PACT is a program model targeted for hard to reach individuals diagnosed with severe and persistent mental illness. It integrates mental health treatment, substance abuse treatment, vocational rehabilitation, case management, assistance with daily living skills and social support within a multi-disciplinary team. This team, which includes a psychiatrist, nurses, masters and bachelor level social workers, counselors, vocational and substance abuse specialists, shares responsibility for providing a comprehensive array of services. There is also a peer specialist who is an individual who is or has been a recipient of mental health services. The PACT team serves as a fixed point of responsibility. Key outcomes are symptom stability, health maintenance and coordination of medical care, minimal use of emergency and psychiatric facilities, stability in independent living arrangements and normalization of activities of daily living (including community integration and employment, either competitive or volunteer).
Individuals who benefit most from the PACT services are those who, because of severe symptomology or otherwise compromised functioning levels, are unable to access and engage with traditional mental health services. Typically, these individuals have frequent interactions with the medical and judicial systems, and are at high risk of incarceration in hospitals and jails. The PACT team formulates a highly individualized plan of treatment, tailored to the consumer's needs and preferences. The team members can rapidly increase service intensity to address or prevent crises. Emergency response is provided by the team and a team member is available 24 hours a day, 7 days a week. Up to 75% of the services are provided out of the office, in the homes and communities where individuals reside. The ratio of clients to staff is low, the national standard is 1:10.
In addition to psychiatric care and medication adherence, other key areas of focus include supportive therapy and behaviorally oriented skill teaching, including structuring time and handling activities of daily living. Supportive therapy is used to help individuals increase their control over their lives and learn to cope with symptoms, medication side effects, poverty and the other myriad challenges of living with a serious mental illness. Concurrent treatment of co-occurring mental health and substance use disorders is the most effective strategy to reduce the detrimental effects on stability and community tenure. Although abstinence from substances is the treatment goal, a more long-range, patient approach is often required with this challenging population. All interventions are aimed at reducing the risk of harm through overdose, infectious disease and self-neglect.
Behavioral skills are taught individually and in psychoeducation groups. Primarily team members instruct, coach, accompany and assist in housekeeping, budgeting, meal planning, shopping, bill paying, and attending health and social service appointments in the settings in which these skills are used ("in-vivo"). Productive daily activity is vital in the attainment of stability and the move to recovery. The PACT team is committed to providing employment related services that are fully integrated into other services within the team.
The ultimate goal of the PACT team is to provide responsive, compassionate, individualized and goal-directed care with the utmost regard for the individuals' dignity, right to self-determination and freedom of choice. An individual's tenure in the program is not time-limited. The intent is to assist individuals toward recovery, the successful attainment of psychiatric stability and the skills necessary to live independently in the community.