Ever since the United States began its process of deinstitutionalization in the 1960s, the mentally ill have been disproportionately represented in America’s prisons, hospitals and homeless populations.
With enough support, most mentally ill people can live independently, maintain a job and support themselves. Far too often, though, these patients fall victim to the myriad social problems that plague the poor and vulnerable.
‘Anything and everything’
Assertive community treatment, or ACT, was pioneered in the 1970s as a way to serve outpatients with severe mental illness, often schizophrenia or bipolar disorder. ACT counselors meet with their clients in the real world, meaning patients don’t come to the office — the counselor goes to them. And at Brownwood’s Center for Life Resources, four ACT team members are working to re-integrate patients into the Brown County community with a lot of patience, time and heart.
Susan Quintana is the ACT Team Director at the Center for Life Resources, which services seven counties in the heart of Texas. “The purpose of the ACT team is to keep people that have mental illness in the community and out of the hospital and out of jail,” Quintana said. “Our responsibility is to be an all-inclusive provider for all services, so we provide substance abuse recovery, counseling, supported employment and supported housing. Anything and everything a client needs.”
ACT teams provide Level 4 care to patients, the most intensive level of outpatient attention available. The Brownwood team meets to discuss every Level 4 patient — currently there are 13 in Brownwood — every day, and often meets each patient multiple times per day at home or at work.
“Whatever their need is, whatever problem they come up with, we are here to help them master skills to be resilient on their own, but we’re also going to be at their side 100 percent,” Quintana said. The ACT team can even accompany patients as they begin a new job, she said.
Every member of the ACT team gets to know every patient, ensuring that someone will always be available for them. The team fields calls in the middle of the night, on weekends, holidays and vacations. “What’s different from general case management,” Quintana said, “is that I’m on call 24/7.”
Quintana’s job can be a moving target. Recently, she said, she drove a client to work. She has several that she takes grocery shopping at night, when there are few customers and less potential for anxiety. Occasionally she will receive calls from residents or police who speculate that one of her clients may be acting out in public — though Quintana can’t confirm who her clients are, even when asked specifically.
“People will call and say, ‘How’s so-and-so doing?’ And we cannot tell them,” Quintana said. “We can’t give out information because of HIPAA. A lot of times it’s like, ‘I live across the street from her, she’s my best friend.’ And we can’t confirm or deny. They get really frustrated. The community has a misunderstanding that we’re not doing things. We are doing things, but we can’t share it with them.”
Quintana said the most important thing for the community to know about ACT is how to get patients help. Many of her clients are referred to the program through law enforcement, the hospital or concerned citizens. “If a community member observes behavior that’s peculiar, threatening, or endangering somebody, call the crisis line or call 9-1-1,” Quintana said. “The police have had training to contact us.”
The 24-hour crisis line is also available at 1-800-458-7788.
“If somebody’s acting peculiar, it could be for multiple reasons,” Quintana said. “But call 9-1-1, and they will get the mental health people involved.”
Because ACT receives patients this way, its patients often exhibit high levels of paranoia, depression or other symptoms at the beginning. Seeing the patients every day, Quintana said, ACT hopes to have them down from a Level 4 to a Level 3 within a year of becoming a client.
It takes about six years, she said, for patients to completely leave the program. Even then, ACT keeps a detailed record of their treatment just in case.
“We always let them know that there are services available,” she said. “I have a record of every one of the clients and every one of the notes from every day that we’ve met. Whenever we get a returning client, I’ll go back and review the notes with my staff to get a ballpark of where they were, where they’re at now and where they might be going.”
Quintana said her staff is her most vital asset. Working in high-stress situations, she said, requires a tight-knit group of loving individuals who trust each other and all earn the trust of every client.
“The most important thing is to first establish that rapport and trust,” she said. “Basically, the ACT team is a substitution for an inpatient hospital for life. ACT wants to give the least restrictive environment while still getting their mental health needs met.”