Chapter VII: Elements of an Effective Mental Health System
Policy Statement 36: Integration Of Services
Recommendation d: Adjust licensing and other regulatory functions to encourage development and operation of comprehensive, integrated services.
Funding is by no means the only issue keeping systems from supporting more effective services. Key providers in a given community, perhaps competing for funding, may operate with different philosophies, undermining opportunities for cross-training, effective communication, or service coordination. At the same time, conflicting or confusing licensing regulations can thwart one agency's efforts to provide integrated services.
To achieve widespread service integration, policymakers will need to coordinate or consolidateregulatory and reporting mechanisms. The purpose is to make creative and effective integrated service models available for people who have mental illness and a variety of other needs.
Example: Assertive Community Treatment
The Assertive Community Treatment model (known as ACT or PACT) was developed in Madison, Wisconsin, in the 1970s. Six states (Delaware, Indiana, Michigan, Rhode Island, Texas, Wisconsin) currently have statewide ACT programs. Nineteen states have at least one or more ACT pilot programs in their state. It is a service-delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illness. Unlike many other community-based programs, ACT is not a linkage or brokerage case-management program that connects individuals to mental health, housing, or rehabilitation agencies or services. Rather, it provides highly individualized services directly to consumers. ACT recipients receive the multidisciplinary, round-the-clock staffing of a psychiatric unit, delivered in the "real world" settings of their homes, local coffee shops, or other places they may frequent. To have the competencies and skills to meet a client's multiple treatment, rehabilitation, and support needs, ACT team members are trained in psychiatry, social work, nursing, substance abuse, and vocational rehabilitation. Recently, ACT teams have placed a greater emphasis on inclusion of consumers as treatment team members, either in the traditional professional positions or as peer counselors able to communicate more effectively with a team's clients. The ACT team provides these necessary services 24 hours a day, seven days a week, 365 days a year. To make ACT programs more accessible, states have adopted funding strategies approved by Medicaid for this purpose. As part of their contracting process, states monitor ACT programs for compliance with certain agreed-upon practice standards.
Example: Village Integrated Service Agency, Long Beach (CA)
The Village Integrated Service Agency in Long Beach was initially developed through state legislation (1989) that attempted to remove administrative and funding barriers from the delivery of comprehensive, individualized mental health services. The three basic elements of Village's program design are collaborative case-management teams, case-rated funding, and a psychosocial rehabilitation/recovery philosophy. As in the ACT model, services at the Village are primarily delivered to the client wherever he or she is: at home, on the job, in the supermarket. Teams of clinicians work with each client and bring complementary skills to the process. Case-rated funding is an important principle because it is focused on outcomes rather than on delivery of units of service. The overarching recovery philosophy imbues staff and clients with a willingness to seek the rewards that come with higher risks, knowing that support will be available when needed. The Village offers a clear, single point of responsibility for everyone it serves and provides coverage 24 hours a day, seven days a week.