Assertive Community Treatment (ACT)
PACT Across America: An Advocacy Strategy
NAMI endorses evidence-based interventions translated into actual service delivery implementation, including the PACT model.
NAMI’s PACT Across America campaign is not simply another effort to educate people about Assertive Community Treatment (ACT). Thirty years of research already demonstrates that ACT is more effective than office-based traditional care for people with the most disabling psychiatric illnesses. ACT reduces the most devastating outcomes of severe psychiatric disorders, including hospitalization, homelessness, and criminal incarceration. Frustrated by the nation’s continued failure to provide the effective treatment that researchers know works, NAMI decided to “take the bull by the horns” and promote the ACT model throughout the country.
|PACT Across America—a NAMI initiative to establish programs of Assertive Community Treatment (ACT) teams in every state — was the subject of a congressional briefing held on October 6, 1998 for members of Congress, their staffs, and media representa-tives. NAMI reported that only a fraction of those with the most devastating and chronic mental illnesses have access to this uniquely effective, community-based care that has been proven to reduce homelessness, hospitalizations, and jail time among people with serious brain disorders. Participating in the briefing were, left to right, Donald M. Steinwachs, Ph.D., William H. Knoedler, M.D., Nancy Abraham, Deborah J. Allness, M.S.S.W., Laurie Flynn, and Dylan Abraham, who has been an active PACT participant since 1977.|
PACT Across America is an advocacy campaign.
Our goal is to make programs of Assertive Community Treatment widely available. The NAMI national office, NAMI state organizations, NAMI local affiliates, and individual NAMI members are all involved, advocating together for ACT teams as a required service option. NAMI is very aware that the ACT model is not the only approach to community-based treatment. With increasingly effective medications, many people don’t need the comprehensive level of services provided by programs of assertive community treatment. ACT is designed specifically to help those with the most severe disorders who are ill served, or not served at all, by fragmented, office-based community mental health models. All health plans that enroll people with schizophrenia should provide ACT teams as one of the services they offer.
How is NAMI achieving its goal?
National NAMI Office
- First, NAMI commissioned two developers of the ACT model, Deborah Allness, M.S.S.W., and William Knoedler, M.D., to put their knowledge into writing. They wrote The PACT Model of Community-Based Treatment for Persons with Severe and Persistent Mental Illnesses: A Manual for PACT Start-up.
- The PACT manual was provided free to NAMI state offices and large urban affiliates, state departments of mental health, state Medicaid authorities, key legislators, and other decision-makers.
- ACT advocacy presentations and workshops are presented at NAMI’s national conventions.
- At the federal level, NAMI seeks congressional action to require states to provide ACT programs. We work with the federal Centers for Medicare and Medicaid to encourage Medicaid programs to routinely pay for ACT.
- NAMI collaborates with expert ACT consultants to assist state and county governments, providers, and health plans to implement and oversee the ACT model.
- NAMI provides support and training on ACT advocacy for grassroots leaders.
- The PACT Advocacy Guide is available for free to the public.
NAMI ACT Technical Assistance Center
NAMI has been awarded a grant by the Center for Mental Health Services to operate the NAMI Assertive Community Treatment (ACT) Technical Assistance (TA) Center. This national TA Center assists NAMI state organizations, local affiliates, other entities, and individuals in their efforts to make the ACT model available in more communities across the country.
The NAMI ACT TA Center matches information about the ACT model with NAMI’s sophisticated and well-documented advocacy expertise. The center provides technical assistance in the use of strategic partnerships, public relations skills, and grassroots determination to achieve the goal of increased access to assertive community treatment.
Suggestions from the PACT Advocacy Guide
- Form an ACT advocacy committee at your local affiliate or state organization level, or at both levels. Coordinate your state and local efforts.
- Take advantage of the NAMI national office and the NAMI regional directors who are available to assist your ACT advocacy committee.
- Learn about the model from NAMI’s website, www.nami.org, and from the PACT manual. To order the manual via the Internet, access the NAMI web site at www.nami.org and click on NAMI store. Please allow three to five weeks for delivery.
- Document your need for ACT by writing down, or making a flowchart of, all the places you have lived, if you are a consumer, or your family member has lived and all the different agencies you have dealt with over the past few years. Would ACT’s comprehensive “one stop shopping” approach help you?
- ACT Advocacy Committees should advocate the program with those who influence which community services are offered for people with severe and persistent mental illnesses, including:
- state department of mental health commissioners
- state Medicaid directors
- state legislators who oversee mental health services and mental health budgets
- your own state legislators and city council member
- other advocacy organizations and coalitions
- management of local community mental health agencies
- management of managed care health plans that enroll people with severe mental illnesses, especially those with—or seeking-- Medicaid contracts
- To explain how ACT can help them, your ACT advocacy committee should meet with law enforcement agencies, including:
- local police departments and sheriffs and their state associations
- local jail officials
- Work with the media.
- write letters to the editor
- meet with editorial boards of newspapers
- consider inviting reporters to your meetings
Officials may object to the cost of ACT, which is $8,000 to $15,000 a year per client. But remember that in many communities the cost for high-quality, comprehensive care will be less than the cost of inappropriately putting a person in the county jail (about $22,000 a year). Costs in a residential treatment facility can approach $50,000 a year, and state hospital costs are often over $100,000 per year. In this time of shorter and fewer hospital stays and tight state budgets, programs of assertive community treatment are essential, cost-effective community alternatives. The 24-hour-a-day, seven-days-a-week ACT approach helps people recover from severe mental illnesses by providing medical psychiatric treatment, substance abuse treatment, help with education, employment, and housing. This practical, comprehensive approach offers the stability often needed by people with the most severe and persistent mental illnesses to move toward recovery.
For more information about Assertive Community Treatment or the NAMI ACT Technical Assistance Center, please call us toll-free at 1-800-950-6264 or email us at ACT@nami.org.