Psychiatry and Integrated Healthcare
Within the multidisciplinary Assertive Community Treatment (ACT) team is a core medical team, including psychiatrist or psychiatric physician extender (“psychiatric care provider”), and nursing staff, primarily RNs.
People served by ACT teams have challenging psychiatric symptoms that significantly impact their life, and are often viewed as relatively “high-risk.” Although ACT is much more than a medication-delivery and support program, most people served by ACT benefit from carefully selected medications to help them with symptom control. Also, clinically sophisticated assessment of psychiatric symptoms and behaviors to assist with service planning is central to good practice. Thus, psychiatry remains to be a critical component of ACT.
ACT teams should have a psychiatrist (or psychiatric physician extender) fully integrated on to the team and operating as a co-clinical leader with the ACT Team Leader. A large team serving 120 individuals should have a full-time psychiatric care provider. Although this role may be shared with more than one psychiatric care provider, role-sharing is limited to promote greater integration and continuity of care. ACT psychiatric care providers meet with individuals often, provide brief therapy in addition to psychiatric assessment and medication oversight, and use a shared-decision making model when prescribing medications. Psychiatric care providers work closely with other psychiatric and non-psychiatric healthcare professionals to coordinate care, and work closely with nursing staff to provide more holistic healthcare oversight and supports. As with all team members, there is an expectation that psychiatric care providers are seeing individuals in the community.
As we know, individuals served by ACT have complex healthcare needs, sometimes secondary to the medications they are prescribed and lifestyle circumstances. Integrated nursing care is also key to providing best practice ACT. Nursing staff often assume a lead role in managing the medication system within the team, and support the psychiatric care provider in ensuring that medications are refilled and distributed, lab work is completed, and that there is continuous symptom and side-effect monitoring. Additional critical nursing services include monitoring and assisting around broader healthcare needs, including preventative care and harm reduction (e.g., smoking cessation, safe sex practices, exercise, and nutrition). A large team should have three full-time nurses, with preference to Registered Nurses (RNs) and for nursing with experience and training in working with those with psychiatric illnesses.
Learn More about Psychiatry and Integrated Healthcare within ACT, including the roles of the psychiatric care provider and nursing staff, through these resources.