The Challenge

Communities in Northern Manhattan have some of the city’s highest rates of mental health hospitalization. For example, in Harlem the mental health hospitalization rate has increased more than 20% during the past decade, with residents having a mental health hospitalization rate at least two times that of the city overall.1 2 This rate is consistent with a lack of effective outpatient treatment services that can be especially problematic for high-frequency users of emergency services for mental illness and related crises. A particularly high-risk subgroup within this population includes those with serious mental illness, histories of significant community dysfunction, and failure in those traditional treatment options that are available in their community.

The Manhattan ACT Approach

In fall 2012, CASES was selected by the NYS Office of Mental Health to lead the Manhattan Assertive Community Treatment (ACT) team. Manhattan ACT provides comprehensive, community-based psychiatric treatment, rehabilitation, and support to people with serious mental illness who reside in Northern Manhattan, including in Harlem, Inwood, and Washington Heights. ACT is an evidence-based model designed specifically for difficult-to-engage individuals who have a history of serious dysfunction and high usage of mental health emergency services. Consistent with ACT guidelines, Manhattan ACT staff deliver services—including psychiatry—primarily in clients’ community settings. Services are available 24 hours a day, seven days a week and include:

• Case management: Comprehensive assessment, treatment planning, and continuous risk assessment and management
• Clinical services: Medication administration and management, weekly treatment groups, and integrated mental health and substance use treatment
• Peer services: Support from peer specialists with their own histories of successfully navigating mental illness
• Other support services: Assistance obtaining Medicaid, food stamps, public assistance, and/or Social Security benefits; targeted support for securing housing; and referrals to external education, job training, and employment providers

The Impact

Manhattan ACT serves men and women with extremely high levels of mental health dysfunction, yet the program has helped recent clients to achieve the following health and wellness improvements:

• 30% increase in employment
• 100% increase in education activity
• 36% decrease in psychiatric hospitalization
• 43% decrease in harmful behaviors in the community