Assertive Community Treatment (ACT)
PACT - A Client's Perspective
Note: Dylan Abraham describes his experiences with the Program of Assertive Community Treatment, or PACT. For more information about the program, visit the NAMI website (www.nami.org), or call the NAMI ACT Technical Assistance Center at 1-800-950-6264.
It was spring of 1977. At that time my life was in a shambles. I was hospitalized in a psych ward for the fourth straight year, desperately trying to find health and peace of mind. I had first been hospitalized in 1974, at the age of 18, with a diagnosis of schizophrenia. My spirits were low, as was my self-esteem. I had no job, no car, no money, and I was not attending college. Generally, after fighting valiantly against my illness, I had hit rock bottom. What was I to do?
A social work student at the hospital arranged to get me into the Program of Assertive Community Treatment, or PACT. I had no idea what PACT was or how it operated. I rebelled against getting involved with the program and hoped-one way or another-I could find a way out of my situation.
But the answer was right under my nose if I would be open to it. That spring I did join PACT, the program that was about to turn my entire world around into a life that I thought I would never reach.
PACT is a true community-treatment program that doesn't use inpatient care unless there are no other options. Most staff time is spent out in the community, dealing with clients and their needs and problems on their turf. Clients and staff keep in touch on a day-to-day basis, whenever and wherever the client needs someone to help. Over 50 percent of PACT clients are working, and if Social Security rules that discourage full-time work are changed, PACT could be even more successful in helping clients obtain work.
That first year, 1977, I literally had to start from scratch, not only with PACT but with my life as well. I was frustrated, bitter, and angry at the system and at myself, feeling as though I had really messed up. I looked at PACT as a dumping ground, a place where they put you when nothing else works. It was a difficult adjustment to be in PACT as opposed to psych wards and seeing a private doctor. But, within the first two years I realized that PACT was more than just a safety net. It was an opportunity if I used the program the right way.
With time, an apartment, a good volunteer job at a children's day care center and another volunteer job at an adult day care center, I was back working. It was a good step, the jobs were enjoyable, and I felt some self-worth and self-esteem returning to my life. It wasn't perfect, but it was a start. I began to appreciate what PACT was attempting to do and began to respect what staff accomplished.
I was becoming somebody again. Slowly but steadily I was doing what I wanted to do and what I liked to do. I wrote a book about my experiences with mental illness. I also began to write poetry. I've written many articles and spoken about PACT and mental illness across the country and in England. Now as well as writing and public speaking, I am a staff member in the crisis service of a community mental health center.
We must remember that recovery is an individual concept. PACT has worked for my recovery and other people's recovery by providing medication, helping with housing and social skills, and finding work. Many people work, some go to school, and others like myself work as a professional and write. People are making it in the community.
Staff have rough times as well as smooth. Sometimes they're dealing with the person who has gone off meds, the client who is being evicted from an apartment, or somebody getting into trouble with the law. Despite a person's problems, PACT is still there for them when they are in trouble. The ill person may need more meds, more contacts with staff, or simply a couple of days off from work. PACT is there 24 hours a day for their people.
I also realize-and so does PACT-that if somebody needs to be hospitalized in a psych ward, it isn't a failure. Rather, it is part of the process for that particular person in their recovery.
One of the good features of PACT is that people have ongoing care that provides stability and continuity in their lives. And the care provided by the staff can mean a break and a relief for the family; no longer do families have to be the treaters. Instead they can live their lives knowing their loved one is being treated, and that eases the stress and strain on families. For the most part, families are a part of the treatment team at PACT. They are listened to and are respected by the program.
This community-based program, in my thinking, is another word for hope. It isn't perfect. But for now, PACT-even after some 25+ years-is still an innovative idea. With time and hard work there will be more PACTs out there with more and more people getting good quality community treatment.
The years have come and gone. I've gone from a man with nothing to a man with a life, a man whose worst nightmare turned into a dream come true. My life took an unexpected turn that in the long run has been positive and has led me to a life that is important, has meaning, and is enjoyable.
PACT has stood the test of time as have I and others. PACT is a program that needs to be tried elsewhere. People need the experience of an independent life. And finally, people just need to be people, and that includes clients at PACT. We are not guinea pigs in PACT. The illnesses and brain disorders are the real guinea pigs we are treating.
To close, I would say that in the long run, PACT has been a key in my recovery and a key to my continued health. Hopefully, we can all have positive experiences when treated for mental illnesses, and I ask all of you to help in making this program sprout nationwide so others like me can have access to it. I can honestly say that PACT gets the job done.