A decade ago, Montanans as seriously mentally ill as the folks that Jay Kirk and Lindsay Berg care for spent much of their lives at Montana State Hospital or on the streets.
That was before PACT, the Program for Assertive Community Treatment. PACT pilots started in late 1999 in Billings and Helena in an effort to reduce the census at the state psychiatric hospital in Warm Springs, save the state money and deliver better care to seriously ill individuals. The program worked so well that PACT teams now function in Kalispell, Missoula, Great Falls and Butte, too. Last month, the Billings program, operated by the Mental Health Center, served 74 men and women ranging in age from 20s to 60s. Virtually all of them have been hospitalized repeatedly at Warm Springs or at Billings Clinic’s psychiatric department. Many have been homeless.
“They were constantly being hospitalized and now they aren’t,” said Berg, a PACT team member.
PACT is a voluntary, long-term program. Among the clients who have left over the years, 38 percent had improved so that they no longer needed care from the nonprofit Mental Health Center and 29 percent moved to less intensive treatment programs.
Hospital without walls
“PACT ideally is a hospital without walls,” said Kirk, the team’s clinical coordinator. The team’s psychiatrist, two registered nurses, two therapists, seven case managers and other mental health workers serve clients 24/7. Team members work seven days a week, someone is always on call. Eighty percent of services are provided at the clients’ homes or in other community settings. PACT staff takes clients grocery shopping and bowling. Because most clients don’t have their own vehicles, team members drive them to vocational rehabilitation and to doctor appointments, and connect them to other services such as Social Security and food assistance. The PACT team helps clients with budgeting and house cleaning, too. The team provides daily medication delivery for clients who need medication to stay well, but may not use it without reminders.
The concept of PACT is that staying healthy involves much more than therapy sessions, pills and doctor visits. Because seriously ill people tend to isolate themselves, PACT steps in to provide friendly attention and opportunities to enjoy the things that other community members enjoy — like pizza and a movie or a ceramics class.
Living in poverty
In addition to coping with the symptoms of schizophrenia, bipolar disorder or other psychotic illnesses, PACT clients struggle with poverty. They are too ill to hold regular, full-time jobs, although about a dozen are working at least parttime and all but one of 74 clients live independently. Most subsist on disability income of around $670 a month. Even for clients who get rent subsidies, housing takes 30 percent of their meager income. They depend on private charity and public assistance for food and health care.
The PACT team is planning the annual Christmas dinner and gifts for its clients, but the holiday celebration is going to be tougher to pull off this year. A donor who in previous years has sponsored gifts for all the PACT clients was unable to contribute this year. So the Mental Health Center is asking community members for help.
The gifts requested are mostly basic necessities, not holiday treats. But without community donors, these are things this group of seriously ill people won’t have this Christmas. Please check the box to see how you can help.