Clinton Administration Supports Assertive Community Treatment
Initiative Challenges the Status Quo, Experts At NAMI Convention Declare
– Amidst all the speeches and announcements at the White House Conference on Mental Health, one little-noticed action by the Clinton Administration has opened the door for what could be a revolution in the treatment of persons with severe and chronic mental illnesses.
In a June 7th letter released today at the national convention of the National Alliance for the Mentally Ill (NAMI), Sally K. Richardson, the Director of the Health Care Financing Administration (HCFA) of the U.S. Department of Health & Human Services advised state Medicaid directors that Assertive Community Treatment (ACT) and Assertive Case Management (ACM) programs "can be supported under existing Medicaid policies" and that states should consider the recommendation of the Schizophrenia Patient Outcomes Research Team (PORT) supported by the National Institute of Mental Health and Agency for Health Care Policy & Research in developing "comprehensive approaches to community-based mental health systems."
HCFA quoted the 1998 PORT study to note that ACT and ACM "are superior to conventional case management for high risk cases." Typically, the programs include:
- interdisciplinary treatment teams with shared caseloads
- 24-hour access and mobile crisis teams
- assertive outreach to treat clients in their own environments
- individualized treatment plans
- medication and support services
"ACT programs meet the real needs of persons with severe mental illnesses," said NAMI Executive Director Laurie Flynn. "They keep people from falling between the cracks. They provide the best results for taxpayer dollars. They are the state-of-the art answer to many of the failings of the current mental health system---which is a system in crisis."
During a plenary discussion at NAMI’s convention on July 1, a panel of speakers on ACT warned that even with the Clinton Administration’s support, persuading states to shift to assertive models involves challenging the status quo.
"Don’t be afraid to be unpopular if that’s what it takes," NAMI Virginia Executive Director Valerie Marsh told the convention of over 2,500 people. "We have a non-compliant system that is office-bound, focuses on emergencies instead of prevention, and doesn’t serve people’s needs. ACT symbolizes the shift that the whole mental health system needs to make."
The HCFA letter also declared: "Consumer participation in program design and the development of operational policies is especially key in the successful implementation of ACT programs."
"Let’s stop assaulting the knowledge and intelligence of people with mental illness," said Deborah Allness of the University of Wisconsin’s School of Social Work, who also spoke on the NAMI panel. "The power of ACT is unassailable. It lets the person shine through."
Dylan Abrams, an ACT emergency services support counselor from Madison, Wisconsin, who has struggled with schizophrenia for 20 years---and whose mother was one of NAMI’s founders--- noted that for individuals diagnosed with severe mental illnesses, ACT can mean the difference between 50 years of living in a community and 50 years in an institution. "It may not be pretty," he said, saying that initially, as a consumer, he did not like some aspects of the model. "But it gets the job done, and that’s the bottom line."