by PATRICK LEJTENYI

One of the priorities in mental health treatment should be getting patients successfuly re-integrated into the community. But faced with increasing government cutbacks to all sectors of health care, that’s been getting harder, and health care workers are having to do more with less. Innovation is key.

One group that has been trying hard to surmount budgetary constraints successfully is the Program for Assertive Community Treatment (PACT), run out of the Douglas Hospital in Verdun. Having just marked their fifth anniversary last month, the 12 PACT staff members work with 65 or so of the neediest mental patients, those usually suffering from schizophrenia or manic depressive disorders, out of the clients’ homes. The program’s goal is to make the patients who use the system the most self-reliant and independent.

“We see some of our clients maybe five or even six times a week,” says PACT’s human relations agent Karl Beck. “We look at all the issues they face: how are their medications working, are they taking them, do they need groceries. We also make sure that their housework is done so that their landlord or the city doesn’t evict them…. It’s very intensive and all-encompassing. We’re looking at the global needs of the person.”

To be eligible for the kind of treatment PACT offers, the client needs to meet certain criteria. “First, a person needs to have a primary psychiatric diagnosis,” says Beck. “They also have to be heavy users of the system, meaning they have to have come to the emergency room at least a few times a year, either for [treatment] or short-term admissions. Most of the clients have visited the ER 10 or more times a year. Then they’re referred to us.”

Building up living skills and levels of confidence is of paramount importance to a client’s treatment. Without either of them, Beck believes, they would quickly relapse. “In the past, many of our clients were put in foster homes, where they would lose some of their living skills,” he says. “Sometimes it works, but other times they don’t fit into the system and cause disturbances or have other kinds of trouble. After a month, they’d leave the home and have to come back to the hospital.”

Easing the strain

Most of PACT’s clients live, like Beck, in and around Verdun, not too far from the Douglas. These neighbourhoods in the city’s south-west have higher concentrations of residents with mental disabilities than the rest of the city, says Josée Pirro, coordinator of the mental health outreach organization Programme d’aide au logement (PAL) in Verdun, partly because of a law that states that mental patients must visit the hospital closest to them. The Douglas, being the largest anglophone mental hospital in the province, is swamped. And that’s why projects like PACT are so important, she says, because it relieves both the physical and fiscal burden the hospital has to bear.

“If you figure in the cost of each patient, which is a bed, a nurse and a psychiatrist, the cost to the whole system can be up to five times higher than having a person in a community group,” she says. She works on occasion with PACT clients, and while she likes the program, she admits monitoring success is difficult.

“It’s very hard to give a number of the people who have successfully re-integrated into the community,” she says. “And how do you define success? I know of some patients who follow their medication, but are so drugged up they just sit around and smoke cigarettes all day.”

Still, Beck and his team try to ensure that their clients achieve a certain level of functionality. Because they cannot force clients to take their medication or keep them in the hospital against their will, a lot depends on the personal bond between caregiver and patient. Sometimes it works, sometimes it doesn’t.

“I know the clients personally, and they know me,” Beck says. “That’s important because it’s a relationship based on trust. Sometimes there’s a lot of paranoid thinking on their part and a lack of trust in the system. But if a client knows you, they are more willing to listen to you.” :