or those who have limited
understanding of their need for help.
What
is the difference between ACT and traditional care?
Most individuals with severe mental illnesses who are in treatment
are involved in a linkage or brokerage case-management program
that connects them to services provided by multiple mental
health, housing, or rehabilitation agencies or programs in
the community. Under this traditional system of care, a person
with a mental illness is treated by a group of individual
case managers who operate in the context of a case-management
program and have primary responsibility only for their own
caseloads. In contrast, the ACT multidisciplinary staff work
as a team. The ACT team works collaboratively to deliver the
majority of treatment, rehabilitation, and support services
required by each client to live in the community. A psychiatrist
is a member of, not a consultant to, the team. The consumer
is a client of the team, not of an individual staff member.
Individuals with the most severe mental illnesses are typically
not served well by the traditional outpatient model that directs
patients to various services that they then must navigate
on their own. ACT goes to the consumer whenever and wherever
needed. The consumer is not required to adapt to or follow
prescriptive rules of a treatment program.
Is
there a difference between ACT and PACT?
There is no difference between the PACT (Program of Assertive
Community Treatment) model and the ACT (Assertive Community
Treatment) model. Not only does NAMI use ACT and PACT interchangeably,
but ACT or PACT is also known by other names across the country.
For example, in Wisconsin, ACT programs are called Community
Support Programs, or CSP. In Florida, ACT programs are called
FACT (Florida Assertive Community Treatment); in Rhode Island
and Delaware ACT programs are called Mobile Treatment Teams
(MTT), while Virginia uses PACT for its assertive community
treatment teams.
While the official name that a state, county, or locality
uses for ACT varies widely, there is only one set of standards
that NAMI sets forth for all programs of assertive community
treatment.
How
do ACT clients compare with those receiving hospital treatment?
ACT clients spend significantly less time in hospitals and
more time in independent living situations, have less time
unemployed, earn more income from competitive employment,
experience more positive social relationships, express greater
satisfaction with life, and are less symptomatic. In one study,
only 18 percent of ACT clients were hospitalized the first
year compared to 89 percent of the non-ACT treatment group.
For those ACT clients that were rehospitalized, stays were
significantly shorter than stays of the non-ACT group. ACT
clients also spend more time in the community, resulting in
less burden on family. Additionally, the ACT model has shown
a small economic advantage over institutional care. However,
this finding does not factor in the significant societal costs
of lack of access to adequate treatment (i.e., hospitalizations,
suicide, unemployment, incarceration, homelessness, etc.).
How
available are ACT programs?
Despite the documented treatment success of ACT, only a fraction
of those with the greatest needs have access to this uniquely
effective program. Nineteen states have at least one or more
ACT pilot programs in their state. In the United States, adults
with severe and persistent mental illnesses constitute one-half
to one percent of the adult population. It is estimated that
20 percent to 40 percent of this group could be helped by
the ACT model if it were available.
Are
ACT/PACT Programs available in New York State?
ACT adaptation programs are available in all 5 regions of
the state: Central New York, Hudson River Region, Long Island
Region, New York City, and Western New York. 71 teams are
planned by the end of 9/03. Call local field office of the
Office of Mental Health for more information.
For more in-depth information about mental illness, treatments
and supports, and medications;
please choose from the following topics:
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Illness | What is Mental Illness?
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