The Future of ACT and Case Management Approaches

What is the future of ACT and related approaches? Gary Bond and his colleagues (2005) have made a number of predictions (see box for a profile of Gary Bond). They believe the "basic" ACT model will continue to improve in two ways. First, ACT will systematically incorporate EBPs such as illness management (Chapter 3), motivational interviewing for dual disorders (Chapter 8), supported employment (Chapter 9), and family psychoeduca-tion (Chapter 13) into its service package. Second, ACT will be enhanced by the development of new strategies. For example, another service that may be integrated within ACT teams is supported socialization. Supported socialization employs volunteers or staff members who go on social and recreational outings with clients. The social isolation and loneliness of many persons with severe and persistent mental illness is well known. Bond et al. (2005) pointed out that ACT has had very little impact on social functioning. Yet most ACT clients deeply desire friendships and social contact. Peer support services, such as drop-in centers or support groups, may provide easily accessible social outlets (see Chapter 12).

In addition, Bond et al. (2005) predict that the scope of ACT may change in two separate directions. First, they believe, given its cost effectiveness, ACT services for the general population of people with severe and persistent mental illness will become more widespread. The second development that is very likely is the wider implementation of specialty ACT teams for specific target populations, particularly for persons with mental illness involved in the criminal justice system.

It is not surprising that the use of case management strategies for the community treatment of severe mental illness has steadily increased. Case management has obvious economic and quality-of-life advantages. Although case management, particularly ACT, can be more expensive than traditional community-based services, it is considerably cheaper than psychiatric hospitalization. Planners on the state and national level see increasing evidence that employing case management strategies reduces hospital usage. Numerous states have adopted case management strategies in an effort to reduce hospitalizations and close some of their state hospitals (see Chapter 14). These new strategies have also proven to be effective for reaching those consumers who have "fallen through the cracks" in the system. Whether because of their illness, underlying personality issues, past experiences that have alienated them from the system, or any number of other reasons, a large number of consumers are unconnected with the mental health system. Today, we know that treatment and psychosocial interventions have a positive effect on the long-term outcomes of these conditions. Assertive community treatment and other intensive case management approaches have proven to be the most effective strategies for reaching out to this group with the treatment and services they need.

Finally, and most importantly, case management models that provide services to consumers in the community are a more normalized form of treatment delivery than the traditional day programs or supervised residences. Such case management strategies allow the consumer to reside and work in the environment of their choice and receive services there. Consumers are not stigmatized by frequently attending a mental health center or vocational workshop. The services provided have a direct relationship to the here and now issues involved with coping with their illnesses and succeeding in the community. This consistency with the PsyR principle of normalization makes case management attractive to many consumers and PsyR professionals.

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