Dr. Gary Morse recently met with federal officials to advocate for Assertive Community Treatment services across the country.
Morse participated in a SAMHSA expert panel in September about Assertive Community Treatment (ACT). The panel of 10 experts spanned several disciplines. Morse, Places for People’s Vice President of Research and Development, is a pioneer in the use of ACT to help people who have experienced homelessness and live with severe mental illness.
ACT is the most intensive community-based model of care available to help people with severe mental illness. An ACT team includes case managers, an employment specialist, substance use specialist, nurse, and access to a prescriber. The model is held to a high standard of quality through fidelity reviews.
“What was partly impressive to me was the level of federal involvement and leadership in it,” Morse said of the discussion.
Assistant Secretary for Mental Health and Substance Use Dr. Elinore F. McCance-Katz helped kick off the daylong session and spent almost an hour with the group.
McCance-Katz said that expanding ACT services is one of her top two priorities in her new role.
“She comes in with a knowledge that this an effective treatment and it really helps people, we don’t have enough of it, we need more of it, and we need leadership to make that happen,” Morse said.
The panel of experts provided input on how to promote the effectiveness of ACT and what would be necessary to expand and improve services.
“I’ve been doing ACT for literally 30 years and it’s the most I’ve ever seen of a commitment as a priority from a high level of government,” Morse said.
One of the ideas was to establish national and/or regional technical centers that could help providers who offer ACT with training and consultation.
An increase in quantity of ACT teams would not be effective without a corresponding increase in quality. Technical centers could help maintain a high standard of quality.
“When you provide high fidelity, you get good clinical outcomes and good cost effectiveness.”
Morse first became interested in ACT as a graduate student when he learned about a precursor approach called PACT in a community psychology course. He noted that the PACT model had good results in helping people living with severe mental illness leave a hospital and re-enter the community.
“In ’87, when I started work for the Department of Mental Health, we were developing community services for people who were homeless,” Morse recalled. He asked, “what if we took the same thing and did it for people who had severe mental illness and were homeless, rather than hospital based?”
Morse applied for a grant to provide the services. The grant received funding and became the impetus for starting Community Alternatives.
“Thirty years later it’s recognized in the national register for evidence-based practices. Things move slowly,” Morse joked.
The ACT approach that Morse and his colleagues developed and researched was entered into the national register for evidence-based practices in spring of 2017 by the National Registry of Evidence-based Programs Practices (NREPP).
Places for People is home to 4 of Missouri’s 12 ACT teams.
“Research findings that will show you compared to typical mental health services, people who receive ACT spend less time in the hospital, they spend more time stably housed in the community, they’re more satisfied with the services, their family is more satisfied with the services, they have greater reductions in mental health symptoms, their functioning is higher.
“What the research data don’t show you though are the really striking differences that happen in people’s lives, from where they were before to a later point after receiving services.”
Over the years, Morse has witnessed extraordinary stories of health and healing.
“It is a real privilege to see the changes that people make in their lives with the right kind of treatment and support.”
SAMHSA is currently preparing the recommendations of the expert panel to be shared with leaders in congress in the hopes of securing funding. Morse is hopeful that the experience will lead to results.
“Here’s this opening in the clouds at a federal policy level. An opportunity to be able to take what we know and trying and dissemination to ultimately improve services for people with severe mental illness.”
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