News

ACT: One "bright spot" in Indiana mental health care

The ACT Center of Indiana: A new partner in implementing evidence to change care

NAMI, the National Alliance on Mental Illness, handed Indiana a grade of D- in its new state-by-state report card for mental health care systems. The national average is a D. No states received an A, and only five, including Ohio, earned grades in the B range. Kentucky and Illinois joined the eight states that failed with Fs.

What may have lifted Indiana from their fate to its barely-passing grade is Assertive Community Treatment (ACT). Headquartered at the ACT Center of Indiana, and noted by NAMI as “one bright spot” in the state’s mental health system, ACT is an intervention that has made a successful journey from a proven but expensive evidence-based practice to a feasible technique implemented on a wide scale.

“Traditionally, people with mental illness have different people separately addressing the different segments of their problems,” explains ACT Center Co-Director, and CHSOR Associate Director, Michelle Salyers. “You’ll have a case manager, a psychiatrist, other doctors, a substance abuse specialist, and an employment case worker.” ACT makes a team of all of them. The team meets every morning about the entire caseload. “Even if there are 100 consumers,” Salyers says, “you have on-the-spot planning and coordination among all these professionals.”

“The idea,” she says, “has been around for 30 years. Research shows it is a great way to keep people out of the hospital, but it's expensive.”

Expensive, but in the end worthwhile. ACT saves money by heading off traumatic and expensive hospitalizations. “ACT programs have a track record of success in reducing far costlier hospitalizations and other adverse consequences of lack of treatment.”

The State of Indiana made ACT a Medicaid-reimbursable service, funded the ACT Center, and tied provider reimbursement to model standards.

The ACT Center’s trainers help mental health centers set up the ACT program. They establish terms of accountability and monitor its implementation.

Since 2000, the ACT Center has helped 31 ACT teams take root across Indiana. And it provides training in other evidence-based mental health practices, like Illness Management and Recovery.

Recovery & goal-setting

ACT aims to help people recover from mental illness. “Recovery used to not even be considered an option,” Salyers remembers. “A diagnosis was a life sentence.” However, today, reports NAMI, “with appropriate services and supports, people with serious mental illnesses can and do recover and lead lives that are productive and meaningful.”

The ACT Center’s practice of Illness Management and Recovery asks consumers of mental health services, “What does recovery mean to you?”

“It may be going off medication forever,” Salyers says. “For someone else, recovery might mean working, or volunteering, or being able to spend time with family.” NAMI defines recovery as "the process of restoring self-esteem and identifying and attaining meaningful roles in society.”

ACT helps consumers get there by laying out a structured way of helping people identify personal goals. Mental health staff and consumers alike then undergo training in the steps to a broadly-focused recovery. The Center follows the objective impact of the intervention by tracking the number of days spent in the hospital, number of days employed, where the consumer is living, and what changes in a consumer's functioning and level of hope.