Community support teams for mentally ill strengthened

Last modified: Sunday, February 16, 2014
When the New Hampshire mental health system was called a model for the nation, the robust community-based support system for people was a large part of the reason for that praise.

But community-based supports can be expensive, and were the victim of round after round of budget cuts in the 1990s and 2000s.

More than $3 million in the current budget was directed specifically to help community mental health centers create, expand or restart the assertive community treatment (ACT) teams that once made the state a national leader in mental health care.

Like supported residential facilities, ACT teams are designed to help people with mental illnesses maintain a healthy life and prevent crises that might land someone in the local emergency room or state psychiatric hospital.

That means team leaders such as Kate May, the new leader of the ACT team for West Central Behavioral Health in Lebanon, spend their days far from their desks.

That’s exactly why May took the new job in July, to spend her time driving around Claremont and Newport checking in on her team’s eight clients.

She’ll first go to their home, and if they aren’t there, to their usual hang-out spots. She checks in, gets a sense of their status for the day and if needed, helps them get to appointments, run errands or arranges for them to meet with other members of the team: a psychiatrist, a substance abuse counselor and a nurse.

All of the members of West Central’s ACT team spend part of their work week with other programs, too. When it’s fully staffed – hopefully by July, said program director Regina Mix – the team will ideally work with 15 patients at a time.

May took the job after several years as a social worker in Massachusetts. During an internship at McLean Hospital in Belmont, she led a therapy group for parents and families of someone with a thought disorder such as schizophrenia or bipolar disorder.

“It was a really touching group to work with, because I saw how much this affects the lives of a family. The first psychotic break creates chaos, and they have to go through something very much like mourning the person they knew,” she said. “The nature of persistent mental illness is it’s severe and it’s persistent. There is no cure-all.”

Instead, ACT teams are designed for management of a disease that clients will live with for the rest of their lives.

ACT teams were first developed in Wisconsin in the 1960s, according to the Assertive Community Treatment Association. Staff at the state hospital there were discouraged by an apparent revolving door. Though they worked to prepare patients for life at home after discharge, the same patients would be readmitted over and over again.

One social worker was having success, though, according to the association. She spent hours with her clients, even after they were discharged. She showed them how to navigate public transportation to their appointments; she helped them do laundry at the laundromat.

Once it was put in place more broadly, that kind of support lowered the number of admissions and readmissions to the state hospital.

“It was developed for people who are very symptomatic and hard to engage, who don’t do well in a traditional treatment setup where they are supposed to come to an office every week for an appointment,” Mix said.

The official guidelines for ACT teams call for 24/7 coverage.

“It’s an expensive model to maintain, and that’s a big reason a lot of us weren’t able to do it all,” Mix said.

As they ramp up services again, the West Central team is working on being flexible.

The psychiatrist, for example, technically works for the ACT team for four hours on Mondays.

But if something came up during the week, May said, she could always stop by the doctor’s office and get advice about how best to proceed.

She had one client, she said, who was struggling to manage his manic symptoms. Once he was placed on the ACT team’s client list, he was able to see the psychiatrist more regularly, and manage his medications better.

“He can report now, ‘My head is slower, my thoughts aren’t going so fast,’ so his quality of life is better,” May said.

“That one client who says, ‘I feel so much better,’ that, to me, is success. . . . It’s a roller coaster, but at least for right now, he’s feeling better.”

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)