An 'assertive' future?

Mental Health Nursing,  Oct 2000  by Libberton, Paula

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Assertive Community Treatment (ACT) is the government's latest way of providing care for people with a severe mental illness who are difficult to engage within existing mental health services. Nearly everyone working in community mental health has probably heard this term by now and some may be wondering what exactly is meant by ACT It may conjure up a variety of images from nurses restraining people over the kitchen table to mental health workers with small caseloads who are able to spend more time with their clients. Whatever it means to mental health workers, clients and carers alike, it is a term that is expected to be used within mental health services for the near future.

This method of care has been around in the United States for over twenty years yet it is only now beginning to catch on in the UK - or is it? Some mental health workers may feel insulted by the name given to this method of treatment as they may consider their own practice to have always been assertive. This leaves people asking:'What can an ACT team offer that a community mental health team (CMHT) cannot? The answer could simply be - time. Most CMHTs have a large ratio of staff to clients which means that mental health workers do not have enough time to dedicate to individuals who do not wish to fit into their usual timetable of work. Clients can easily be forgotten or left to their own devices with dire consequences for both themselves and others.

A significant amount of importance is given to engagement when discussing ACT However, this is something that is considered a core skill for all mental health workers. How can anyone expect to be heard if they have not first attracted the other person's attention? The small number of clients cared for by the ACT Team allows staff more opportunities to try different methods of engagement. This may include visiting at a venue of the client's choice or assisting with buying food. After all, who is going to be interested in discussing different methods of therapy if they have not yet succeeded in ensuring that they always have enough food to eat. These interventions are basic but often not given the same importance by professionals as they are by clients.

The current dilemma that NHS trusts are experiencing is how to implement or ensure that ACT is happening with the clients in their area who can benefit from this kind of treatment. Some services are choosing to maintain fidelity to the model of ACT whereas others are adapting the model to suit their own requirements. This has left some mental health workers unsure as to the validity of this method of treatment. It has also raised concerns about ensuring that staff do not burnout with the strain of a potentially very demanding group of people. ACT is here to stay for the short term, so we need to know what it is about and how best to implement it for the benefit of everyone involved with it.

Copyright Community Psychiatric Nurses Association Oct 2000
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