On February 1, Places for People launched another ambitious program designed to help those living with serious and persistent mental illness. The agency has implemented an Assertive Community Treatment (ACT) program that targets men and women with untreated psychiatric disorders who also have a history of substance abuse, chronic homelessness and frequent psychiatric hospitalization.

This new effort is being funded by the Missouri Department of Mental Health and is being tested statewide. The $1.8 million program was approved by the state legislature and was announced by Governor Matt Blunt in January.

The ACT program aims to reach people who are not only extremely ill, but also those who have been deemed “high users” – people who utilize a disproportionate amount of publicly funded health services.

“They are among the most challenging in our system, “explains Joe Parks, M. D., Director of the Division of Comprehensive Psychiatric Services for Missouri’s Department of Mental Health, “…they are hard to reach and to keep in treatment.”

PfP Executive Director Francie Broderick notes that the ACT program should not be viewed as a punitive program, “It’s important to understand that these individuals are not ‘bad people’ who are ‘abusing’ the system….they’re simply people who are very sick, very poor, and who have no access to healthcare. The people we will be reaching are people who have not been able to maintain relationships with community providers, because of paranoia, substance abuse problems, inability to stay housed…or a combination of the three. Many times, their illness is so severe, so extreme, that traditional treatment methods have failed.”

Broderick continues, “Even when they have been linked with service providers, the time and resources needed to get them stabilized have not been available.”

PfP’s ACT program is designed to dramatically reduce the number of costly psychiatric hospitalizations by providing an extremely aggressive and comprehensive level of individualized care. These services include:

• Assistance in finding, getting and keeping housing
• Assistance with community integration, creating supportive relationships and overcoming fear of others
• Assistance with establishing life and individual recovery goals, e.g. school, work, parenting
• Assistance with managing Medicaid, Social Security and other public assistance
• Coordination of all medical and psychiatric care
• Medication management
• Money management
• Parenting Supports
• Problem solving and crisis intervention
• Social skills training
• Substance abuse services
• Teaching and supporting people in activities of daily living
• Treatment planning

These services are very similar to the supports that PfP’s existing continuous treatment teams have been utilizing since 1992. PfP has six teams of trained social workers to provide vital mental health and community support services 24-hours a day, 365 days a year.

Where the ACT approach differs is that the team also includes substance abuse and vocational rehabilitation specialists, as well as a dedicated nurse and psychiatrist. This team will address the needs of the 75 clients who are expected to enter the program in its first year.

The ACT model utilizes a ten-to-one ratio of clients to support workers, a ratio that PfP employs on all of its support teams. While many healthcare and social service programs are burdened with caseloads of hundreds of clients per social worker, the ACT method focuses on extremely individualized services.

The ACT project is being managed by the agency’s HOME team, a community support program started in 1998 to provide mental health outreach services to St. Louis’ homeless population.

“Our team of community support workers have an amazing track record of helping people stabilize their lives,” explains Broderick. “We’re hopeful that the addition of highly specialized and trained medical specialists will allow us to reach and to help people we’ve been unable to reach before.”

Developed in Wisconsin in 1978, the ACT model has proven to be effective in treating severe mental illness, especially schizophrenia and bipolar disorder.

According to the National Association of Mental Health, six states have implemented ACT programs on a statewide level.

Labels: Assertive Community Treatment, Homeless Outreach, Winter-Spring 2008