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The article, Assertive Community Treatment: Evidence Based Hope for the Seriously Mentally Ill, raises the question of whether the seriously mentally ill population suffers from greater health care needs than any other segment of the population because of their mental illness. If so, does this make it more difficult for mental health professionals to provide quality health care for this population?
According to Rice, evidence shows that change is needed because of the ever-expanding list of medical health care issues that make it increasingly difficult for this population to gain access to primary care services, which further complicates their conditions (Rice, 2011).
Rice states the change agents who offer the greatest opportunities to address this problem are the Assertive Community Treatment teams, or ACT teams (Rice, 2011). These teams offer inter-professional support services which include social work, counseling, psychiatric nursing psychiatrists, and vocational rehabilitation for early intervention (Rice, 2011).
The target audience in outpatient mental health in patients with severe mental illness and their families. This group needs specialized care because of the many problems they face as highlighted above. Mental Hospital Deans, the heads of the healthcare sector, and practicing doctors are key in outpatient mental health since their contribution and opinions run the healthcare industry.
Rice conducted a study and obtained summaries from the current best available evidence. He analyzed services within mental health and identified the difficulties associated with conducting a valid study, especially with the dually diagnosed population. He compares data from one study of mental health consumers who are receiving structured case management services to those who are receiving ACT team services to decide if the evidence supports the need for change. Rice concludes that upon closer examination of the evidence, there is a need to look beyond the probabilities given in the small sample sizes and examine the effect of the size of the interventions (Rice, 2011). Rice identifies the problem, the population, and suggests early intervention through ACT involvement. He compares other mental health services to the ACT team and focuses on outcomes. He admits that the study is small which may indicate it is possible that there are not enough participants to show that a difference actually exists between the intervention and the comparison group. Further studies need to be compiled to further support the evidence. The article does not offer statistics in order that the reader can extrapolate his or her own conclusions.
The author adopted the protocol to fit his specific service providers and the ACT model. He noted that evidence-based practice shows that ACT teams need to integrate primary medical care into their protocol. Rice noted that evidence shows that operations of ACT teams indicate that vocational services may be undervalued and underemphasized in consumer treatment plans, so he suggests providing rehabilitative and vocational services based on the recovery model.
The writer identified the barriers to using the knowledge and identified the characteristics of the staff that is on the ACT teams being the biggest obstacle. He wrote that the pessimistic attitudes and a lack of advanced education may not be compatible with the philosophy of recovery in the ACT model. Other barriers identified were funding and cutbacks in state-funded services.
The article did not address the dissemination plan, the evaluation plan, or the way to pilot test the evidence-based practice for the ACT team. We need to formulate a dissemination plan which includes a tailored protocol for mental illness patients and their families. It should also include a training schedule for outpatient mental health nurses. All other social workers and related departments need to be informed on the contents and progress of the plan. After dissemination, check the plan by developing a method for data collection and analysis that will help find the success predictors. Data collected could include the number of mentally ill patients without homes or those with more health risks like substance abuse and diabetes. More importantly, find a competent person who will carry out this evaluation plan. A pilot test is important because it allows research to be conducted under controlled conditions and could be a source of valuable information. For instance, ten patients with mania could be individually monitored and the model implemented. The process should then be evaluated, and in doing so, the following questions answered. How far are the actual results from the predicted value? Are there fewer cases of substance abuse among the mentally ill? How many now have homes? How many now have their diabetes under control?
After making the necessary edits, we can carry out the practice change. There are several steps involved. First, put a proper training mechanism in place. Secondly, avail the necessary resources like medication, food, clothing and adequate staff. Thirdly, communicate to the target group through pamphlets, protocols or through organized seminars. Fourth, evaluate the outcome of the implementation process by gauging its effectiveness in terms of cost and the difference it makes in the patient’s life. If well implemented, many mentally ill patients will get food and shelter; they will have other illnesses like diabetes and metabolic syndrome addressed, and acceptance of the ill patients into society will increase (Huber, 2010). This is how we will know that the model makes patients’ lives better. Maintaining the change is important and we do this through monitoring feedback and disseminating the results of the change to clinicians and stakeholders. This will go a long way in making clinical and financial improvements that are important for effectiveness.
In conclusion, using the Assertive Community Treatment model in managing mentally ill patients is both worthwhile and effective. Cost-effectiveness and results make it a workable plan. Since its implementation, cases of mortality and morbidity among mentally ill patients have reduced, acceptance for more patients in society is high and most lead an almost normal life.
Reference List
Huber, D. L. (2010). Leadership and nursing care management (4th ed.). Maryland Heights, MO: Saunders Elsevier.
Rice, M. J. (2011). Assertive community treatment: Evidence based hope for the seriously mentally ill. American Psychiatric Nurses Association, 17, 13-15.
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