Teams of Experts Help Patients Cope Holistically with Array of Problems

Andrew Kitchenman | February 27, 2014 | Health Care
Coordinated approach to mental health addresses wide range of issues ranging from joblessness to addictions to physical health

Cory Storch, executive director of Elizabeth-based Bridgeway Rehabilitation Services.
Treating patients with severe mental illnesses holistically – dealing with problems as varied as joblessness, health issues and addictions in combination with psychiatric care – has proven effective in keeping them out of hospitals and helping them lead productive lives.

That’s the lesson from a statewide program that is going beyond traditional mental health care to include wellness initiatives and even job training, according to healthcare experts

Elizabeth-based mental-health services provider Bridgeway Rehabilitation Services has been leading this effort through the Program for Assertive Community Treatment, or PACT, which utilizes teams of professionals, including a psychiatrist, nurses, and experts specializing in wellness, vocational training and recovery from both mental illness and addictions.

The teams visit the homes of people with serious mental illnesses and work with them to achieve concrete goals using strategies that have been shown to be successful.

The PACT program operated by Bridgeway was singled out yesterday in the first of several visits being organized by the Good Care Collaborative, a new statewide coalition seeking to highlight programs that have found success in helping patients by offering a comprehensive and coordinated set of healthcare services.

The collaborative wants to use these successful programs as models for the statewide approach to Medicaid, which the primary program for healthcare services for low-income residents and the primary source of long-term care.

PACT focuses on patients who have had involuntary hospitalizations due to mental-health issues but who are no longer hospitalized and need help in their lives. The patients also must have a history of refusing other treatment approaches, such as traditional mental-health counseling that requires them to visit a therapist’s office.
Bridgeway operates nine of the 31 PACT teams in the state, including the team for Somerset County, and provides training for all of the teams. Other PACT providers include Atlanticare Behavioral Health, Cape Counseling Services, Catholic Charities of Metuchen and Trenton dioceses, CPC Behavioral Healthcare, Cumberland County Guidance Center, Mt. Carmel Guild Behavioral Healthcare, New Point Behavioral Health Care, Ocean Mental Health Services Inc., St. Clare’s Behavioral Health, and Twin Oaks Community Services, The program is funded through a combination of Medicaid and grant money.

Bridgeway Executive Director Cory Storch said PACT is particularly well-suited for those with both mental health and physical health issues, since it draws on a variety of experts.

“We’ve been progressively adding disciplines due to the complexity of the problems that we see,” Storch said.

The ultimate goal is to help patients reach a point where they can manage their own lives without having to return to a hospital.

Bridgeway Associate Executive Director Buddy Garfinkle said PACT has evolved since it debuted in the state in the 1970s, when it originally focused on bringing services normally found in a hospital into community settings.

Garfinkle said PACT team members are experts at encouraging patients to participate in their treatment by pursuing personal goals. That approach helps people with many aspects of their lives, from managing psychiatric medications to helping with job training, from managing poverty-level personal budgets to taking patients shopping.

“All of the different things you need to live a successful life,” Garfinkle said. “We want to get people to the point where they don’t need these services any longer.”

Team members work with family members and landlords to help patients’ maintain stable lives, and frequently have to help patients recover from hospitalizations Garfinkle said team members visit patients in the hospital and suggest ways that they can change their behavior to avoid future emergencies.

The 10-member PACT team for Somerset County held a brief staff meeting to demonstrate the rapid-fire way they update each other daily on the progress being made by each of 68 patients, focusing on the 15 patients visited the previous day. The meeting was held in Bridgeway’s office in the Fords section of Woodbridge, because none of the organization’s Somerset offices are large enough for the crowd.

As the team members spoke of the list of challenges that each patient faces – from a person who had decided against pursuing disability benefits to others who were struggling with addiction — other team members offered suggestions for follow-up conversations and kept track of scheduling future assistance for each patient.

“There is no such thing as failure – we work with the person as long as the person needs,” Garfinkle said.

Team leader Roges Nazaire and clinician James Weber cited an example of a patient whose problems included mania, paranoia and aggression.

With the help of medication and engagement with the PACT team, that patient is living a healthier life — including frequent fishing trips.

“The change was astonishing,” Weber said.

PACT teams also have members who are on-call 24-7, and are able to quickly connect patients with specialists when crises occur.

The PACT model demonstates how “every patient, every day, should get great care,” said Dr. Jeffrey Brenner, who leads the Camden Coalition of Healthcare Providers and is medical director of Cooper Health System’s Urban Health Institute.

“It’s by paying attention to individual patients and not losing track of people” that PACT delivers individualized care that frequently isn’t provided to many Medicaid patients, said Brenner, who said PACT was an inspiration for the Camden Coalition, whose staff members are coordinating the Good Care Collaborative’s work.

The Good Care Collaborative plans a series of site visits to other programs to highlight other potential models for delivering healthcare.

Brenner said that while such programs are successful, they are “at risk, whenever the budget-cutting axe comes,” because they have higher costs. But these costs are worthwhile because of the benefits to patients, Brenner said.

“I think all of us need to defend these programs as examples of good care,” he told a group of healthcare experts and advocates. “And instead of each program going and lobbying for their own bucket of money, I think we need to knit together a broader coalition that defends good care models.”