(onscreen text)
Numerous people contributed to the development of this DVD.
The video was produced by the New Hampshire-Dartmouth Psychiatric
Research Center under contract number 280-02-8070 with the
Substance Abuse and Mental Health Services Administration (SAMHSA),
U.S. Department of Health and Human Services (DHHS).
Neal Brown and Crystal Blyler served as the lead Government Project Officers.
The views, opinions, and content of this video are those of the producer
and do not necessarily reflect the views, opinions,
or policies of SAMHSA or HHS.
All material appearing in this video is in the public domain
and may be reproduced or copied without permission from SAMHSA.
Citation of the source is appreciated.
However, this video may not be reproduced or distributed for a fee
without the specific written authorization of the Office of Communications,
SAMHSA, DHHS.
For additional free copies of this video
please call SAMHSA's National Mental Health Information Center
at 1-800-789-CMHS or 1-866-889-CMHS (TTD).
Originating Office
Division of Service and Systems Improvement, Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road, Rockville, Maryland 20857, Produced 2005
National Implementing Evidence-based Practices Project
Assertive Community Treatment, Introductory Video
Assertive Community Treatment is an extensively tested treatment
for serious and persistent mental illness.
The program featured in this video is just one of the many
throughout the U.S., Canada, England, and Australia.
♪ Music ♪
I went to a Judy Collins concert with my mother and I had a great time.
So that shows you ...
and I went to Charlotte and saw Heart and had a good time.
So that shows you that I can get out and I can be a part of the community.
I just want to be a part of the community like...
like everybody else.
♪ singing ♪
(Tell us what that was.)
That's (inaudible) Bolero.
There are some famous people over the years who have had mental illness too.
And they've learned to cope with mental illness.
And I just want to cope with mine.
And live out a good life.
♪ Music ♪
This South Carolina native who we will call simply Jimmy has been struggling
to cope with his schizo-effective illness for over two decades.
I went through a lot of hospitalizations.
I went through thirty or more hospitalizations.
I've been diagnosed paranoid schizophrenic,
borderline psychosis.
And I've been diagnosed manic depressive.
And I think I have a brain disorder caused by a chemical imbalance in the brain.
Before he was stabilized, in part with the help of medication,
Jimmy's thoughts tortured him.
He heard voices, suffered from delusions and fits of temper and sometimes
devastating self-destructive impulses.
♪ Music ♪
Jimmy's mother Jessie.
You know, you get up in the middle of the night.
The lights would all be on.
The TV would be blaring.
And things that maybe don't sound that bad.
But when you have to live with it.
This is relaxing.
Oh, my gosh.
I'm thinking about getting a great ...
putting that picture that I have right there,
that I have right there, up in this room to add a little more color.
Thanks to a program for assertive community treatment called PACT,
Jimmy now lives in his own one bedroom apartment.
He just seems to be much more stable.
Now he does his shopping and does his cooking.
But he can ...
he calls me up and tells me he's cooking this.
And he still ...
to me, he's very dependent on someone though.
He needs that person to help him.
Jim, good morning.
How are you?
Okay. Are we ready to do some grocery shopping?
I want you to go through your refrigerator and look in your freezer and check real
carefully and make up a grocery shopping list.
You got your list?
In Outreach, a PACT model, staff spend about five hours a week with Jimmy
in multiple contacts.
A melding of support, teaching, problem solving, and therapy.
♪ Music ♪
I see nothing.
For me nothing.
Patty, she gets her medication Monday through Thursday today.
And she has a one-to-one with Andrea.
And we give her a phone call at night to remind her to take her evening medicines.
It's a non-traditional approach.
Rather than individual caseloads, typical with most mental health clinics,
the team shares total responsibility for the entire client population.
The team of ten mental health professionals meets daily to
review each client.
But most of the direct client work goes on outside of the office.
Good morning.
I've got a present for you.
This is your casement.
It's a kind of therapy to go where no problem is too much.
PACT director Barbara Julius.
What makes mental health might not just be a visit to your psychiatrist.
It might also mean having your entitlements in place.
Or it might mean having your rent paid on time.
It might be knowing how to go grocery shopping.
So instead of meeting with a person and talking about how they're doing,
how they feel once a month or twice a month,
what we do is everything that it takes to keep people in the community
living independently.
Providing assistance with social relations,
employment and basic needs like housing and food.
That corn looks pretty good.
What's the price on that?
Seventy-nine.
That's not bad for three fresh ears.
Treatment strategies are tailor made for each client,
including facilitating health care.
I'll be right behind you.
Over the years, clients remain in the program,
even though their need for services may fluctuate.
Some people come in the program needing all of those services,
needing three or four staff interacting with them on a daily basis.
Lots of phone call support, lots of emergency crisis intervention.
And as they see that support there, they get better.
So that people who once were in this program needing three,
four, five interventions a day every day, might at this point come in weekly
for a med refill.
We don't fire people when they get too sick.
You know, that's a key point for us.
But we keep them all.
They're all here.
And we take responsibility for that treatment.
And really are willing to try almost anything that it will take to support them
in getting better.
This holistic treatment concept with its shared team responsibility,
hands-on individualized service and lifetime commitment to clients makes
assertive community treatment unique.
It's extremely rewarding for me.
Because I can see changes.
I can see the impact that we're having.
I know that what I do each day really makes a big difference.
That's why I'm here.
I do it because it's worth doing.
My mother raised the seven of us, right, my mother (inaudible)
The intensity of involvement with clients demands a low staff
to client ratio, one staff to ten or twelve clients.
Low staff ratios pay off, reducing inpatient hospital days
by as much as 85 percent.
Reduced hospital admissions mean fewer crises.
But because of the close contact and constant availability of staff,
when a crisis does erupt, the client gets the benefit
of early personalized intervention.
He was okay during the evening last night.
He was threatening yesterday to break the windows out.
And he's still saying the same complaints from yesterday,
that the pressure's on.
(The voices are worse?) The voices are worse.
That's what's happening.
And he's been working up to this over the last ten days.
I don't know what I'm going to do.
I have to do something.
I just can't stand going on.
That means I'll hurt myself if I don't hurt somebody or something.
It's a rough road for clients and families in crisis,
sometimes involving the court, the police or sheriff,
neighbors and landlords, hospital emergency room personnel and 911.
Not with PACT.
The team handles it all.
♪ Music ♪
With the nurse's guidance,
clients prepare their own medication for the week.
And all staff share in making daily, morning and evening medication deliveries
for those who need it.
All right.
You take that.
And you take this.
Nice and cold too.
I already feel like I'm whistling Dixie.
(You do?)
You lowered your Deprocote?
Yeah.
I used to take three Deprocotes at night, now I only take two.
Any reason he did that?
Memory.
Your memory?
To increase it?
No, to decrease it.
To decrease your memory?
No, (laughing) I mean to make my memory come back.
Okay.
I get paranoid.
I think people are after me.
I think little creatures are bothering me.
And I see things on the floor or on the ceiling.
I don't see them anymore.
If I take my medicine, I'm fine.
If I don't take them, I get sick and I end up in the hospital.
And tell me why you're taking the Deprocote.
Deprocote is for mood swings.
And the Meleril is for clear thinking.
When you spoke to Dr. Christie last, you said that you weren't hearing voices.
No, I wasn't hearing voices.
I'm just having a hard time sleeping.
I was in and out of the hospital
because I couldn't face the fact about being mentally ill.
I cried a lot.
I didn't want to take my medicine.
I said I don't need this medicine.
That's not for me.
This mental illness will go away.
It will go away.
But the mental illness, schizophrenia, did not go away.
Yolanda's mother Lillian.
From the time she was sixteen until give or take eighteen,
I could say on average she's been in the hospital about twenty or thirty times
within that length of time.
After she got into outreach, it was a tremendous burden relieved off of me.
Because at least they would check on her.
They would make sure she takes her medication.
They would make sure if she had any place to go, to the store.
And I feel so much better.
♪ Music ♪
I did pretty good in the program.
I came out and in and out of hospitals sometimes.
But I have moved into my own apartment for the first time.
That's nice.
You can do what you want to do in your own apartment.
You don't have to share anything with nobody.
If you want to walk around here with your bra and underwear on,
you walk around with your bra and underwear on.
Can I say that? (laughs)
(inaudible)
Now Yolanda is taking steps towards even greater independence.
Studying for her GED and learning to handle her own finances
with PACT team help.
Can I open a bank account in the borough of Savannah (inaudible)?
I can.
This is delicious.
♪ Music ♪
Both Jimmy and Yolanda experience the documented benefits of PACT
with fewer symptoms and hospitalizations and greater independence.
That's my favorite.
That's the guitar.
That's the ocean.
That's (inaudible) that's a rose.
That's a rose.
That's greenery.
That represents a forest.
Programs for assertive community treatment offer some comfort and hope.
Are you going to be the only signer on this account?
Yes.
Okay, the minimum to open the account is fifty dollars.
And then our least expensive checks are eleven dollars and (fade out)
Without outreach, I'd be back in the hospital.
I know I would.
Sometimes I get upset (inaudible) about the program.
But it's best.
I wish the whole country could get it.
Because it would be very good for the mentally ill.
It could probably make us feel like a whole new brand new person.
A mother in her ninth month, ready for a girl or boy,
eight pounds of love, a bundle of joy.
To think that a woman can have a man's child and that child can grow up
to be a successful doctor, lawyer ...
Outreach gives me confidence.
Because I think that it's given me independence.
And it's given me the freedom to be myself.
And when I'm talking straight, I'm making sense.
And when I'm making sense, I'm making progress.
And when I'm making progress, I'm getting to meet my goals.
And my goal is to be an educator.
I would like to educate people that they can do something with their lives.
That there is hope.
There is hope out there.
And with hope comes faith, and with faith comes hope.
And you can do anything you want to.
If you just get your mind in the right order,
you know, you can do anything. 283 00:15:12,800 --> 00:00:00,000 ♪Music ♪