Imagine a time when all your needs were taken care of – physically, emotionally, and mentally. You were fed, clothed, and sponsored in extracurricular activities. You didn’t worry about healthcare details – you showed up at appointments and followed directions. You never had a second thought about housing or bills. And you had plenty of people surrounding you who cared about your well being.
And then you moved out.
Suddenly you needed to know how to do laundry, cook, clean, fill out doctor’s forms, and have your social security number memorized?! But you adapted. You learned. You became a (mostly) self-sufficient adult.
I realize this blanket description of a privileged millennial doesn’t apply to everyone’s life experience, but I’d like to use it as a reference point. You see, when the average person moves out to take life by the horns, they figure it out. But what if someone had a debilitating severe mental illness such as schizophrenia, or any other psychotic disorder? “Figuring it out” isn’t exactly in their mental capacity. How does moving out work for them? They can’t stay in a hospital for the rest of their lives, and not everyone has a family or support system with the capacity and resources to fund and maintain care for someone’s entire life.
This is where I introduce (or reintroduce if you’ve heard of it) the Assertive Community Treatment (ACT) Program. This model of treatment takes the idea that those with mental illnesses too severe and persistent to have normal adult functioning, receive round-the-clock, in-home support from a team of professionals designed to adapt to their specific needs and goals (NAMI).
Deinstitutionalization, which began in the 1950’s, changed the focus of responsibility of individuals with severe mental illnesses (SMI) from hospitals to communities. As this change in locus was taking place, initial findings indicated that these persons with SMI were having trouble initiating and coordinating all the services and resources that were being provided. Additionally, they seemed to have a very limited capacity to advocate for themselves (Drake). Progress that had been made in hospital treatment was not continuing after discharge. Thus was born the ACT program.
Care in a hospital is 24 hours and all encompassing to a patient’s needs. ACT set out to mimic that approach by creating a team of staff from different disciplines to be available to their client 24 hours a day as well, but in the comfort of a client’s own home an community (Nami pdf).
Evolved from the work of Arnold Marx, M.D., Leonard Stein, M.D., and Mary Ann Test, Ph.D. in the 1970’s, ACT is actually “one of the oldest and most widely researched evidence-based practices in behavioral healthcare for people with severe mental illness.” The research done has shown that this population prone to hospitalizations, involvement in the criminal justice system, homelessness, and psychiatric crisis, see a reduction in these services. Not to mention the increases in treatment retention, independent living.
The convenience and adaptability of this treatment model makes it no surprise that it has been one of the leading evidence-based programs to treating SMI individuals across the country for decades. With technology and science advancing simultaneously, it also makes no surprise that pairing ACT with telepsychiatry seems like a natural progression. Telepsychiatry, or the fusion of modern telecommunications with psychiatric care and treatment, seems to be a likely addition to the ACT program, which is already a service-delivery approach. Clients in an ACT program receive personalized treatment from a selected team who make sure to provide their services to the client in his/her home or community. Enhancing this delivery of service and treatment with already existing telecommunications technology such as videoconferencing might enrich the service-delivery model that is ACT.
Assertive Community Treatment Programs have proven to enhance the treatment of mentally ill clients. With its history of studies and research to uphold the value of this treatment model, the advancements in science and technology only stand to improve the ACT Program.
Center for Evidence-Based Practices at Case Western Reserve University. (n.d.). Retrieved March 24, 2017, from https://www.centerforebp.case.edu/practices/act
Drake, R. E. (n.d.). Brief History, Current Status, and Future Place of Assertive Community Treatment. Retrieved March 24, 2017, from http://onlinelibrary.wiley.com/doi/10.1037/h0085086/abs tract
NAMI. (n.d.). Retrieved March 24, 2017, from http://www.nami.org/Learn More/Treatment/Psychosocial-Treatments
Nami . (n.d.). Assertive Community Treatment (ACT).Retrieved March 24, 2017, from http://www.namihelps.org/assets/PDFs/factsheets/General/Assertive Community-Treatment.pdf