Assertive Community Treatment (ACT) a well-rounded, adaptable option for SMI patients

If you’ve watched the news or social media discussions during the past few months, there has been a lot of discussion about mental health in regards to the social consciousness and actions of America’s citizens.

According to the National Institute of Mental Health (NIH), a serious mental illness (SMI) is defined as “a mental, behavioral or emotional disorder resulting in serious functional impairment that substantially interferes with or limits one or more major life activities”.

Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (46.6 million in 2017). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate to severe.

Two broad categories can be used to describe these conditions: Any Mental Illness (AMI) and Serious Mental Illness (SMI). AMI encompasses all recognized mental illnesses. SMI is a smaller and more severe subset of AMI.

According to 2017 mental health data, an estimated 11.2 million adults — or about 4.5 percent of U. S. adults —were diagnosed with an SMI. Individuals with SMI suffer from symptoms that severely impact their ability to function in daily living. Often, this results in frequent and/or repeated hospital stays and incarcerations. This can cause complications to be compliant with medical/mental health treatment, sustain housing and employment, and foster supportive relationships. Those with an SMI often go untreated, leading to a rapid decline in both their mental and physical wellbeing.

There are treatment options available for SMI patients.

One option, in particular, is the Assertive Community Treatment (ACT) model, an intensive and highly integrated approach for community mental health service delivery. This model is recommended for individuals with an SMI who have a history of repeated hospitalizations or homelessness.

It is a team-based program that provides clinical and care-management services to help clients stay in the community. This is accomplished by allowing the client to maintain a safe residence in the community and increase compliance with antipsychotic and other medications while reducing the need for emergency psychiatric services and hospitalizations.

This approach includes case managers, psychiatric providers, primary care and legal advocates. Case managers assure the patient is aware of follow up appointments and often accompany that person to appointments.

Patients who are part of ACT teams are monitored closely with some having daily calls or visits. This daily patient contact has proven to improve medication adherence. The team-based approach assures that the client has the resources needed to live in the community (such as transportation), help with budgets, shopping and coordinating the often-complex healthcare system.

In randomized trials, ACT led to a 37 percent reduction in homelessness and a 26 percent improvement in psychiatric symptoms compared to standard case management. The ACT treatment model indicates a dramatic reduction in the need for repeat hospitalization. Close monitoring resulted in improved treatment compliance and reduced psychiatric symptoms in SMI patients.

The ACT model has shown improvements in comorbid chronic medical conditions. This is a direct result of the collaborative interdisciplinary care within the treatment team. ACT patients are healthier — both mentally and physically.

The ACT model provides the least invasive and most well-rounded treatment for an individual. It is highly adaptable to existing mental health services and may be an ideal choice for SMI patient health care needs.

For more information about ACT, please download this fact sheet provided by the National Alliance on Mental Illness Minnesota.