My experience in an ACT

Once the nightmarish grip of psychosis had been broken with the use of antipsychotic medication, it was time to engage in the recovery process. 

As described in an earlier post, the recovery from psychosis can be just as traumatic as living through the psychosis itself. 

“. . .the reality is that breaking from psychosis is an equally disruptive event — all of a sudden, everything you trusted and believed in crumbles into disturbing remnants of delusion. Your universe is flipped upside down and nearly destroyed. It is a cataclysmic experience.

I had to attend almost six months of intensive outpatient rehabilitation treatment. Much like soldiers recovering from PTSD, I had to learn to look people in the eyes again, verbally address strangers, and hold my cool at the sudden onset of loud noises or disruptive surroundings.”

Prescribed by my psychiatrist and psychologist care team, my marked and dramatic recovery process began at Harbor City. Harbor City, part of the University of Maryland Medical Center, is an intense, on-location, psychiatric rehabilitation program center. Harbor City is also known as an ACT or Assertive Community Treatment program.

The more common, mainstream approach to mental illness recovery involves a visit to your psychiatrist once a month and a therapist once a week or every other week. ACTs take an entirely different approach. Instead of leaving the patient entirely on their own and responsible for making their appointments, take medicine, repair financial problems, and the like, an ACT employs a “wraparound” approach. “Wraparound,” meaning that there is an aggressive effort to assist the patient in every possible way to become successful and rehabilitated back into society.

Much like a collegiate environment, the time invested in the program was divided into “semesters” or six-week increments. The semesters were further split into “courses.” In addition to a primary advisor that I met weekly, I developed relationships with course instructors that interacted and followed up with me 5 days a week. 

The courses could focus on anything from conflict resolution, making social connections, Dialectic Behavior Therapy (DBT), interview skills and job searching, psychical exercise, stress management, money management, and other life coping skills.

A syllabus was distributed and homework assigned for many of the courses. Open dialogue was highly encouraged in each class, and engagement was hardily rewarded with genuine thanks and praise. Many times candy served as a lighthearted prize for success.

The staff knew everyone by name, and cheerfully addressed you with even inconsequential passing in the hallway. Each one, also if you were not directly involved with them, had an idea of what you were working on and would compassionately ask you how things were going or congratulate you on reaching a goal. 

There was a great effort to humanize the experience with recognizing birthdays marked with the traditional birthday song and pictures posted in the hallways. Each holiday was celebrated with the constant changing of seasonal decorations and menu selections catered in the lunchroom. Fridays were devoted to a weekly community recap of how all the members were personally doing and free socialization time in the TV room, a room vibrantly set up with a pool table, and plenty of board games. 

Harbor City was a very happy place for very sad people. And their compassionate and humanistic approach worked. Through their efforts to promote hope and positivity in the darkest of personal times, it was almost impossible to feel, at least, a little better about life.

While ACTs are generally reserved for those exhibiting the most severe symptoms and repercussions of mental illness, I see a version of approach as applicable to society as a whole. Many studies have statistically shown that ACTs can be successful in reducing hospitalizations, cutting down on incarcerations, and ultimately saving taxpayer’s money. If we could employ this model somehow on a less intensive, broader, and more accessible scale, I think it would be a great benefit to our society.

During my time there, I watched incredible transformations. I saw people exhibit bursts of rage, anger, and inconsolable crying only to return day after day with a little more calmness and hope in their eyes. I witnessed tragic people who, in their first days, couldn’t even hold their heads up turn into charismatic, chatty, and gregarious community members. I celebrated with those once homeless secure housing, and those without an education accomplish earning their GED. 

Each member entered the community dragging a broken heart along with a tragic story. I was one of them. And I am thankful for my experience at Harbor City.

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