The Bristol-Myers Squibb Foundation has made a $1.9 million grant over three years to the New York State Office of Mental Health Research Foundation for Mental Hygiene to develop, implement and evaluate a model for transiting some schizophrenic patients from the high intensity services offered in an outpatient setting by Assertive Community Treatment (ACT) teams, to fewer ­ and more appropriate levels of service along with greater community integration.

ACT is one of a small number of widely accepted evidence-based practices for serious mental illness. It has been described as a “hospital without walls,” and represents the highest intensity service that can be received in an outpatient setting for those suffering from mental illness. ACT teams have low case ratios, are multidisciplinary and mobile, and provide care in community settings for clients who have not been able to engage in traditional services. ACT has been associated with improved client outcomes, including a decrease in hospital days, and is considered cost effective when delivered to high need clients.

However, incorporating recovery and community integration into ACT team services has presented some challenges. When the ACT model was initially developed decades ago, it was conceived of as a lifelong service. But the belief that people with schizophrenia would need this high intensity service for life does not comport with more recent findings indicating that a third or more of those with schizophrenia can fully recover over time. Research and clinical experience both suggest that for some clients, discharge from ACT and community integration should be goals of treatment.

There is scant data available on ACT step down and graduation models. Critical concerns include how to build community engagement skills, how to retain and extend gains made while on the ACT team after graduating clients, and ensuring clients have support and a safety net while transitioning. Developing such a model would offer two important benefits: greater independence and community integration of people with serious mental illness; opening up capacity on ACT teams for those still in need.

One goal of this project is to develop new regulations, policies and procedures to support the step down model.

The Bristol-Myers Squibb Foundation has made a grant of $1.1 million over two years to the Alabama Coalition for a Healthier Black Belt.

The grant will help focus on better serving those suffering from serious mental illnesses in these rural areas. The project will be build on community mobilization and education; integrated and efficient mental health and primary health care services with a special focus on adults with serious mental illness, and implementation of evidenced-based practices to support recovery of these patients.

The coalition receiving the grant includes the Alabama Department of Mental Health & Mental Retardation, University of Alabama -- Birmingham, NAMI Alabama, Community Mental Health Centers (Cahaba and West Alabama) and the Community Care Network.

The Black Belt region of Alabama includes twelve of the most rural, impoverished and scarcely resourced counties in the state. Community-based mental health services are extremely limited in these counties. At the same time, patients are presenting with much more acute disease requiring more institutional care in the region when compared to the rest of the state -- those served are disproportionately in need of state hospital care and stay longer once admitted. Such findings are consistent with national data indicating that residents in rural areas are generally sicker and require more intensive services by the time they access services. Individuals who are committed to state psychiatric hospitals are those most acutely ill and require the most intensive follow-up to prevent re-hospitalization. Approximately 58 percent of those entering a state hospital are being readmitted.

Among the specific actions that will be supported:

• Collaboration between primary care and mental health care through co-location, increased use of mobile outreach vans, coordinated scheduling, and cross-education.
• Use of video-conferencing to provide direct services more efficiently and to improve case consultation between primary care and mental health care providers and between state psychiatric hospitals and mental health centers.
• Enhanced training in rural areas through use of physician fellowships and social work internships.
• Increasing service capacity through more mobile medical outreach, use of psychiatrists through telemedicine, and increased mental health center staff.
• Increased use of community resources, particularly pastors, to reduce stigma through an improved understanding of and attitude toward mental illness and to provide general health and mental health education.
• Provision of evidence-based practices in collaboration with the Alabama Institute for Mental Health Services and the Alabama Department of Mental Health/Mental Retardation.
• Implementation will occur in selected counties during the first grant year with expansion to all twelve counties over the period of the project, based on upon lessons learned during the initial implementation phase.

A $192,500 grant from the Bristol-Myers Squibb Foundation is aimed at helping expand mental health services for disadvantaged populations in Trenton, New Jersey, by developing and launching an innovative program that integrates behavioral health counseling and treatment into the delivery of primary care.

Currently Mercer County, which includes Trenton, is experiencing a sharp rise in demand for behavioral health services, overwhelming existing providers and forcing patients seeking help on an outpatient basis to wait up to three months for some treatments.

The grant recipients, the Capital Health System (CHS) in collaboration with the Henry J. Austin (HJA) Health Center in Trenton, would work together to help alleviate this problem. CHS psychiatrists will develop a behavioral health curriculum to be used to train HJA primary care providers in diagnosing and treating common mental health problems. In addition, CHS psychiatrists also would begin direct clinical interactions with HJA patients as they are co-located into HJA's primary care setting.

Not only would patients receive mental health screenings and treatment, they also would be screened for other major health problems through the program's collaborative, multi-disciplinary approach. The result would be to promote a more holistic model for patient care. Potential costs savings to the county's health care systems are expected to be substantial as psychiatric hospitalizations brought on by waiting until a problem reaches a crisis level are prevented. It is expected this approach would also improve overall patient outcomes by enhancing patient compliance.

Especially significant, it is expected that Reach Out! in the U.S. will be able to reach historically underserved groups who are at-risk and hard to reach - including Hispanic females, who suffer from the highest rates of suicide attempts, depression and eating disorders, African-American males, exposed to the highest rates of community violence and drug use, Asian-American females, who suffer from high rates of depression, anxiety and suicide attempts, and gay, lesbian, bi-sexual and transgender young people, who are 3-5 times more likely to attempt suicide compared to all other young people. Content on acculturation, the specific issues these groups face along with the use of digital storytelling, social networking and other relevant platforms are expected to help address many of these groups and their concerns.