Assertive Community Treatment Model Analysis

In an effort to transform the public mental health system, in 1963, President Kennedy proposed the Community Mental Health Act. It was the first among several federal initiatives to create a community mental health care system. Once the act was ratified, there was an intense deterioration in institutionalization, otherwise known as “deinstitutionalization”, and by 1980 there was a 75% declined of the inpatient population at many public psychiatric hospitals. In 2000, there was less than 10% of the public institutionalized just fifty years earlier. In 2009, there was even a more dramatic shift among children and adolescence whereby there was a 98% decline in

Those opposing the use of CTO’s are influenced by three reasons to support their position. The first reason deals with the current evidence base. For starters, international research literature has found no strong evidence on the positive or negative effects of CTO’s on three key outcomes. These outcomes are “hospital readmissions, length of hospital stay, and ‘patients’ quality of life” (Lawton-Smith et al, 2008) Furthermore, a 36-month study of 198 “patients” concluded that CTO’s do not prevent relapse and readmission of psychiatric inmates with severe and enduring “mental illnesses”. The study showed that results were in line with the current national use (Rugkasa, Yeeles, Koshiaris, & Burns, 2016). Analysis of these results shows that there is no compelling reason for CTO’s to continue to exists, given the lack of improvement that they provide.

With states closing many of its mental facilities in the communities, there were a lot of people in need of outpatient care who fell through the cracks of the system and ended up in prison. Prison is where many of them died from inadequate treatment. Prisons were suddenly receiving inmates with the following types of mental illnesses: Schizophrenia, bipolar, and deep depressions. These prisons just did not provide these inmates with any medication during their incarceration. Because the community based health services is lacking, and patients aren’t receiving sufficient outpatient care, it makes the effectiveness of deinstitutionalization a serious problem. Without the availability of 24/7 psychiatric services that are well structured, I believe that deinstitutionalization is what is accounting for the increase of the mentally ill inmates in the correctional facility.

Florida Assertive Community Treatment (FACT) is a program that provides comprehensive community counseling to individuals diagnosed with a debilitating mental illness. It is federally funded by the State of Florida Department of Children and Families and serves a clientele of 100 adults in the Volusia and Flagler County areas. It is a derivative of the Program of Assertive Treatment (PACT) which was developed in Wisconsin in the 1970s when deinstitutionalization was a major practice in the mental health field. This outpatient program is rehabilitation and recovery oriented. FACT is unique in that it is the only service available that offers a housing, medication, and flexible funding subsidy to enrolled individuals which help to integrate them back into mainstream civilization to be productive members of society—reducing hospitalization, homelessness, and criminal incarceration among the mentally ill.

The dynamics of the client-therapist relationship in cognitive therapy is a collaborative effort. Cognitive therapists elicit patient’s goals at the beginning of treatment. They explain their treatment plan and interventions to help patients understand how they will be able to reach their goals and feel better. At every session, they elicit and help patients solve problems that are of greatest distress. They do so through a structure that seeks to maximize efficiency, learning, and therapeutic change (Robert & Watkins, 2009). Important parts of each session include checking the client’s mood, a connection between sessions, setting an agenda, discussing specific problems and teaching skills in the context of solving these problems, setting of self-help assignments, summary, and feedback (Robert & Watkins, 2009). The status that CBT has with insurers and funding agencies is a result of concrete and measurable goals, goal-focused processes and clear outcomes-based evaluations/results. Therapy is typically conducted in an outpatient setting by trained therapist in cognitive behavioral techniques. Treatment is relatively short in comparison to some other forms of psychotherapy, usually lasting no longer than 16 weeks.

Regarding the treatment of mental illness, there are two effective forms that have caused considerable debates in the field of psychology: the medical and the recovery models. While there are significant differences between these two models, they are both effective when used concurrently. The efficacy of the medical model alone is diminishing as it focuses too narrowly on treatment goals, and may ignore the needs of the client. On the other hand, the recovery model focuses on the client and allows them to take control of their treatment and rehabilitation, which helps promote positive change. Recovery is often seen as a lifelong journey that requires the client to be wholly involved in the recovery process. This is why the recovery model values

The United States criminal justice system has been continuously increasing incarceration among individuals who suffer from a sever mental illness. As of 2007 individuals with severe mental illness were over twice as likely to be found in prisons than in society (National Commission of Correctional Health Care, 2002, as cited in Litschge &Vaughn, 2009). The offenses that lead to their commitment in a criminal facility, in the majority of cases, derive from symptoms of their mental illness instead of deviant behavior. Our criminal justice system is failing those who would benefit more from the care of a psychiatric rehabilitation facility or psychiatric hospital by placing them in correctional facilities or prisons.

NDCC 25.03.2-06 creates admission criteria for psychiatric residential treatment facilities, or also known as residential treatment centers. The main criteria outlined is a diagnosis of an mental illness or emotional disturbance by a psychiatrist or psychologist, which cannot be treated at a lower level of care. While in general a seemingly good policy with positive aspects, there are a few issues with NDCC 25.03.2-06 that both policy makers and social workers working in PRTFs should be aware of. This paper will analysis the policy in further depth to determine if changes should be made.

The mentally ill got actual treatment for their mental illnesses instead of just being tossed into jail. This approach reduced the amount of time law enforcement officers had to wait in the ER on a mental illness case from 8-14 hours to about 15 minutes when police took those in crisis to treatment centers. The amount of money spent by sending those with mental illnesses to jail was $2,995 per incident but with this approach of instead taking them to a treatment center, the amount of taxpayer’s money spent went down to $350 per incident. The third approach took place in Seattle and it involved the LEAD program which was a treatment program. The LEAD program works with drug abusers which often times are long-term drug abusers to help them customize a way out and get them back on their feet instead of ending up dead or in jail. The approximate cost per person for 30 days in jail was $3,104 of taxpayer’s money opposed to $240 in the LEAD

Kendra’s Law established a procedure for obtaining court orders for individuals with a mental illness to receive AOT who respond well to a structured environment (e.g. hospitalization, or assisted living) but, struggle to maintain stabilization while out in the community. In addition, clients can voluntarily enroll in AOT, also known as, diversion. The AOT provisions of Mental Hygiene Law section § 9.60 were designed to identify at-risk individuals using specific eligibility criteria to assess whether court-order outpatient treatment is required.

In today’s society there is a greater awareness of mental illnesses. With this greater awareness one might assume that there would be a substantial increase in government involvement or funding in the area of mental illness treatment. Unfortunately this isn’t the case in the U.S. today. There are hundreds of thousands of people with mental illness that go untreated. These potential patients go untreated for many reasons. These reasons are discussed in the Time article “Mental Health Reform: What Would it Really Take.

In 1965, there was a histrionic change in the method that mental health care was delivered in the United States. The focus went from State Mental Hospitals to outpatient settings for the treatment of mental health issues. With the passing of Medicaid, States were encouraged to move patients out of the hospital setting (Pan, 2013). This process failed miserably due to under funding and understaffing for the amout of patients that were released from the State Mental Hospitals. This resulted in patients, as well as their families, who were in dire need of mental health services. This population turned to either incarceration (jails and/or prisons) or emergency departments as a primary source of care for their loved ones.

In the early 1960’s, Canada began its movement towards deinstitutionalization, based on the belief that community based care would better serve populations affected with mental illness (Davis, 2014). As a result, legislation sanctioning involuntary treatment within community settings became increasingly used (Davis, 2014). Currently under civil law, there are three methods of initiating mandatory outpatient treatment in Canada (Davis, 2014). In British Columbia, mandatory outpatient treatment occurs when an individual is placed on a leave provision following involuntary admission in hospital (Davis, 2014). Once this is completed, the individual is considered to be on extended leave, and their care is transferred to a community mental health

Assertive Community Treatment (ACT) is a mobile out-reach treatment model for adults who suffer from mental health illness. A community based, individualistic support program, ACT is designed provide the same type of support and treatment a patient would find in a clinic (McAuliffe. W. E., 1990). The program considers circumstances of why an individual became homeless and aims to provide mental health care along with vocational training to find a job and stable housing (McAuliffe. W. E., 1990). ACT is based on the health belief model of behavior change. The stages of behavior change are employed by counseling sessions that address mental health symptoms and encourage self-efficacy through coping skills and job training.

Specific Purpose: To inform my audience how treatment of mental illness in America has changed.