Community care for the mentally ill - Research Paper Example

? Final Paper Outline and Number] of Lecturer] Introduction The mentally ill are among the most vulnerable groups in society and no efforts and resources should be spared while addressing their proper care and management. There are several reasons for which care and management are crucial for mental illness patients in a community. To address these reasons, specifically the need for quality and enjoyable life for the mentally ill, many a stakeholder has designed and implemented numerous approaches, interventions, and policies (Knoedler & Allness, 2003). On effect of mental illnesses is that they kill their victims rather more prematurely compared to with the rest of the population. The main explanation for these premature deaths among the mentally ill is the occurrence of other related health issues and conditions, which the mentally ill fail to report or manage well. In fact, in most cases, these conditions go unnoticed and untreated. It is thus important that homes and communities give the best possible care and management for the mentally ill to meet some, if not all of their needs such as access to healthcare so that further pain and premature deaths due to physical and psychological conditions are prevented (Knoedler & Allness, 2003). Core in a patient-centered care for the mentally in communities such as the Assertive Community Treatment (ACT) is a team/community-based care, which seeks to help the mentally ill achieve their self-sufficiency goals. Person-centered care management for the mentally ill has been described as among the best policy options for protecting and improving the health and well being of vulnerable populations and reducing the cost of healthcare for these people. This report explores the Assertive Community Treatment model for caring for the mentally ill. Assertive Community Treatment (ACT) Model Generally, care management for the mentally ill should involve the coordination of health and social services to counter the unnecessary use and waste of services and resources on fragmented and ineffective interventions. On the contrary, such a care should seek to prevent avoidable conditions and promote not only self-care but also independence among mental illness patients. There are various models in which mental illness care management manifests in communities including utilization management, personalized nurse counseling, case management, pharmacy review, and depression management programs (Witheridge, 1991). The emphasis that care management professionals lay on mental illness care augers well with the current healthcare systems’ movement towards recovery-, independence-, and resilience-oriented policies. Regardless of the model of community-based care applied to a given patient or community, there are several core functions that such a model should perform (Witheridge, 1991). These functions include but are not restricted to educating and enlightening patients, their families, and caretakers, building and ensuring a rapport with patients and other stakeholders, and communicating diagnosis and evaluation findings to patients, families, and healthcare providers. The other functions of community-based healthcare models for the mentally ill include the development and maintenance of self-care action plan and the minimization of adherence to strict plans when care- or treatment-emergent problems occur to allow for the application of the best alternative (Witheridge, 1991). Principles, Features, and Strengths of ACT Past and recent researches and literatures have extensively tackled the Assertive Community Treatment model for mental illness patients with regards to its principles and effectiveness in offering care and management to the affected. The model has been reported to be particularly useful for patients whose mental conditions have rendered them physically and psychologically dysfunctional, weak, or ineffective. Among the aspects of victims’ lives rendered functionless by some mental conditions are relationships, work life, physical health, self-esteem, and self independence among others (Witheridge, 1991). There are several core characteristics of ACT, which make it quite ideal for patients of serious mental illnesses with interrupted or impaired functionalities. First, ACT emphasizes the need to focus on patients in serious mental health issues. That is, it recognizes that these patients are the reasons such healthcare programs are implemented and should therefore get the maximum possible benefits out of these programs. Consequently, the ACT model of mental patient care has the sole objective of ensuring patients achieve full rehabilitation, independence, recovery, and self-reliability. In realizing such objectives, ACT will have solved other mental illness-related problems such as negative outcomes, prolonged and unnecessary hospitalization, stigmatization, low self-esteem, and homelessness (Witheridge, 1991). To further involve the immediate community of its participants, ACT emphasizes the importance of home visits and outdoor interventions. An ACT Team and its Functions Teamwork is the other critical feature of the ACT model, which makes it a favorite of mental healthcare professionals. In these teams, all the professionals work with and for all the participants, under the leadership of a qualified mental health professional. The staff diversity is also important since an interdisciplinary approach to mental healthcare is important for full rehabilitation of patients (Stein & Santos, 1998). These professionals are involved in all the stages and aspects of mental healthcare such as planning, implementation, evaluation, and policy reformation. To be included in these teams are social workers, substance abuse specialists, occupational therapists, vocational rehabilitation specialists, medical doctors, nurses, psychiatrists, and peer specialists (Stein & Santos, 1998). Besides an interdisciplinary approach, ACT also identifies with the willingness on the part of the stakeholders to be part of the bigger team, each member taking responsibility for the progress and the wellbeing of the participants. There are other specific features of ACT worth mentioning. For instance, ACT teams have the mandate to support special types of mental illness patients such as those who have been hospitalized regularly or for long periods or have undergone dual diagnoses. A dual diagnosis may include mental illness and developmental disability or substance abuse or any other condition (Stein & Santos, 1998). These patients may also be those having been involved with the criminal justice system in one way or the other, and thus may have special needs. Because of the different and distinctive conditions of participants, ACT programs should be tailored to meet the needs, preferences, and objectives of each client. Since it is a community-based approach to dealing with mental illness and its effects on it victims, ACT prefers a mobile team, which moves from one location to another while delivering its services (McFarlane, 2004). This promotes participants’ receptiveness, relaxation, convenience and comfort. The ACT team provides a number of crucial services to its clients such as case and crisis assessment and intervention, substance abuse services, work-related services, daily living activities, and consultation, educational and awareness services to clients, families, and local communities (Stein & Santos, 1998). The other services are assessment of symptoms, individual supportive therapies, monitoring and documentation, leisure, social, and interpersonal relationship training, and medication prescription, administration. ACT as an Evidence-Based Mental Illness Care That ACT is a favorite of mental healthcare professional is evidenced by the many literatures and researches on the model and its modifications. In fact, starting with the initial Madison studies by Len Stein and Mary Ann Test and their colleagues, ACT stands out as one of the most extensively researched models used in community mental healthcare and management. However, it is not only the original ACT that has caught the attention of authors and researchers: rather, its many variations that have come up since the 1970s when it emerged (Johnson, 2010). Covered by research and literatures are the many styles and approaches to ACT, which have been put in practice in recent times. These variations and modifications have been necessitated by the need to effectively address the ever emerging mental problems and delivery challenges. Examples of the challenges for which the original ACT model has been modified include the need to treat a mental illness patient with a co-occurring psychiatric or substance abuse-related complication or to help a victim of mental illness retain a well paying job by incorporating a rehabilitation-oriented variation of ACT (Johnson, 2010). ACT has also been modified to help patients to reclaim the ability to manage their illness and recovery and to take charge of their daily activities and life in general. Research findings have also indicated that ACT is an evidence-based model of caring for the mentally ill in the community. First, research reports show a high rate and a track record of success for ACT and its modifications. This success is not restricted to particular regions or class of patients: rather, it has been reported for a wide range of geographical, socioeconomic, cultural, and institutional settings. The model’s success has thus attracted a lot of researchers and authors/educationists who want to delve deeper and study the principles that make ACT such an effective tool in caring for the mentally ill in a communal setting (Johnson, 2010). Among the private professional and governmental agencies and organizations that are currently intrigued by the success of ACT and have since taken a keen interest on the model are the National Alliance on Mental Illness (NAMI), the Commission on Accreditation of Rehabilitation Facilities (CARF), Robert Wood Johnson Foundation, and the US's Substance Abuse and Mental Health Services Administration (SAMHSA). These agencies concur that ACT is a model worth disseminating to all the needy mental illness patients. Despite its reported and apparent success, ACT has not escaped criticism from certain quarters. For instance, some research groups and individual researchers feel that ACT is an inherently coercive model of healthcare for mental illness patients and many of the studied supporting it could be scientifically invalid. This criticism has been leveled against ACT despite its success with mental illness patients in the last four decades. In fact, in many regions, ACT has replaced institutional care for mental illness patients. The main source of the criticism of ACT is the fact that most past studies on its success seem not to include data on client satisfaction. Additionally, most of the past reports on satisfaction levels did not use recognized instruments to measure the satisfaction, opting to apply improvised client satisfaction questionnaires, which give rather generalized measures of satisfaction (National Alliance on Mental Illness, 2002a). These ad hoc approaches to these surveys have only failed to capture certain aspects of dissatisfaction. The majorly used general satisfaction questionnaires thus tend to yield exaggeratedly positive results. It has since been recommended that domain-specific measures should be taken to ensure an approach equally sensitive to satisfaction and dissatisfaction is adopted. Once such approach has been identified and due to the increased use of ACT to treat persons with serious mental illnesses, clients’ opinions on and satisfaction with the ACT model is now solicited. Studies such as mailed surveys should therefore be applied while seeking information from clients on how the service rendered under ACT may be optimized (National Alliance on Mental Illness, 2002b). The mailed survey approach has particularly been proposed for such assessments since it is efficient and nonintrusive for the anonymous collection of data on client satisfaction. As a matter of fact, such a mailed survey to measure client satisfaction with Assertive Community Treatment was conducted in by Gary J. Gerber, Ph.D.; Pamela N. Prince, M.A. in 1999, reporting a similar result to those reported earlier. That this study’s findings reported same level of satisfaction with the ACT model among respondents implies its effectiveness in treating serious health problems at the community level. However, there were some reported needs that clients felt were not adequately addressed by ACT. Some of these needs have since been addressed in the subsequent ACT programs. The changes include the review of medication policies to strengthen the information on the benefits and side effects of some medications. Second, summaries of patients’ treatment plan are now given and the clients’ asked to sign, acknowledging their participation. In some programs, cards containing the medications received, the purposes and dosages of drugs, and their adverse effects are given to patients. Health Rights for the Mentally Ill Notwithstanding the criticism directed at ACT and other models of community-based care for the mentally ill, these models and their programs are quite crucial not only in rehabilitating mental illness patients but also in making them self-reliant and dependable members of society once recovery is complete. There are several vital functions that ACT and other such models play as community mental health and social care tools. First, community-based care for mental illness patients ensures that their rights to healthcare services are protected (Dixon, 2000). It is sad to note that most healthcare programs and resources are directed at other forms of illnesses, leaving mental illness patients unattended or neglected by the sector. The health needs of the mentally ill should equally be assessed to ensure they meet the eligibility criteria for admission into various mental health programs (Dixon, 2000). In fact, for mental patients, such an assessment should cover health as well as social welfare/needs so that both services are offered concurrently. Luckily, the government has made available several laws and documents that ensure mental illness patients are entitled to community- and non-community-based social and health services. An example of these vital documents is the National Service Framework [NSF] for Mental Health. The NSF details the policy guidelines on mental illness patients’ entitlement to services, giving a broader definition and coverage of mental illness. This definition covers even the commonest of mental health problems, which should be addressed under a 24-hour access to local services policy (Dixon, 2000). Conclusion Assertive Community Treatment (ACT) is one of the many intervention models used to care for and treat mental illness patients. The outstanding feature of this approach to mental healthcare and management is that it is person-centered and is offered by a team of professionals, each member with a designated responsibility for clients with special needs and circumstances. An ACT team incorporates social workers, substance abuse specialists, occupational therapists, vocational rehabilitation specialists, medical doctors, nurses, psychiatrists, and peer specialists. The functions of these professionals are case and crisis assessment and intervention, substance abuse services, work-related services, daily living activities, and consultation, educational and awareness services to clients, families, and local communities. The other services include assessment of symptoms, individual supportive therapies, monitoring and documentation, leisure, social, and interpersonal relationship training, and medication prescription, administration. References Dixon, L. (2000). Assertive Community Treatment: Twenty-Five Years of Gold. Psychiatric Services, 51, 759-765. Johnson, S. J. (2010). Assertive community treatment: evidence-based practice or managed recovery. Transaction Publishers. Knoedler, W. H., and Allness, D. J. (2003). A manual for ACT start-up: based on the PACT model of community treatment for persons with severe and persistent mental illnesses. Arlington, VA: National Alliance on Mental Illness. McFarlane, W. R. (2004). Multifamily groups in the treatment of severe psychiatric disorders, first edition. The Guilford Press. National Alliance on Mental Illness. (2002a). What about Assertive Community Treatment? An Interview with PACT's William H. Knoedler, M.D. Retrieved on September 17, 2012 from http://www.nami.org/Content/ContentGroups/Programs/PACT1/What_About_Assertive_Community_Treatment_An_Interview_With_PACTandNum8217;s_William_H_Knoedler,_M_D_.htm National Alliance on Mental Illness. (2002b). Where Does Assertive Community Treatment Fit into Your Mental Health System? Retrieved on September 17, 2012 from http://www.nami.org/Content/ContentGroups/Programs/PACT1/Where_Does_Assertive_Community_Treatment_Fit_into_Your_Mental_Health_System_Court_Decision_Should_Op.htm Stein, L. I., and Santos, A. B. (1998). Assertive community treatment of persons with severe mental illness. New York: Norton. Witheridge, T. F. (1991). The active ingredients of assertive outreach. In N. L. Cohen (Ed.), psychiatric outreach to the mentally ill). San Francisco: Jossey-Bass. Read More