Reaction to the DVD, Movie Review Example

The introductory video to the Assertive Community Treatment (ACT) model provides an overview of the basic services and approaches used in ACT. The film focuses on several patients, and demonstrates how ACT services work in a real-world context. The overarching purpose of ACT is to provide community-based services and support to individuals who have serious mental illnesses while making it possible for these individuals to live on their own. One of the primary goals of ACT is to minimize the incidences of hospitalization and inpatient care for persons with mental illnesses by providing routine structure and support on a continuing basis, while also providing specific interventions for crises and other issues as needed. ACT is an evidence-based approach to providing mental health services and is a model that has been shown to effectively reduce hospitalizations for patients with serious mental illnesses.

While some mental health service models rely on individual case workers who manage caseloads of clients, the ACT model is a team-based approach. These ACT teams are made up of individuals with backgrounds in a variety of disciplines, and together they provide education, medication monitoring, social support, and other services as needed. In the introductory film the team is shown meeting on a regular basis to discuss the clients they serve and to determine if any specific issues need to be addressed. This allows the team member so different backgrounds to coordinate care, support, and interventions in a timely and responsive manner. Unlike the individual caseworker model, the team member model serves as a more holistic approach which is less focused on crisis intervention and more focused on a support-based model that can serve to minimize issues before they can become crises.

What is most interesting about the ACT model is that the clients served by such programs are able to live in their community on their own, instead of in a group home or an inpatient facility. The ACT team members have a relatively low staff-to-client ration of about eleven clients for every one staff member (at least that is the ratio of the team shown in the introductory video). Rather than have clients come into offices or other clinical settings on a monthly basis to be questioned about how they feel or whether they are taking their medications, the team members visit the individual clients in their homes on a daily basis. Because ACT is an interdisciplinary approach, the purpose and goals of these daily meetings are subject to change as needed. Some ACT team members deliver medications to clients at their homes and monitor their use, while other team members provide support and assistance in other ways.

What seems to make ACT effective is the way that it supports clients in managing the many tasks and errands of daily life. In one scene in the film, a team member is shown calling a client on the phone to discuss the need for the client to put together a grocery-shopping list. Team members are subsequently shown accompanying clients on shopping trips to help ensure that these clients are following through on such necessary tasks and are not overwhelmed by dealing with such responsibilities. For clients with serious mental illnesses, navigating such daily activities can be challenging. By providing ongoing, routine, and dependable support, the ACT team can help clients avoid being stressed and triggered into behavior that might lead to more serious interventions and even hospitalizations.

This adherence to a dependable and even lifetime model seems to be one of the keys to the success of ACT. As one team member explains, some clients may require regular interventions, sometimes several times a day, when they first enter the program.  As these clients begin to see that they can rely on the members of the ACT team to help manage the routines of daily life, they learn to trust the model and often require fewer interventions as time goes on. Because mental illness can be so difficult to treat and overcome, clients may need the support of the ACT team for a lifetime, and the ACT framework is clearly not set up to be a short-term approach to treatment.

The ACT model provides a range of specific services, all of which are designed to support the ability for clients to remain a part of their communities and to take on and manage daily responsibilities. Although clients have their medication delivered on a daily basis, they meet with team members weekly to discuss their medications and to organize their dosages of each medication. Clients are encouraged to work when possible and to participate in other community activities. Unlike group homes where a number of clients live under one roof under the oversight of an in-house caseworker, clients in ACT are given the tools and support to live as independently as possible while still managing serious illnesses. Although the film primarily discusses the positive aspects of ACT, there are some negatives as well. Patients may not wish to adhere to medication regimens, or may have symptoms that become unmanageable (Mahoney, 2005).  The greatest challenge for ACT team members is that they must remain aware of changing circumstances and coordinate care with other team members to avoid crises with clients. With the broad range of services and the multidisciplinary background of the team members, however, it seems that potential crises can often be spotted and intervened before they become serious.

The long-term care model of ACT means that clients are dependent on the team members, especially when they first enter the program. As the interviews with several family members of clients make clear, however, these individuals were already dependent on others who were often unable to provide the support and care necessary to help them. The ACT model avoids taking a crisis-intervention approach to treating mental health issues, and instead takes a crisis-avoidance approach. While this model may not work for all clients, it does seem to be an effective way to help individuals manage serious illnesses and remain productive and active members of their communities.

References

Assertive Community Treatment — Introductory video. (2012).

Mahoney, D. (2005). Assertive community treatment. Clinical Psychiatry News, 33(7), 46.