ACT teams should really be called multi service teams. I was first introduced to ACT teams by a presentation I heard by Richard Sabo quite a few years ago. The ACT teams I knew were somewhat controversial, because of their name if nothing else, Assertive Community Treatment. They help the very ill. ACT teams as I understood them were a method of ensuring that people took their medication, and although I knew how critical that was in schizophrenia, I could understand why consumer advocates would feel that was coercive. The image was of an ACT team nurse hunting someone down in the streets to give them a needle of medication. It's easy to jump to conclusions when you don't know very much.
In an ACT team you have 10-12 health care professionals using evidence based practices. It would include a psychiatrist, nurse, case manager, occupational therapist, addiction specialist, etc. etc. The ACT team is typically available 24 hours a day, seven days a week. Because they are a team that provides all services they learn more about the individual then any single service from a variety of agencies. They can learn who the person is, and they share information amongst themselves. No other agency or service can do that.
Typically you see a psychiatrist at an outpatient clinic. You have a case manager from a different agency. For employment you go to a different agency. An addiction counselor works for a different agency. None of those people are seeing more then the part of the person their service supports and none of them are talking to each other, and certainly not every day like an ACT team. The client ends up having several friendly visitors who really don't know very much about them, because these friendly visitors see so many people, and spend so little time with each person.
An ACT team can realistically look at what is needed for the recovery of an individual. A lot of research has been done in the last ten years on "recovery" and what that means. It has been generating what are called "best practices" or "evidence based practices", and they all point to the ACT team as the most effective method of service delivery. Treatment, rehabilitation and support, can be provided simultaneously by an integrated team of specialists. ACT teams are a best practice that is also the best method of delivering best practices.
An ACT team is probably the best practice for someone with schizophrenia and a substance abuse problem, a particularly difficult population to treat and/or support. It is the best practice for the population currently in a revolving door cycle where the patient is in and out of hospital on a regular basis. It can provide crisis intervention, housing support, vocational rehabilitation, addiction counseling, employment programs, life skill training. etc. If a patient is prescribed a dose of medication that is too high, members of the ACT team can tell the psychiatrist the adverse effects immediately. They may see the patient on a daily basis and the team meets every morning to discus the entire caseload.
Many people wonder about the cost of ACT teams because they are a million dollars a team every year. Richard Sabo said that dollar for dollar they are cheaper then all the combined services an individual would utilize. I have to admit that they seem awfully expensive to me but there are other hidden costs. There is a human cost of homelessness, prison, and repeated relapse that may cause irreparable brain damage. I remember being discharged from a hospital as a "sink or swim" situation. I was being thrown into the deep end of the pool. There were no outpatient services for me except the appointment with a psychiatrist, and a referral to a day program.
When I look back to my hospitalization I can recognize that being referred to an ACT team on discharge would have helped me considerably. I was really shook up after a ten year psychotic episode that was actually quite traumatic. I had nightmares for two years after beginning medication, and I had a really difficult time adjusting to my new life. I felt abandoned by a mental health system that appeared to place a very low value on my life. Even with case management a few years later, I would have a friendly visitor for one hour once a week. In reality she often cancelled our appointments to deal with some crisis, and over a two year period she never really learned who I was or what I needed. And that is just what an ACT team is, a team of professionals that values your life. They want you to become who you are, to recover as much as possible, to do and be the things you've always wanted. It's not coercive so much as a recognition of your human dignity.
Although ACT teams will be reserved for a population with severe and persistent symptoms, notably schizophrenia, they could be used for everyone experiencing a disruption caused by mental illness. ACT teams are really an improved method of service delivery, a more efficient and cost effective method of service delivery, one that will theoretically minimize the suffering of mental illness more then any other method of service delivery.
They are already being used with first psychotic episode patients who have had a relapse. They are a recognition that mentally ill people are human, and deserve the care and services needed to help them regain their life in society.
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