|National Alliance on Mental Illness
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What Do Consumers Want To Know About PACT (Program of Assertive Community Treatment)?
What is PACT ?
When NAMI folks refer to PACT we mean the model described in The PACT Model of Community-Based Treatment for Persons with Severe and Persistent Mental Illnesses: A Manual for PACT Start-Up, (for short called the PACT manual) and in the National PACT Standards. PACT teams are made up of a psychiatrist, social workers, peer specialists (people who are or have been recipients of services for severe and persistent mental illness who are paid PACT staff), nurses, paraprofessional mental health workers, employment specialists and substance abuse specialists. Any staff position on a PACT team can be held by a qualified person who is recovering from a severe mental illness. Many consumers find employment on an assertive community treatment team to be satisfying work.
Unfortunately, there are programs that call themselves programs of assertive community treatment that do not live up to the real PACT model. These programs may be under-staffed, under-trained, and lack key services (such as employment or substance abuse treatment.) They may lack the weekend and evening operations, and crisis services that the PACT Standards require. Poor programs that use the name PACT or assertive community treatment (ACT) without fully implementing the assertive community treatment model, can give a bad impression of assertive community treatment.
Is PACT a narrow medical model ?
No, PACT provides much more than medical care. PACT helps people get and keep employment or further education, make friends and enjoy leisure time. The PACT team helps with independent housing and with entitlements, such as Social Security, Medicaid, and Section 8 rental assistance. The PACT staff does directly provide psychiatric and substance abuse care and coordinates with medical care providers.
Who is PACT for ?
Most people with severe and persistent mental illnesses do not need as much help as PACT offers. But people who have both severe mental illness and substance abuse disorders, who are at high risk for arrest and jail, who don't go to mental health office appointments, or who cannot meet their own basic needs and are homeless may benefit from PACT.
In PACT do consumers have to take medications ?
PACT consumers have choices, including choice about taking medications. If a person does not want to take medication they are not discharged or abandoned. PACT continues to work with them in other areas such as housing, finding a job, and managing symptoms without medications.
If a consumer does choose to take medication, do PACT team staff come to their house every day to bring medication and watch them take it?
PACT does not deliver medications to most PACT consumers' homes. Rather, consumers develop individualized strategies with staff, when both agree it would be helpful, to develop a medication schedule that will optimize the medication's potential benefits and fit with the consumer's daily routine. Such strategies may include putting medications in plastic daily or weekly containers, or giving reminders, or providing the option of picking up medications at the PACT team's office, or in some circumstances delivering medications on a daily basis to the consumer's residence. The goal is for each person who takes medication to manage their own medicine as part of their recovery process. Medication is one tool that, when carefully used and adjusted based on the consumer's feedback, helps many people to better manage their health.
Are people involuntarily committed to PACT ?
The vast majority of PACT consumers are voluntary, likely more than 80%. National figures are not available. PACT was developed in the early 1970s as a less restrictive alternative to inpatient, often involuntary, treatment. Courts do order some people to receive care in the community and a PACT team may be able to help some people avoid a return to jail or prison, or involuntary hospitalization.
Does PACT foster dependency ?
From the start in 1972 in Madison, Wisconsin, assertive community treatment's intent was to provide consumers with enough support so they are able to meet their needs and grow, but never to do for consumers what they are able to do for themselves. PACT can help provide the stability and continuity for people to take control of their lives, move ahead with their recovery.
Is PACT coercive ?
A PACT team that meets the National PACT Standards should not be coercive. A small segment of consumers who are on involuntary court orders may have some of their choices limited by the court order whether they are served by a PACT team or another provider. A PACT team should have a respectful, collaborative, trusting, recovery-oriented relationship between staff (that includes consumer-providers/peer specialists) and consumers.
Over the years, the PACT model has evolved and continues to improve as it learns from consumers. Dr. Mary Ann Test, a PACT co-founder, notes some examples of the way PACT works now:
- "Care plans and updating are done very collaboratively with consumers and are based on the consumer's goals;
- Staff and consumers know one another very well and have very strong partnerships;
- Consumers ARE encouraged to try new things and learn from experiences, the same as we all do;
- There is a huge emphasis on education and on helping consumers "come to terms" with their illness and self-manage it, including actively assisting people in enhancing their (already existing) strategies for stress and symptom self-management;
- The original goals of assisting consumers to have a decent and satisfying life are still there, but with no preconceived limits as to what that might be."
NAMI ACT Technical Assistance Center