An ACT Program for Co-Occurring Disorders

To the Editor: In many states, the care of persons with co-occurring mental illness and mental retardation remains limited to that provided in institutional settings or community group homes, where individual services are provided by vendors from separate and autonomous systems such as mental health, developmental disabilities, and vocational rehabilitation (1,2,3). We implemented a community living program designed to care for 21 persons with mental illness and mental retardation based on the assertive community treatment (ACT) paradigm (4).

The core interdisciplinary team was accessible 24 hours a day seven days a week, shared integrated clinical and rehabilitative responsibility for all clients, and maintained close communication with family members and employers. Residential arrangements centered mainly on clusters of apartment for one to two persons, although several clients chose to live in other housing units scattered throughout the city.

Overall, the program helped participants maintain community tenure, supported employment, and consistent contact with significant others without clinical deterioration or increase in the use of inpatient hospital services. Our experience is consistent with that of ACT programs in Michigan and overseas (5) and supports the assertion that such programs can be implemented and sustained without exceeding budgetary constraints of parent agencies and without adverse client outcomes.

Mr. Meisler is with the division of public psychiatry in the department of psychiatry and behavioral sciences at the Medical University of South Carolina in Charleston. Ms. McKay is president and chief executive officer of Connections Community Service Program, Inc., in Wilmington, Delaware. Mr. Benasutti is with the South Carolina Department of Mental Health in Columbia.