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Where Does Assertive Community Treatment Fit into Your Mental Health System?

Court Decision Should Open Doors
to the Community for Consumers

by Elizabeth Edgar, Director of the NAMI ACT Technical Assistance Center

For many years, programs of assertive community treatment (ACT) have helped people with severe psychiatric disabilities, such as schizophrenia and bipolar disorder, live in their communities. Research demonstrates positive outcomes for this comprehensive outreach approach that uses multidisciplinary teams.

For most enrollees, ACT programs lead to significant improvement in their quality of daily life and in their psychiatric conditions. Hospitalizations, homelessness, arrests, and incarceration decrease. Consumers served by ACT teams generally express strong satisfaction with their care. The teams effectively, and cost-effectively, work with people who have been discharged from psychiatric hospitals and jails and people who are homeless. For many people, ACT is an alternative to hospitalization.

The Olmstead Decision

In June 1999, the U.S. Supreme Court affirmed that under the Americans with Disabilities Act (ADA), it is discrimination to confine a person in a nursing home or mental hospital if, with proper support, he or she could live in the community.

Based on a case in Georgia (Olmstead v. L.C.), the court found that unjustified isolation in an institution is discrimination on the basis of disability and a violation of the law. The court also stated that the ADA does not mean an end to placement in institutions for people who require the highest level of care and that people who want to remain in a nursing home or mental hospital should not be required to live in the community.

The Olmstead Decision provides an opportunity for the development of more assertive community treatment teams to help consumers who want to live in their towns and cities.

Because of the Olmstead Decision, the federal government requires every state to plan for community treatment for people with disabilities whose needs can be met outside an institution. States must demonstrate to the federal government that they have "comprehensive, effectively working plans" for providing services to people with disabilities in "less restrictive settings" and that waiting lists for community services move at a "reasonable" pace. Every state department of mental health is developing a plan to meet the requirements of the Olmstead Decision.

Assertive community treatment is one option that should be a part of every state's Olmstead plan because ACT programs exist specifically to give consumers the choice of living in a community or in an institution. An ACT program can overcome the barriers to living in communities faced by people leaving, or being diverted from, admission to institutions.

• ACT provides individualized, flexible services that support people over time and work with the cyclic nature of serious, persistent, long-term mental illnesses. The continuing support of ACT team staff, who are known and trusted, can prevent some crises and help people hold onto housing and employment if symptoms worsen.
• Adequate income is required for community living. ACT staff help consumers enroll in programs so that they receive benefits such as Social Security and housing subsidies and find and keep employment.
• ACT fosters community integration. With team staff support available 365 days a year, ACT helps consumers live among the general public. Rather than thinking in terms of only group homes, ACT supports a wider range of integrated housing, which usually includes apartments.
• Nurses and the psychiatrist on the ACT team help consumers get adequate primary medical and dental care.
• ACT teams prevent fragmentation of services. Rather than referring people to various agencies, the team itself provides psychiatric treatment, substance abuse treatment, and housing and employment support services. The team guides consumers into taking part in community activities and relying on supports such as family, friends, and peer support groups.
• ACT helps consumers more clearly understand mental illnesses and how to manage their own health.

As the U.S. Surgeon General's Report on Mental Health states, "Across the nation, certain mental health services are in consistently short supply. These include assertive community treatment. It is essential to expand the supply of effective, evidence-based services throughout the nation."

Again, the Olmstead decision offers every state excellent reason to improve community services, including assertive community treatment.

Please contact your state NAMI office to learn about public input for your state's Olmstead plan.

The NAMI ACT Technical Assistance Center has an email group called ExpertsRus@nami.org for consumers employed as staff on assertive community treatment teams. Here they can talk about what it is like to be both an ACT staff member and recovering from a mental illness. To join, please send an email to Elizabeth@nami.org

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