Assertive Community Treatment
Assertive Community Treatment (ACT) is a team-based treatment model that provides multidisciplinary, flexible treatment and support to people with mental illness 24/7. 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. Learn more about ACT.
While there is no single agreed upon definition of illness self-management, most definitions converge on describing it as intervention designed to help consumers better manage their psychiatric illness.
What is illness self-management?
While there is no single agreed upon definition of illness self-management, most definitions converge on describing it as intervention designed to help consumers better manage their psychiatric illness. Using a broad definition such as this, most psychiatric rehabilitation approaches could be conceptualized as illness self-management. Many people prefer to define it more narrowly to refer to it as the management of the psychopathology of the disorder (symptoms, relapses, re-hospitalizations), but not necessarily all the associated impairments (work, social relationships), which then invokes the field of psychiatric rehabilitation. Note, however, that that management of a psychiatric illness requires attention to social relationships (e.g., supports), involvement in meaningful activity, etc., so that effective illness self-management requires focusing on more than symptoms.
What does illness self-management involve?
The research literature on illness management identifies four different treatment components that were supported by the evidence:
- Psychoeducation about psychiatric illness and its management, which has been found to improve knowledge of the illness, but not to influence its course;
- Behavioral tailoring to address medication non-adherence, which involves helping people fit taking medication into their daily routines, and has been found to improve medication adherence;
- Developing relapse prevention plans, which has been found to reduce relapses; and
- Teaching coping strategies for dealing with persistent symptoms, which has been found to reduce symptom severity and distress.
These four treatment components are included in the illness management & recovery implementation kit (or toolkit), developed as part of the SAMHSA-sponsored evidence-based practices project.
Does illness self-management help with symptoms? Improved outcomes? What are the positive effects of illness self-management?
Based on the research, the positive effects include reduced symptom severity and distress, and reduced relapses and re-hospitalizations. The illness management and recovery intervention teaches illness management skills in the context of helping consumers articulate and pursue personal recovery goals.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a common type of mental health counseling (psychotherapy). With cognitive behavioral therapy, you work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. Cognitive behavioral therapy helps you become aware of inaccurate or negative thinking, so you can view challenging situations more clearly and respond to them in a more effective way. Click here to learn more about Cognitive Behavioral Therapy.
This is a general overview of psychiatric medications, with the focus on “what to look out for” in terms of special precautions, possible side effects, interactions, signs of overdose, etc. (Note that this page is for informational purposes only.)
The following is a general overview of psychiatric medications, with the focus on “what to look out for” in terms of special precautions, possible side effects, interactions, signs of overdose, etc. What’s been left out is much of the “good news:” the positive difference these medications have made in the lives of many, many thousands of people. Hopefully, you or your loved one will experience that difference and be able to build upon it for a better future.
SURVIVAL SKILLS FOR TAKING MEDICATIONS
- Keep a list of all medications, including over the counter and herbal medicine. Show this list to all doctors and your pharmacist.
- Use one pharmacy, so they can detect drug interactions and call your doctor if any interactions are detected.
- Follow your doctor's instructions for taking medications, but work with your doctor to fit your medication schedule to your schedule: when you need to get up, go to bed and get things done. Ask the doctor what to do if you miss a dose. Never take two doses at the same time unless you have the doctor's OK.
- Avoid alcohol and other street drugs. Report changes in nicotine and caffeine consumption to all your doctors.
- Keep all appointments. Don't hesitate to ask questions (make a list ahead of time). Tell the doctor about any health problems or side effects. Tell the doctor if you are pregnant, planning to get pregnant or nursing.
- Make sure your psychiatrist knows what your medical doctor is doing for you (whether prescribing a medication or recommending an operation or medical procedure) and vice versa.
- Store medications in a cool, dry place away from children and pets.
- Be patient. Remember, many side effects diminish in a few weeks. It may take a few weeks before you begin to feel better, too.
CAUTION: NAMI-NYS does not give medical advice. This page is for informational purposes only. Discuss all medication and medical decisions with your physician.
Supported employment is a well-defined approach to helping people with disabilities participate in the competitive labor market, helping them find meaningful jobs and providing ongoing support from a team of professionals. Click here to learn more.
Most consumers with severe mental illness (SMI) want to work and feel that work is an important goal in their recovery. When they identify work as a goal, consumers usually mean competitive employment, defined as community jobs that any person can apply for, in integrated settings (and in regular contact with non-disabled workers), and that pay at least minimum wage. Unfortunately, assistance with employment is a major unmet need in most mental health programs: less than 15% of consumers are competitively employed at any time.
Supported employment is a well-defined approach to helping people with disabilities participate in the competitive labor market, helping them find meaningful jobs and providing ongoing support from a team of professionals. First introduced in the psychiatric rehabilitation field in the 1980s, supported employment programs are now found in a variety of service contexts, including community mental health centers (CMHCs) and psychosocial rehabilitation agencies.
The evidence for the effectiveness of supported employment comes mainly from two types of research: day treatment conversion studies and experimental studies. Four studies have examined what happens when day treatment programs are replaced with a supported employment program. In every case there was a substantial increase in employment rates. The percentage of consumers obtaining competitive jobs quadrupled after conversion of day treatment to supported employment, while competitive employment rates in centers not converting their services were unchanged. No negative outcomes were reported in any of these studies, except a small minority of consumers who missed the social contact in day treatment. Centers converting to supported employment had overwhelmingly favorable reactions from consumers, family members, and program staff.
A second source of evidence has been 9 carefully controlled experimental studies comparing supported employment to traditional vocational approaches (e.g., skills training preparation, sheltered workshops, transitional employment). All 9 studies showed better employment outcomes for consumers receiving supported employment. Importantly, these studies suggest that supported employment is superior to other vocational approaches in both urban and rural areas, for persons of different ethnicities, for both men and women, and for a wide range of other consumer characteristics. In fact, we have yet to find any characteristic that would be the basis for excluding someone from a supported employment program. For example, consumers seem to benefit more from supported employment than alternative programs regardless of employment history, clinical history, diagnosis, or, surprisingly, the presence of co-occurring substance use disorders.
Together, these two lines of research suggest that between 40% and 60% of consumers enrolled in supported employment obtain competitive employment while less than 20% of similar consumers do so when not enrolled in supported employment. Other employment outcomes, such as duration of employment and wages, also generally favor supported employment programs. Moreover, the beneficial effects of supported employment are long lasting, as seen in one study that interviewed consumers 10 years after they were first enrolled.
Many consumers hold more than one competitive job before finding one that is optimal for them. Research suggests that when consumers have jobs that match their preferences and capabilities, they are able, with ongoing assistance from the supported employment team, case managers, family members, and others, to keep these jobs over a period of time. Career advancement is a critical issue for all workers. Unfortunately, job opportunities available to consumers with SMI are often restricted because of consumers' limited work experience, education, and training. Consequently, most initial supported employment positions are unskilled. In addition, most supported employment positions are part time. A continuing challenge for supported employment programs is helping consumers capitalize on educational and training opportunities so that they may qualify for skilled jobs and develop satisfying careers.
Research has identified several critical ingredients of supported employment that are predictive of improved employment outcomes. These include the following:
- Services focus on competitive employment: The agency providing supported employment is committed to competitive employment as an attainable goal for its consumers with SMI, devoting its resources for rehabilitation services to this endeavor, rather than to intermediate activities, such as day treatment or sheltered work.
- Eligibility is based on consumer choice: No one is excluded who wants to participate.
- Rapid job search: Job search begins soon after a consumer expresses interest in working. Lengthy pre-employment assessment, counseling, training, and intermediate work experiences are not required.
- Integration with mental health treatment: Employment specialists coordinate plans with the treatment team (case manager, psychiatrist, etc.).
- Attention to consumer preferences: Choices and decisions about work and support are individualized based on the consumer’s preferences, strengths, and experiences.
- Benefits counseling: Employment specialists provide individualized planning and guidance on an ongoing basis with each consumer to ensure well-informed and optimal decisions regarding Social Security and health insurance. (see information on the Medicaid Buy-In)
- Time-unlimited and individualized support: Individualized supports are provided to maintain employment, as long as consumers want the assistance.
Supported employment programs with greater fidelity to these principles have been found to have higher employment rates. We use a "fidelity" rating scale to measure the degree to which a program follows these practice standards. Already in widespread use, the 15-item Supported Employment Fidelity Scale provides consumers and family members with a tool to identify local providers who offer the best practice and to advocate for better services.
Supported employment has not been found to lead to increased risk for re-hospitalization or any other negative outcomes. On the other hand, enrolling in a supported employment program does not, by itself, increase quality of life or self esteem. However, consumers who are employed for a meaningful length of time demonstrate significant improvements in self-esteem and symptom management compared with clients who do not work.
Access to supported employment continues to be a problem, despite extensive evidence showing its effectiveness. Less than 25 percent of consumers with SMI receive any form of vocational assistance, and only a fraction of them have access to supported employment. Supported employment programs are now commonly found in CMHCs, but their capacity falls far short of the need. Barriers to implementation of high-quality programs exist at many levels-within federal, state, and local governments (e.g., insufficient and fragmented funding, complexity of Medicaid reimbursement policy, lack of attention to outcomes), within agency or program administrations (e.g., resistance to change, preoccupation with financial issues, leadership issues), among clinicians and supervisors (e.g., low expectations for recovery, lack of understanding), and in the collaboration with consumers or families (e.g., lack of information). Information about a national strategy to address these issues can be found at the New Hampshire-Dartmouth Psychiatric Research Center web site.
Consumers and family members can have influence over setting standards and ensuring adherence to the standards of supported employment at all levels. They need to know what good services look like and how to advocate effectively in legislation and funding decisions. They should seek membership on advisory boards at all levels. They can collaborate with state officials to fund supported employment programs and to establish standards according to evidence-based practices and have them incorporated in licensing standards, requests for proposals for grant funds, and so on. At the program level, consumers and family members can demand that entrance criteria for supported employment be based on a consumer's desire to work rather than symptoms or work history. They can also participate in designing supported employment programs. On an individual level, consumers and family members can advocate for consumer choice and for services that are proven to be effective.
In conclusion, the main message that we would like to convey is that supported employment is well defined, it is effective, and it is relatively easy to implement, compared with many other types of psychosocial practices.
Transcranial magnetic stimulation
Transcranial magnetic stimulation (TMS) is a procedure that uses magnetic fields to stimulate nerve cells in the brain. Click here to learn more.