Treatment Addresses Life with Severe Mental Illness

Assertive Community Treatment is a method for helping people with severe mental illness. ACT is a comprehensive approach that addresses a patient's basic needs — how to do laundry, how to manage a budget, how to get a job — as well as dealing with deeper psychological issues.

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ALEX COHEN, host:

It often takes more than just medication to treat mental illness. People with schizophrenia, bi-polar disorder and severe depression also may need therapy and assistance with daily living.

MADELEINE BRAND, host:

One method of treatment combines all those elements. It's called assertive community treatment, or ACT. That has changed the life of 43-year-old Cindy Mead(ph), who suffers from severe depression and other problems.

COHEN: We now hear her story. But first a word of caution: Parts of this story may be disturbing to some listeners.

Unidentified Woman #1: How are your plants? (Unintelligible).

Ms. CINDY MEAD (Assertive Community Treatment Participant): Good. Good.

Unidentified Woman #1: (Unintelligible).

Ms. MEAD: Yeah, I went yesterday and bought some mulch and…

COHEN: Every Wednesday morning a caseworker picks Cindy Mead up from her house and takes her to a therapy appointment at a place called Pacific Clinics. Cindy chats easily with her caseworker, with fellow clients at the clinic, with me. But she says when she first started with this assertive community treatment program she didn't talk to anyone.

Ms. MEAD: I just isolated myself. And I was afraid of people in general, you know, and didn't think anybody cared.]

COHEN: Cindy suffered physical and sexual abuse throughout her childhood, and battled addiction to drugs and alcohol. Deep white scars line Cindy's tanned arms and throat. They mark the places where she used to burn and cut herself.

Ms. MEAD: I have had so much pain swell my heart I thought the only way that I could continue breathing is to let some of that out. I thought, well, if I cut, then I would release some of that pain and suffering.

COHEN: Cindy says it was only after she came to this ACT program that she learned how to deal with pain without hurting herself. That's because there was an entire team of caseworkers and therapists working with her. When Cindy was afraid to go outside, someone would come to her house. When she didn't feel up to a doctor's appointment or an AA meeting, someone would come and drive her there. Eventually, when Cindy became confident enough to drive on her own, her therapist taught her how to get to the clinic by letting Cindy follow her.

Ms. MEAD: One day she did it like four or five times, you know, until I got the hang of exactly what markers I would make out there on the streets, you know, to identify where I'm at. She gave me so much confidence that I could do this on my own.

COHEN: The assertive community treatment approach has been helping people like Cindy for nearly 40 years. Elizabeth Edgar of the National Alliance on Mental Illness says the idea began in the early 1970s, when many state hospitals began discharging mental health patients. She says hospitals would try to prep them for life outside.

Ms. ELIZABETH EDGAR (Senior Policy Analyst, National Alliance for Mental Illness): There would be, you know, stoves and refrigerators and a mock living room and that kind of thing, and folks would, as a group, prepare a meal for, you know, five or 10 people.

COHEN: But Edgar says once these patients actually got into the community they found themselves cooking for one instead of for 10, on gas stoves instead of the electric ones they had trained on. They quickly got confused, ran into problems and often round up having to be hospitalized again.

Meanwhile, a social worker at a state hospital in Madison, Wisconsin, was doing things a bit differently. She taught her discharged patients how to cook in their own homes, how to clean their clothes at the laundromat, and these patients wound up fairing quite well. That, says Edgar, gave doctors an idea.

Ms. EDGAR: What if we moved the whole unit into Madison and we work as a team like on the ward in the hospital?

COHEN: That assertive community treatment model, an interdisciplinary team available 24/7 in a real world environment, now exists throughout the country. But providing one-on-one support round the clock can be expensive and time-consuming. Many cities and states just don't have the resources to support ACT programs.

Dr. PAUL IRONS(ph) (Los Angeles County Department of Mental Health): This sort of service actually pays for itself often times because the outcomes are so favorable and…

COHEN: Dr. Paul Irons is with the Los Angeles County Department of Mental Health. He says the ACT model is particularly well suited for individuals who might otherwise wind up on the streets or in prison. He says in California, assertive community treatment programs have been highly successful.

Dr. IRONS: For example, they've reduced hospitalization days by over 50 percent, reduced homeless days by something like two-thirds, 67 or 65 percent.

COHEN: And, he adds, keep in mind each one of those numbers is a person like ACT client Cindy Mead.

MS. MEAD: Today I'm self (unintelligible), free of drugs for the last four and a half years. I no longer isolate. I feel safe in the world. Without this clinic, I couldn't have become the person I am today, self-sufficient.

COHEN: Forty-three-year-old Cindy Mead talking about her experience with assertive community treatment.

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