Chelan-Douglas Regional Support Network/
Prepaid Health Plan

For years, communities around the country have been experimenting to find the best ways to help people with serious mental illnesses stay out of the hospital and remain in their communities with as much independence as possible.  Because mental illnesses affect so many aspects of life, people who live with them may need a wide safety net of services, including help with social skills, personal care, employment, housing, finances, education, and medical treatment.  Ideally, such services are well-coordinated and continue throughout the various stages of a long-term, chronic condition.  The most effective community service programs build on individual strengths, provide a sense of belonging, emphasize the possibility of work and personal growth, and focus on the particular needs and preferences of each person.

Although a number of model programs have emerged, in many parts of the country non-medical services for people with mental illnesses are fragmented, under-staffed, and under-budgeted, making them difficult for families and consumers to find and use.  In most cases, a family member still needs to take responsibility for managing and coordinating the care of a relative who has a sever mental illness.

Where community services offer social, vocational, housing, and other help, they are making a significant difference in the lives of people with mental illnesses and their families.  The clubhouse model, begun in New York City over 50 years ago, has spawned hundreds of similar programs across the country.  New York's Fountain House, the first clubhouse of its kind, is a social and vocational center serving hundreds of members with serious mental illnesses.

Every day, clubhouse members work as equals alongside Fountain House staff to operate a kitchen, administrative offices, housekeeping services, and programs in education, research, financial management, and employment opportunities.  A transitional-employment program helps members find and keep jobs.  Fountain House staff work closely with local hospitals and psychiatrists to coordinate members' medical treatment and assist when a crisis occurs.  However, they deliberately maintain a non-clinical atmosphere at the clubhouse itself.

More than half of the members live in housing made available through Fountain House and supported by its professional staff.  A 24-hour-a-day housing-support team reaches out to members in their homes when help is needed.

Those who work in and belong to this clubhouse strongly believe that every person can make a contribution to the community and can move toward wholeness and independence.  Their experience over nearly five decades supports this belief.

Another approach is taken by the Program of Assertive Community Treatment (PACT), an intensive, multidisciplinary team effort in local communities to help people with persistent mental illnesses - including people with co-occurring substance abuse - stay out of the hospital or jail and live independently.  Instead of operating a center where people with mental illnesses gather and receive services, PACT professionals meet their clients where the clients live.  They are available 24-hours-a-day, seven-days-a-week, at-home support at whatever level is needed and for whatever problems need to be solved.

On frequent one-on-one home visits - sometimes several times a day - professionals help clients manage their medications and help them meet the challenges of daily life - from grocery shopping and keeping doctors' appointments to managing money and getting and keeping employment.

Rather than referring consumers to fragmented services, the PACT staff directly provides psychiatric, rehabilitation, substance abuse, crisis intervention, and other support services.

PACT programs are now statewide in six states and growing in other states.  In these places, PACT is significantly reducing hospital admissions, improving the quality of life, and providing opportunities for those it serves.

To learn more about PACT, visit the NAMI Web site at www.nami.org/about/pactfact.html.

In general, comprehensive community services such as those described in these pages are available to people with disability income or other public assistance, and the costs to individuals are covered by that income.  In addition to government funding, some programs also receive financial support from foundations, corporations, and individual donors.

While comprehensive services are expensive for governments and local communities to provide, the economic and social costs of frequent hospitalization - for individuals, families, and communities - are far greater.  On average, hospitalizing a person with a serious mental illness costs three to five times as much per year as providing comprehensive services in the community.  Where people are served by such programs, they and their families are finding the respite and stability they need to manage their persistent and sever mental illnesses over the long term.

To find mental health services in your community, contact your state of county mental health department or your local affiliate of NAMI (the National Alliance for the Mentally Ill), usually listed in the white pages of the telephone book, or call NAMI at 1-800-950-NAMI (6264).

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