Florida Assertive Community Treatment Program

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.

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.

This article focuses on the use of faith-based education to educate African-American youth on the topic of HIV and AIDS prevention up to and including drug use and sexuality activity as opposed to a more secular approach.

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 clients 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

Ridgely, S.M., Borum, R., & Petrila, J. (2001). RAND: The effectiveness of involuntary outpatient treatment: Empirical evidence and the experience of eight states. Retrieved from http://www.rand.org/content/dam/rand/pubs/monograph_reports/2007/MR1340.pdf

The program has implemented five elements of intervention. They are group therapy, support groups, individual counseling and urinalysis. The therapists apply motivational enhancement therapy, cognitive, therapy, and psych-educational therapy (New Horizons Community Mental Health Center, 2014).

The Louis de la Parte Florida Mental Health Institute (2002) states that substance abuse can occur in many clients who also have anxiety/stress disorders. The user believes that using alcohol or drugs will help lessen the feelings they have and somehow enable them to “cope” (The Louis de la Parte Florida Mental Health Institute, 2002). Unfortunately, most users like James are unable to realize the substances are not helping their problems. Most people with alcohol and other drug use disorders who also suffer from other mental health disorders require an integrated care plan for the best chance at recovery (Sterling, Chi, & Hinman, 2011).

Seeking to improve care and lower costs, Florida became the first state to offer a Medicaid health plan designed exclusively for people with serious mental illnesses, such as schizophrenia, major depression, or bipolar conditions. The plan offered by Connecticut-based Magellan Complete Care - is part of a state experimentation to co-ordinate physical and mental healthcare for those enrolled in Medicaid. Mental illness is a big driver of Medicaid costs because it is twice as prevalent among beneficiaries of the public insurance program for the poor as it is among the general population. Studies show that enrollees with mental illness, who also have chronic physical conditions, account

The difference should not affect the quality and success of the program, as the target population for PATH is 18 and older. Each of the EBPs reviewed were developed for individuals with mental illness and/or substance abuse to be utilized during reintegration into a more independent living environment. The Critical Time Intervention (CTI) aims to prevent recurrent homelessness in individuals with severe mental illness leaving shelters, hospitals, or other organizations aiding the homeless (Critical time intervention - top tier, (2013). Not all of these approaches have been tested on the targeted homeless demographic. The Modified Therapeutic Communities (MTCs) focus on offenders with mental illness and chemical abuse (MICA) disorders (Modified Therapeutic Community for Offenders with Mental Illness and Chemical Abuse Disorders (MICA). However, the U.S. Department of Housing and Urban Development (2012) classify offenders and incarcerated adults as at risk of homelessness. Therefore, these strategies should still produce a similar positive outcome for the targeted homeless population. Research has indicated that community integration and recovery from mental illness and substance

Due in part to the community's lack of preparedness and resources, the needs of many of the deinstitutionalized has not been meet. Therefore many of the mentally ill have ended up exchanging hospitalization for institutionalization in prison or jail." This situation left many mentally ill on the streets with no one to look after them except the nation's police. Another reason for the increasing number of mentally ill individuals in the community is the expense of mental health services. Many individuals are unemployed and therefore without income. Many are not covered by health insurance and the individuals who do have insurance are often smothered under restrictions on coverage for mental illness. Others face time limits on in-patient treatment that will have rewarding effects. Others have difficulty accessing government-funded health coverage. Others depending upon their condition are not even aware that this program exits. Regardless of the reasoning police, as well as judge's and probation officers are on a daily basis faced with the increasing number of mentally ill individuals that are rotated amongst the system.

Regardless of age, life can challenge an individual with complex issues such as mental illness and substance abuse. The Cone Health Behavioral Health Hospital, one of the many

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 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.

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.

The purpose of the article is to identify a clinical approach and challenges around the transition from assertive community treatment to less intensive services. According to the article, the data used was collected from four focused group which includes client/clinical, family and natural supports, assertive community treatment staff and team, and public mental health system. In order to identify the challenges several factors were considered in the process, the belief that clients and families would not want to terminate services (due to loss of relationships, fear of failure, preference for ACT model), clinical concerns that transition would not be successful (due to limited client skills, relapse without ACT support), systems challenges