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Understanding Assertive Community Treatment
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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
During the 1960’s, America’s solution to the growing population of mentally ill citizens was to relocate these individuals into mental state institutions. While the thought of isolating mentally ill patients from the rest of society in order to focus on their treatment and rehabilitation sounded like a smart idea, the outcome only left patients more traumatized. These mental hospitals and state institutions were largely filled with corrupt, unknowledgeable, and abusive staff members in an unregulated environment. The story of Lucy Winer, a woman who personally endured these horrors during her time at Long Island’s Kings Park State Hospital, explores the terrific legacy of the mental state hospital system. Ultimately, Lucy’s documentary, Kings
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.
Treatment under this model is one of problem solving and utilizing an individual’s strengths to overcome his or her issues. The goal is to foster empowerment and self-sufficiency in order for the client to return to his or her environment (Woodside & McClam, 2014).
Mental healthcare has a long and murky past in the United States. In the early 1900s, patients could live in institutions for many years. The treatments and conditions were, at times, inhumane. Legislation in the 1980s and 1990s created programs to protect this vulnerable population from abuse and discrimination. In the last 20 years, mental health advocacy groups and legislators have made gains in bringing attention to the disparity between physical and mental health programs. However, diagnosis and treatment of mental illnesses continues to be less than optimal. Mental health disparities continue to exist in all areas of the world.
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.
Perkins, R. Repper, J. (1998) Dilemmas in Community Mental Health. Oxon: Radcliff Medical Press Ltd.
In patient programs can also be very effective, especially for those with more severe problems. They are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. Treatment Centers differ from other treatment approaches principally in their use of the community—treatment staff and those in recovery—as a key agent of change to influence patient attitudes, perceptions, and behaviors associated with drug use. Patients in TCs may include those with relatively long histories of drug addiction, involvement in serious criminal activities, and seriously impaired social functioning. The focus of the TC is on the resocialization of the patient to a drug-free, free living lifestyle and delivers healthy coping mechanisms for individuals that have not been able to function in society without the use of a mood altering substance.
Sacks, J. Y., McKendrick, K., & Hamilton, Z. (2012). A randomized clinical trial of a therapeutic community treatment for female inmates: Outcomes at 6 and 12 months after prison release. Journal Of Addictive Diseases, 31(3), 258-269. doi:10.1080/10550887.2012.694601
Since the beginning of deinstitutionalization in the mid twentieth century, there has been a significant need for community mental health care, which was recognized after long term institutional care was considered ineffective. One concept that arose during the community mental health movement was case management. An important goal of the community mental health movement was to create full time mental health centers throughout the United States, and case management was to provide outpatient care to those who suffered from severe mental illness. Case management is still widely recognized today, and continues to be effective in providing care to clients who suffer from mental illness. Case management is a fundamental solution to the advocacy, recruitment, treatment, and care of both the disadvantaged and mentally disabled individuals.
In a study done by Johns, Oliver, Khondoker, Byrne, Jolley, Wykes, & Morris (2016), 69 participants were involved in 13 ACT groups with 4-8 participants in each one. There were four two-hour sessions that consisted of skills-building workshops (Johns et al., 2016). Participants were also asked to fill out a satisfaction questionnaire at the end of the study. The study showed that ACT group therapy was beneficial to these participants. Participants showed a “reduced experiential avoidance/greater acceptance; reduced cognitive fusion; and increased mindfulness (Johns et al., 2016. Pg. 261).” Participants also experienced an improvement in functioning as well as in mood (Johns et al.,
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,
NASMHPD. (2014, Accessed April 27). Retrieved from NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS: http://www.nasmhpd.org/About/AOMultiStateDisaster.aspx
...row WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry. 1993 Feb;50(2):85-94.