7.9 Co-ordinating treatment

A Family Guide to concurrent Disorders - Part III: Treatment

Assertive community treatment

The assertive community treatment (ACT) model was developed to meet the needs of clients with severe mental illness who often experienced relapse and rehospitalization, frequently due to their inability or unwillingness to go to local mental health centres. The ACT team provides around-the-clock support and services such as case management, assessment, psychiatric care, employment and housing assistance, family support and education, substance use treatment and other services that help a person to live in the community.

ACT teams may include a psychiatrist, psychologist, psychiatric nurse, social worker, peer support worker (someone with a similar problem or issue who offers support), caseworker, recreation therapist, addiction specialist, vocational (job) specialist and/or occupational therapist who help with tasks of day-to-day living. Some team members are linked to a hospital; others are based in the community.

ACT team members usually meet with the client every day in the community (e.g., in the person’s home or in a coffee shop). They make sure that people receive consistent care and strong, ongoing support from the team members.

ACT team services are usually accessed through a mental health agency. Like many other services, you are more likely to find ACT teams in cities and larger communities. In Ontario, the criteria used to decide which clients get priority for ACT services are:

• a diagnosis of schizophrenia, bipolar disorder or another psychotic disorder
• significant problems with basic activities of daily living
• long-term problems (such as a co-occurring substance use disorder) that require eight or more hours of service per month.

More details about the criteria are available in the Ontario Program Standards for ACT Teams.

Case management

Clinical case management has been the dominant model for co-ordinating and delivering mental health treatment. The overall goals of this model are:

• to assess clients’ needs
• to identify and provide necessary services to meet those needs
• to monitor client outcomes to determine the success of treatment interventions or the need for other services.

In the ACT model, the responsibility for delivering services is shared by the team. In the case management model, services are provided by the case manager. However, case management is most effective when the case manager is part of a multidisciplinary treatment team that also includes a psychiatrist and various other mental health care professionals (e.g., nurses and vocational specialists).

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