We sat down with Ben Davis, Program Director at our Assertive Community Treatment (ACT) program, to learn more about the intensive services the program provides to people with serious mental illness in the Bronx and upper Manhattan.
What is Assertive Community Treatment (ACT)?
The idea with ACT is: we bring the treatment to you. It’s a mobile, interdisciplinary treatment team that works with people who haven’t been effectively served by traditional forms of mental health treatment, people who have serious mental illness and who don’t tend to keep appointments with psychiatrists or therapists, don’t always take medication, and who are frequently hospitalized and at high risk.
We go out into the community, meet with people where they are, whether it’s at home, shelter, work, on the street, families’ places, wherever. Our team is a combination of social workers, case managers, psychiatrists, and nurses who all go and work with the clients. If you’re a client in the ACT program, you’re not just seeing one person; you’re seeing at least three different people on the team every month.
We work very closely with other social service providers, particularly housing providers, and try to be a service to those other providers who don’t always have the flexibility or the staff to be able to do some of the things we can do. The goal is to help people make the best use of community support.
What is the history of the ACT model?
In the past, people with serious and persistent mental illness were institutionalized. There was a big push to close down a lot of those institutions and get people into the community. ACT was developed in the 1970s in a rural area where you had people living in the community, but they didn’t have access to clinics. So a mobile model was developed, where people would drive out into these rural areas and provide treatment to people. It was then brought into cities and modified in certain ways, but kept the same founding principles. If we’re not keeping people in institutions because we want people to live meaningful, fulfilling lives in the community, how do you provide services they need? Not everyone fits the mold of traditional clinic services.
What would you say makes CUCS’ ACT team unique?
If you look at our graduation rates, at least compared to other Bronx programs, we’re among the highest. We’ve been consistently able to graduate two people a month over the last year. We’re also at the forefront of new city and state initiatives such as health homes and managed care.
What does someone need in order to graduate?
We try to make it as specific to the person as we can, so it depends on what that client’s individual goals and needs are. The key thing that makes ACT different is you don’t need to worry about keeping appointments. We come to you, we find you. To be able to move on, you’re probably going to need or want some level of services after us. You’ll need to be able to keep appointments and if you need medication to help you stay stable in the community, we want to make sure that you are able to take it. And also, that you’re stably housed. Some people are stably housed, but they want a more independent level of housing, so that’s what we work on with them before they graduate. Some people want to work on employment or on returning to school. Those are the fundamental things we work toward for most people.
Tell us one of your favorite success stories.
We have a client who is working on graduating this month. She has been with the team for about nine years. When she came to us, she had been frequently hospitalized for schizoaffective disorder and had a child who had been taken away from her. She had lost her housing as well, all in connection with her mental illness and not having adequate treatment.
One of the big issues was with her schizoaffective disorder. When she was manic, she would spend all of her money. She had borderline intellectual functioning and she was very easily preyed on by others and pretty vulnerable. People would move into her housing and they would take all of her money.
CUCS became her representative payee. Rather than the money going to her, her money came to us, and we helped her pay her rent and bills and helped her to budget.
She hadn’t been keeping appointments with outpatient providers. Part of it was due to the fact that she had mobility issues and it wasn’t easy for her to get around, so we got her Access-A-Ride. She’s been using Access-A-Ride to come to the office to see us and keeping appointments consistently. She’s now stable on medication. After a while on rep payee with us, she was more and more independently paying her bills and we were able to give her increasing responsibility over her money to the point where she was getting all of it once a month and just showing us the bill receipts to make sure she was paying them.
Over the last couple of months, she transitioned off rep payee entirely. She’s now independent financially, she’s paying her rent and all of her bills, and she’s keeping all of her appointments with us. She’s been stable, so we have an appointment set up this month for an outpatient clinic. She’ll see a counselor and a psychiatrist and once she’s connected with them, we’re going to graduate her. She doesn’t have people staying at her house anymore and she’s hoping to reconnect with her child, who is now an adult. She also wants to become an American citizen. She’s very excited and very happy to be more independent.