Assertive Community Treatment Promotes Recovery:
Interview conducted by Elizabeth Edgar, Director of the NAMI ACT Technical Assistance Center, for the NAMI Advocate (Winter 2001)
An Interview with Joe Phillipps
NAMI: Joe, could you please tell us how you became involved with assertive community treatment?
I had just graduated from a small high school in rural, southern Wisconsin. I had been hearing voices and was having trouble with confusion, but was able to graduate and work. I got very high grades in high school and was working 50-to-60 hours a week, but I knew something was wrong.
One day I had my first major psychotic episode. I was put in a psych ward. All I remember was waking up in a seclusion room with no idea what I had done to get there. Over the next two years I spent 16 months in psychiatric units. I was from a small county and basically saw a counselor once a month, at the county facility. I was a revolving door client, and my life was seemingly becoming more hopeless. I was living with my parents or in a hospital, the main source of psychiatric support.
In the early 80s my county began an assertive community treatment program, and I was chosen as a client. Assertive community treatment was extremely different. I was given help to find my own place to live, vocational assistance, proper medication supervision, and help to learn to live on my own. I got relevant care, where I needed it. (The emphasis is Joe's).
Before assertive community treatment, my case manager kept changing, and there was no continuity. I found over the years, even with several staff changes on the team, that the team knew what was happening and what my past was. I also could trust the assertive community treatment people because we had a long relationship. Many times I felt I could count on the people who staffed the team. I could share feelings with them that I couldn't share with my large, loving family. I was also encouraged to make choices.
As time went on, I chose to fulfill a lifelong dream, getting a college degree. I did this with support from my assertive community treatment team. I also now work on an assertive community treatment team and have recently become self-sufficient, without Social Security and SSI. I choose to work in an assertive community treatment model program because I feel we can help clients who may need extra care but who have a right to live in the community. I hope to help people with severe and persistent mental illness recover and be able to pursue happiness in life.
NAMI: How did assertive community treatment help you get where you are today?
The long-standing, consistent support really helped me. They helped me find resources that I couldn't access by myself. Over time I came to trust them. They helped me to have a better situation than being in the hospital or on the street. They were, and are, willing to be there for me on a long-term basis. The best thing my assertive community treatment team did was motivate me to work and not accept hopelessness. They helped me develop a vision for my future and to make choices that would help me in the future.
NAMI: How did you work with the team?
Assertive community treatment offered choices and helped me make better choices about places to live, medications, and employment. Assertive community treatment was very different than what I experienced when I had a case manager who I saw once a month. The case manager saw me and then, I felt, forgot about me. The team is interested enough to help me to recover; not just tell me, "That's nice. Good luck." Often I did not agree with my ACT team, and I was given freedom to make mistakes. A main point about ACT is that, as my needs changed, so did the treatment provided by the team. Flexibility helped me to be more independent. When issues became too stressful, I received more support. I had the opportunity to determine what treatment I wanted, including making decisions about medication.
NAMI: Could you say more about the vocational aspects of your recovery?
The team helped me with paid jobs, not volunteer work or being in a sheltered workshop. They helped me make choices, like when I decided to go to college so I could get work I really wanted. Based on how the team had come through for me over the years, I trusted the team to let go when needed and hold on when needed.
I feel they also listened to me and let me know my dreams mattered. Recovery is a process. My first job was as a dishwasher, then I became a receptionist, janitor, then a cleaning-company assistant. All these jobs taught me the simple, basic aspects of work: showing up, learning to problem solve. The team helped me to see that I could do more and, if I wanted, to grow vocationally. I would, over the years, grow personally as well. I look at myself as a worker and colleague instead of a person with a mental illness. My illness is still part of me, but I chose to define myself as a person first.
NAMI: Are there other things the assertive community treatment team did that helped?
Yes, they helped me learn more about schizoaffective disorder. I became educated about the illness and about medications. I learned what to expect and how to deal with it. They helped me face the illness and work with it. I began going to conferences. I also went to a consumer-run, self-help group. Assertive community treatment encouraged participation in the consumer-support group. Just because you have an illness, your life doesn't have to end.
I think ACT's longtime relationship builds your confidence to do things and to take personal responsibility for your choices. It's a natural progression toward recovery. You can overcome and attain your goals. You can live independently. Some consumers feel assertive community treatment programs inhibit recovery. In my case, I found it really assisted me in my independence. I needed help, and the help I received from assertive community treatment empowered me.
NAMI: You have said many positive things about assertive community treatment.
Assertive community treatment is not perfect. I've liked some staff better than others. I've not always agreed with the teams' suggestions. But the team has the ability to offer a longterm relationship to people in the community who otherwise could be in a hospital, in jail, or homeless. This program isn't just about meds, or only for people with court orders like some people think.
Dreams are different for everyone. Assertive community treatment programs help those that most program models cannot. Some dreams may be to live in the community, not in a hospital, and to have a part-time job. The relevant community interventions of these programs can help create an environment for people with severe and persistent mental illness in which they can succeed, rather than being in institutions or on the streets with no treatment at all.
NAMI: How would you sum up?
It's the trusting relationship that makes ACT programs work. It's the give-and-take, the relationship with several staff on the team over time that helps people feel good about themselves and good about their life. The relationships help you get your confidence back and achieve your dreams. I no longer see myself as a person with mental illness. I see myself as Joe Phillipps, a person.