The management of change in a community mental health team

Assertive Community Treatment (ACT) is the most widely studied and well supported evidence based community management model for persons with severe mental illness (SMI) in the mental health literature. This report details the replacement of an unevaluated generic model of case management with ACT in a metropolitan inner city area. This is work in progress and detailed patient outcomes are not yet available. The steps taken and the problems encountered in changing clinical practice are important over and above the intervention itself and are discussed. The main difficulty that we encountered was moving staff from focusing on and becoming demoralized by potential problems and obstacles to problem solving and implementation of the best available solution. Staff were consulted at all stages of the project. The use of an 'action research' strategy maximised their sense of ownership and ultimately enabled the project to be implemented although in a revised format to that originally envisaged. Flexibility in this regard was crucial since the budget granted was only 40% of that requested. The original aim of having all 3 sector teams of the Inner City Mental Health Service (ICMHS) involved did not eventuate due to internal organisational issues and only one team undertook to implement the ACT approach.