Assertive Community Treatment (ACT)
Pilot Program Unveiled in Metro Louisville
10% of the population in corrections facilities has a severe mental illness. Most are there for non-violent offenses or crimes committed while they were untreated. And without support they move between jails, homeless shelters, alleys and abandoned buildings and emergency rooms. These “frequent fliers” as they are often referred to cost the system millions in tax payer dollars and their long-tern outcome for recovery is bleak.
Enter ACT or Assertive Community Treatment
Assertive Community Treatment (ACT)is designed to engage persons with a Severe Mental Illness whose needs are not met by traditional outpatient services. Services are delivered in the context and environment where they are needed (i.e. the team goes to the person). The services are flexible and are available 7 days per week, 24 hours a day.
- case management,
- individual and group therapy,
- nursing services,
- medication management,
- psychiatric services,
- supported employment,
- peer support and
- payee services
The services are ongoing and are not time limited. Qualifying individuals will remain in this program until they have stabilized enough to tolerate and benefit from traditional outpatient services.
Seven Counties Services, in partnership with Metro Corrections and the State Department of Behavioral Health, recently kicked off a $1.2 million program targeting 50 people whose chronic struggles meet the admission criteria for the program.
- Individuals with a primary diagnosis of schizophrenia, schizoaffective disorder, or a severe mood disorder who have had several psychotic episodes resulting in multiple hospitalizations and/or incarcerations, current (or imminent risk of) placement in a personal care home, or homelessness are given priority.
- Other eligible individuals are those who are diagnosed with a chronic mental disorder resulting in significant impairment in social, occupational, self -care, community functioning, home management or interpersonal functioning.
ACT is an Evidence Based Success Story
Although this is the first Assertive Community Treatment program in the state, it is not new. Over 30 years of research demonstrates that an ACT approach is both clinically successful and cost-effective. ACT is recognized nationally as an evidence-based practice that is endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA). The Louisville program consists of a team of full-time workers, including a nurse, psychiatrist, social worker and case manager who will work with identified individuals, placing them in apartments and providing around the clock support. Participation in the program is voluntary.
The ACT team will work with each individual to ensure they take their medications, follow a substance-recovery plans, help them obtain employment, help them shop for food and clothes, teach them to cook and clean, complete paperwork and in essence, do anything and everything that will aid them in beginning to live life in a responsible and healthier way.
The primary goal of ACT is to reduce inpatient time, jail time and crisis episodes while working towards integration or reintegration into society in a functional manner.
Why it works so well
- Repeated research shows that best practices in treating mental illness are community integration rather than segmented treatment.
- There is inherent value for an individual working towards recovery to work with an advisor-supporter-mentor-or coach rather than a clinician or controller.
- Continuous long-term involvement with a consistent team allows the ACT Team to truly meet the individual “where they are”, at their level and in their environment.
- The ACT Team is committed to doing what it takes to help each individual meet his/her personal success.
On an annual basis a community without an ACT Program can spend upwards of $54,000- $72,000 per chronic offender over their lifetime. With the ACT Program this cost is reduced by as much as 30%. One two year study in Chicago showed an annual jail savings of over $209,000 and over $1 million in hospital stays savings per 30 people in the ACT program.
Additional funding through Medicaid Managed Care is sought to subside the state funds used in the pilot. And the state hopes to duplicate this program elsewhere in Kentucky once initial outcomes are publicized.
The bottom line
ACT is a well-researched, clinically and cost effective intervention for reducing hospitalization and other crises. It can be effectively used with corrections populations to improve transition services, ongoing supports and inter-agency coordination. Our most ill clientele, those living with severe mental illness pose a major public health, public safety, public tax and public decency problem. The ACT Team brings a long term, evidence based program to help create a long term solution to the problem.
ACT helps keeps individuals on track and puts them on the road to recovery. And most important, through ACT the community at large can meet our combined mission of supporting the recovery of people to help them reclaim their lives. ACT offers HOPE.
The ACT team’s office hours are Monday through Friday from 8:30 am to 5:00 pm.
- Staff work from 8:30 am to 8:30 pm Monday through Saturday and can be reached by cell phone.
- Sunday and holiday hours are from 9:30 a.m. to 6 p.m.
- A team member is available to current clients after hours to provide crisis management and emergency assistance via an on-call system.
Referral forms can be requested by emailing firstname.lastname@example.org or calling the ACT office at 287-0661. Referrals are usually screened within a few days of receipt. The team maintains a data base of all screened individuals and admissions are based on acuity level (i.e. level of support needed, intensity of symptoms, lack of other supports, and inability to manage without almost daily assistance).
The ACT team is funded by the Department for Behavioral Health and is also partnered with Louisville Metro Corrections, Louisville Metro Housing Authority and the Louisville Department for Community Services.