Abstract
This qualitative study assessed the experiences of assertive community treatment (ACT) team members regarding the integration of physical and mental health self-management for persons with serious mental illness. Three focus groups elicited information from participants concerning barriers, strategies, and recommendations. Findings from inductive analyses revealed six overarching themes: (1) collaboration with primary care, (2) improvements in engagement, (3) team-focused roles, (4) education and training, (5) recommendations for system level barriers, and (6) systems collaboration. Participant recommendations suggest that ACT teams are well positioned to integrate mental and physical health treatment, but further research is needed to support integrated care.
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Allness, D., & Knoedler, W. (2003). A manual for ACT start-up: Based on the PACT model of community treatment for persons with severe and persistent mental illnesses (2003rd edn.). Arlington, VA: NAMI: National Alliance for the Mentally Ill.
Bond, G. R. (1991). Variations in an assertive outreach model. New Directions for Mental Health Services, 1991(52), 65–80. doi:10.1002/yd.23319915207.
Bond, D. G. R., Drake, D. R. E., Mueser, D. K. T., & Latimer, D. E. (2001). Assertive Community Treatment for people with severe mental illness. Disease Management and Health Outcomes, 9(3), 141–159. doi:10.2165/00115677-200109030-00003.
Boust, S., Kuhns, M., & Studer, L. (2005). Assertive community treatment. In C. E. Stout & R. A. Hayes (Eds.), The evidence-based practice: Methods, models, and tools for mental health professionals (pp. 31–55). Hoboken, NJ: Wiley.
Chadwick, A., Street, C., McAndrew, S., & Deacon, M. (2012). Minding our own bodies: Reviewing the literature regarding the perceptions of service users diagnosed with serious mental illness on barriers to accessing physical health care. International Journal of Mental Health Nursing, 21(3), 211–219. doi:10.1111/j.1447-0349.2011.00807.x.
Colton, C. W., & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease, 3(2). Retrieved from http://www.ncbi.nlm.nih.gov.ezp3.lib.umn.edu/pmc/articles/pmc1563985/.
Crump, C., Sundquist, K., Winkleby, M. A., & Sundquist, J. (2013). Comorbidities and mortality in bipolar disorder: A swedish national cohort study. JAMA Psychiatry, 70(9), 931–939. doi:10.1001/jamapsychiatry.2013.1394.
Cuddeback, G., & Shattell, M. (2010). Nurses and assertive community treatment teams: A critical combination. Issues in Mental Health Nursing, 31(11), 751–752.
Cuddeback, G. S., Morrissey, J. P., Cusack, K. J., & Meyer, P. S. (2009). Challenges to developing Forensic Assertive Community Treatment. American Journal of Psychiatric Rehabilitation, 12(3), 225–246. doi:10.1080/15487760903066362.
De Hert, M., Cohen, D., Bobes, J., Cetkovich-Bakmas, M., Leucht, S., Ndetei, D. M., & Correll, C. U. (2011a). Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry, 10(2), 138–151. doi:10.1002/j.2051-5545.2011.tb00036.x.
De Hert, M., Correll, C. U., Bobes, J., Cetkovich-Bakmas, M., Cohen, D., Asai, I., … Leucht, S. (2011b). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry, 10(1), 52–77. doi:10.1002/j.2051-5545.2011.tb00014.x.
Druss, B. G., Zhao, L., Von Esenwein, S., Morrato, E. H., & Marcus, S. C. (2011) “Understanding excess mortality in persons with mental illness: 17-Year follow up of a nationally representative US survey.” Medical Care 49(6), 599–604. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005650-201106000-00011 (June 9, 2015).
Ehrlich, C., Kendall, E., Frey, N., Kisely, S., Crowe, E., & Crompton, D. (2014). Improving the physical health of people with severe mental illness: Boundaries of care provision. International Journal of Mental Health Nursing, 23(3), 243–251.
Fleischhacker, W. W., Cetkovich-Bakmas, M., De Hert, M., Hennekens, C. H., Leucht, S., Maj, M., & Lieberman, J. A. (2008). Comorbid somatic illnesses in patients with severe mental disorders: Clinical, policy, and research challenges. The Journal of Clinical Psychiatry, 69(4), 514–519.
Furlong, M., Leddy, J., Ferguson, J., & Heart, K. (2009). Assertive community treatment and recovery at thresholds. American Journal of Psychiatric Rehabilitation, 12(2), 108–123. doi:10.1080/15487760902812998.
Graham, C., Griffiths, B., Tillotson, S., & Rollings, C. (2013). Healthy living? By whose standards? Engaging mental health service recipients to understand their perspectives of, and barriers to, healthy living. Psychiatric Rehabilitation Journal, 36(3), 215–218. doi:10.1037/prj0000009.
Happell, B., Davies, C., & Scott, D. (2012a). Health behaviour interventions to improve physical health in individuals diagnosed with a mental illness: A systematic review. International Journal of Mental Health Nursing, 21(3), 236–247. doi:10.1111/j.1447-0349.2012.00816.x.
Happell, B., Scott, D., Platania-Phung, C., & Nankivell, J. (2012b). Should we or shouldn’t we? Mental health nurses’ views on physical health care of mental health consumers. International Journal of Mental Health Nursing, 21(3), 202–210. doi:10.1111/j.1447-0349.2011.00799.x.
Hardy, S., & Thomas, B. (2012). Mental and physical health comordibity: Political imperatives and practice implications. International Journal of Mental Health Nursing, 21(3), 289–298. doi:10.1111/j.1447-0349.2012.00823.x.
Laursen, T. M. (2011). Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophrenia Research, 131(1–3), 101–104. doi:10.1016/j.schres.2011.06.008.
Lawrence, D., & Kisely, S. (2010). Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology, 24(4 suppl), 61–68. doi:10.1177/1359786810382058.
Maj, M. (2009). Physical health care in persons with severe mental illness: A public health and ethical priority. World Psychiatry, 8(1), 1–2.
Monroe-DeVita, M., Teague, G. B., & Moser, L. L. (2011). The TMACT: A new tool for measuring fidelity to Assertive Community Treatment. Journal of the American Psychiatric Nurses Association, 17(1), 17–29. doi:10.1177/1078390310394658.
Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24(1), 37–74.
National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council (2006). Morbidity and mortality in people with serious mental illness (Technical No. 13). Alexandria, VA: NASMHPD.
Robson, D., & Gray, R. (2007). Serious mental illness and physical health problems: A discussion paper. International Journal of Nursing Studies, 44(3), 457–466. doi:10.1016/j.ijnurstu.2006.07.013.
Shattell, M. M., Donnelly, N., Scheyett, A., & Cuddeback, G. S. (2011). Assertive community treatment and the physical health needs of persons with severe mental illness: Issues around integration of mental health and physical health. Journal of the American Psychiatric Nurses Association, 17(1), 57–63. doi:10.1177/1078390310393737.
Sodhi, S. K., Linder, J., Chenard, C. A., Miller, D. D., Haynes, W. G., & Fiedorowicz, J. G. (2012). Evidence for accelerated vascular aging in bipolar disorder. Journal of Psychosomatic Research, 73(3), 175–179. doi:10.1016/j.jpsychores.2012.06.004.
Stein, L. I., & Test, M. (1980). Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37(4), 392–397. doi:10.1001/archpsyc.1980.01780170034003.
Trangle, M., Gary, M., Paul, G., & Christensen, R. (2010). Minnesota 10 by 10. Reducing morbidity and mortality in people with serious mental illnesses. Minnesota Medicine, 93(6), 38–41.
Vanderlip, E. R., Williams, N. A., Fiedorowicz, J. G., & Katon, W. (2014). Exploring primary care activities in ACT teams. Community Mental Health Journal, 50(4), 466–473. doi:10.1007/s10597-013-9673-8.
Weinstein, L. C., Henwood, B. F., Cody, J. W., Jordan, M., & Lelar, R. (2011). Transforming Assertive Community Treatment into an integrated care system: The role of nursing and primary care partnerships. Journal of the American Psychiatric Nurses Association, 17(1), 64–71. doi:10.1177/1078390310394656.
Wiley-Exley, E., Domino, M. E., Ricketts, T. C., Cuddeback, G., Burns, B. J., & Morrissey, J. (2013). The impact of assertive community treatment on utilization of primary care and other outpatient health services: The North Carolina experience. Journal of the American Psychiatric Nurses Association. doi:10.1177/1078390313494170.
Wilkinson, S. (2003). Focus groups. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to research methods (pp. 184–204). Thousand Oaks, CA: SAGE.
Wolff, N., Frueh, B. C., Huening, J., Shi, J., Epperson, M. W., Morgan, R., & Fisher, W. (2013). Practice informs the next generation of behavioral health and criminal justice interventions. International Journal of Law and Psychiatry, 36(1), 1–10.
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This project was supported through funding from the Medicaid Adult Quality Measures grant program outlined under the Catalog of Federal Domestic Assistance Number 93.609 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. However, these contents do not necessarily represent the policy or views of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.
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Meyer-Kalos, P.S., Lee, M.G., Studer, L.M. et al. Opportunities for Integrating Physical Health Within Assertive Community Treatment Teams: Results from Practitioner Focus Groups. Community Ment Health J 53, 306–315 (2017). https://doi.org/10.1007/s10597-016-0043-1
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DOI: https://doi.org/10.1007/s10597-016-0043-1