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An ACT Program for Co-Occurring Disorders

To the Editor: In many states, the care of persons with co-occurring mental illness and mental retardation remains limited to that provided in institutional settings or community group homes, where individual services are provided by vendors from separate and autonomous systems such as mental health, developmental disabilities, and vocational rehabilitation (1,2,3). We implemented a community living program designed to care for 21 persons with mental illness and mental retardation based on the assertive community treatment (ACT) paradigm (4).

The core interdisciplinary team was accessible 24 hours a day seven days a week, shared integrated clinical and rehabilitative responsibility for all clients, and maintained close communication with family members and employers. Residential arrangements centered mainly on clusters of apartment for one to two persons, although several clients chose to live in other housing units scattered throughout the city.

Overall, the program helped participants maintain community tenure, supported employment, and consistent contact with significant others without clinical deterioration or increase in the use of inpatient hospital services. Our experience is consistent with that of ACT programs in Michigan and overseas (5) and supports the assertion that such programs can be implemented and sustained without exceeding budgetary constraints of parent agencies and without adverse client outcomes.

Footnotes

Mr. Meisler is with the division of public psychiatry in the department of psychiatry and behavioral sciences at the Medical University of South Carolina in Charleston. Ms. McKay is president and chief executive officer of Connections Community Service Program, Inc., in Wilmington, Delaware. Mr. Benasutti is with the South Carolina Department of Mental Health in Columbia.

References

1. Dudley JR, Calhoun ML, Ahlgrim-Delzell L, et al: A consumer satisfaction survey of people with mental retardation and mental illness. Psychiatric Services 48:1075-1077, 1997[Abstract/Free Full Text]
2. Torrey WC: Psychiatric care of adults with developmental disabilities and mental illness in the community. Community Mental Health Journal 29:461-475, 1993[Medline]
3. Thomas JR: Quality care for individuals with dual diagnosis: the legal and ethical imperative to provide qualified staff. Mental Retardation 32:356-361, 1994[Medline]
4. Stein LI, Santos AB: Assertive Community Treatment of Persons With Severe Mental Illness. Norton, New York, 1998
5. Van Minnen A, Hoogduin CAL, Broekman TG: Hospital vs outreach treatment of patients with mental retardation and psychiatric disorders: a controlled study. Acta Psychiatrica Scandinavica 95:515-522, 1997[Medline]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Meisler, N. Articles by Benasutti, R. Search for Related Content PubMed Citation Articles by Meisler, N. Articles by Benasutti, R. Dual Diagnosis Patients Social Security, Other Entitlements Adults With Mental Retardation, Developmental Disorders

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