Assertive Community Treatment Team (ACTT) and Housing Needs

1. Assertive Community Treatment Team (ACTT)and Housing Needs Cathy Fudge, MSW, RSW Team Lead, ACT Team

2. What is The ACT Team? • The ACT Team is a service-delivery model for providing comprehensive community based treatment to persons with severe and persistent mental illnesses. • An ACT Team is an evidence-based practice that has proven success when it is practiced properly within its intended service population.

3. ACT Team Composition • Team Lead/Social Worker (1) • Psychiatric Nurses (2) • Occupational Therapist (1) • Addictions Specalist Social Worker (1) • Mental Health Support Workers (1, vacant) • Mental Health Worker (1) • Peer Support Specialist (1) • Program Assistant (1) • Psychiatrist (Weekly/Bi-Weekly)

4. ACT Team Services • Attending Medical/Dental/Legal Appointments • Counseling Services for Individuals, Families/Groups • Financial Support Advocacy • Money Management Strategies • Strategizing Re: Transportation • Management of Medications/Long Acting Injections • Housing Advocacy • 24 Hours/Seven Days a Week

5. Recovery Model/Fostering Independence Assisting clients with: • Structuring time and gaining employment • Activities of daily living • Social and interpersonal relationships and use of leisure time. • Groups: Peer Support, Knitting, The Decider, Art, Walk-In

6. Goal of The ACTT Model • To manage the debilitating symptoms of mental illness thereby lessening/preventing acute episodes • To meet basic needs and enhance quality of life • To improve functioning in adult social and employment roles and activities • To increase community involvement • To lessen the family’s burden of providing care

7. ACT Team Clients: Target Population • Adults with a diagnosis of severe and persistent mental illness that causes debilitating symptoms that impair mental and behavioral processes (with psychotic symptoms) • Difficulty with Activities of Daily Living

8. Target Population • “Clients in greatest need” • People who have major symptoms that improve only partially or not at all with medication and other treatment. • People who appear to “resist or avoid” involvement in services, and are often blamed for it; include individuals whose illnesses change their beliefs and perceptions.

9. Target Population People who are more likely to: • Frequently use emergency and inpatient services • Be homeless or live in substandard housing • Be arrested and incarcerated • Die prematurely from suicide or physical illness

10. What is Psychosis? • Psychosis is a mental state characterized by distortion or loss of contact with reality and may involve severe disturbances in perception, cognition, behavior and feelings.

11. Many Disorders Can Have Psychoses as a Symptom • Schizophrenia • Schizoaffective disorder • Bipolar 1 Disorder • Delusional Disorder • Psychotic depression • Brief reactive psychosis • Drug induced psychosis • Organic psychosis

12. What is Schizophrenia From a Biological Prospective • Schizophrenia is a set of illnesses which results from a disturbance in fine interaction and balance between multiple neuro-transmitter systems. • Mostly involved are Dopamine and Serotonin and epinephrine/ norepinephrine systems.

13. Signs/Symptoms • Hallucinations – any of the 5 senses • Delusions • Persecutory • Referential • Grandiose • Religious • Somatic • Loss of control over Mind or Body • Disorganized or confused thinking

14. Schizophrenia I feel judged , stop it!! I don’t know what's real. Who can I trust? I don’t know if I believe you. The voices are loud in my head,. it’s driving me crazy!! I was involved with a murder, my family is not real, I was in the war, I’m a rapper, my neighbors are controlling my mind with a computer, I was a hitman for a gang, my family stole my inheritance, I had a home invasion (20 x), I am waiting for the calling Why is he looking at me?? I just want peace please! What do you want from me??

15. Signs/Symptoms Emotional • Feelings of depression and anxiety • Changed feelings – quiet or moodiness • Emotions not in keeping with situation or thought • Inappropriate affect or laughter • Changed mood-euphoric, dampened emotions or mood swings • Anger

16. Signs/Symptoms Social • Social withdrawal/isolation • Significant deterioration of social relationships • Unexpected aggression • Suspiciousness and/or paranoia • Dropping out of activities, school or work

17. What is Bipolar Disorder? • Mood disorder • Mood is affected causing unusual shifts in a person’s energy and ability to function • Usually experiences both periods of depression and mania

19. Symptoms of Hypomania • Of at least four days…. • Elated/irritable mood • Increased involvement in pleasurable activities • Reduced sleep • Grandiosity/inflated self-esteem • Flight/racing thoughts • Agitation/increase in activity • Decreased need for sleep • Talkative/increased rate of speech

20. Symptoms of Bipolar Disorder (Mania) • Full of energy • Persistent/elevated euphoric mood • Excessive talking • Talking too fast/loud • Excessive spending • Lack of sleep • Easily irritated • Easily distracted • Interruptions in Daily Activities

21. Symptoms Mania • Grandiosity/Inflated self-esteem • Aggressive behavior/pushy • Racing thoughts • Poor judgment • Loss of ability to control impulses • Unusual sexual behavior

22. Symptoms of Bipolar Disorder (Depression) • Changes in appetite or weight • Changes in sleep • Changes in productivity • Persistent sadness • Lack of energy or motivation • Fatigue • Difficulty thinking, concentrating or making decisions

23. Symptoms (Depression) • Apathy • Inability to feel pleasure or enjoy activities • Excessive crying • Social withdrawal • Unexplained aches • Feelings of hopelessness, guilt, self-blame, worthless, anxiety, irritability, pacing, fidgeting, suicidal thinking

25. Mental Illness Can Make Individuals Feel…….. • Afraid • Low self-esteem • No confidence • Constantly worried • Unsure of Reality

26. Challenging Behaviour • Anger Outbursts at Neighbours • Delusional Thoughts • Destructive • Lack of Cleaning • Hoarding • Criminal Behaviour • Snow Shovelling • Not Paying Bills

27. Parents and Their Adult Children: “Why Can’t They Live With You”?? • No communication and/or support from other family members • Ability to make decisions and/or provide discipline is challenged • Difficult to be consistent • Denial • Blurred boundaries • Violence or abuse • Addictions • Extreme sense of loss/guilt

28. Dr. Abraham Maslow • Maslow’s Hierarchy of Needs

29. Maslow’s Hierarchy of Needs

30. Challenges • Complex Cases • Risky/Violent Behaviour • System Policies/Rules • Funding/Money Sources • Decrepit Housing Options • Safety Issues • Stigma

31. What makes an Act Team Work? • Partnerships

32. What is Working Well? • Creativity • Willing to try to give our clients an opportunity/chance (Duty to Warn) • Interagency Collaboration (Formal and Informal) • Common Goal: Clients to be Safe

33. Client Harold C. • Severe and persistent diagnosis (Paranoid Subtype) • Mid forties, single, elderly parents, lack of extended family support • Violent criminal history (arson, physical assault) paranoia, domestic violence (past relationships) • Challenging medication compliance • Past success in a job • Lives in substandard housing, however his delusions are persistent especially at night and he is tormented by the noises of his neighbors. Has damaged his apartment in frustration. • What is the solution???

34. In Conclusion …Severe Mental Illnesses are: • Biological brain disorders that interfere with normal brain chemistry • More prevalent than most people realize • Equal opportunity disease • Treatable!