ACTive on the streets in Abbotsford and Mission

Assertive Community Treatment team focuses on people with severe mental-health and substance-use issues

Jolene Federici (left) and Joan Cooke are staff members on the Assertive Community Treatment team

Jolene Federici (left) and Joan Cooke are staff members on the Assertive Community Treatment team

Shawn Murray wasn’t used to getting much sleep. He lived outdoors, and falling asleep could mean getting “rolled” – robbed of what few items he possessed. So, when he closed his eyes, his rest was fretful.

He could scarcely imagine what it would be like to have a place of his own, but now the opportunity was presenting itself.

He was being shown a fully furnished one-bedroom apartment that would soon be his new home. It was warm, dry and safe.

And it had a bed – a real bed, not a makeshift spot on the hard ground, but a full box spring and mattress with blankets and pillows.

That spot called out to Shawn, and he couldn’t resist the urge to succumb. He stretched his lanky form across the bed, shut his eyes and drifted off into a sleep that was so deep he couldn’t remember another like it.

* * * *

Shawn, 50, was first diagnosed with a psychotic disorder as a teenager and had been in out of the mental health system ever since.

Treatment was sporadic and only temporarily effective, at best. He would see a doctor, usually after being taken to the hospital in the midst of a psychotic episode. He’d be placed on one type of medication or another, and be sent back into the community.

Shawn would be given recommendations on where to go for outside support, but he rarely followed up. He would stop taking his medication, and he didn’t have family or friends to fight for him. Without any long-term support, Shawn’s mental illness took over. He would often see people or things that weren’t there, and he would walk the streets, muttering to himself.

Sometimes, he imagined people were trying to attack him and he would have to fight back. He was aggressive, and his behaviour often frightened others.

Concerned citizens would report him, and he would be taken by police or paramedics to the hospital for treatment.

Shawn turned to drugs – mainly crystal meth – as a coping mechanism, but it made him even more paranoid. His drug addiction resulted in turning to crime to support his habit.

Shawn committed a series of bank robberies, and spent about 20 years of his life in prison.

But even being in a controlled environment didn’t result in successful mental health treatment. If he acted out, he would be segregated. He often compared the prison system to being “warehoused.”

That was Shawn’s life up until about a year ago. Then he met some people who cared, and everything changed.

* * * *

The Assertive Community Treatment (ACT) team came to Abbotsford and Mission in late 2014, funded by the Fraser Health Authority – one of four such teams in the Lower Mainland/Fraser Valley.

ACT provides support for individuals living with severe mental health and substance use disorders.

Joan Cooke, client care co-ordinator for the Abbotsford-Mission team, says ACT staff provide the kind of ongoing and personalized support that their clients – who must have a serious and persistent mental illness to participate – don’t get from traditional services.

She said the clients often have financial difficulties and substance use issues, have been in and out of the hospital and/or prison, have had extensive police contact, are homeless and can’t get jobs.

“Typically, they’re people who haven’t been served well with regular office-based services – people who have fallen through the cracks,” Cooke said.

Clients are referred to the program by various sources, including hospitals, doctors, community agencies, mental health centres and police.

A multitude of staff are involved in ACT, including nurses, social workers, police, clinical counsellors, occupational therapists and psychiatrists. They rotate shifts so that the program can operate daily – weekdays from 8:30 a.m to 8:30 p.m. and weekends from 10 a.m. to 6 p.m.

Clients have access to a pager number they can call after-hours.

Jolene Federici, peer support specialist, says the support provided to each client varies.

This can include receiving social assistance payments, finding a doctor, obtaining medication, getting support for legal issues, finding housing, learning basic life skills, and receiving addiction treatment.

“It’s about meeting the client where they’re at. Sometimes it’s a coffee. Sometimes it’s a pair of socks.”

They also offer lots of group activities such as cooking sessions, an education group about substance use, bowling and barbecues.

Federici said members of the ACT team build a rapport with clients, and often walk the streets to talk to people living there and ask them what they need.

Follow-up support is a crucial aspect of ACT. Staff who are on shift for the day meet each morning to discuss particular clients and any issues that need to be addressed.

Care can include such things as visiting a client daily to ensure they are taking their medication, or driving them to a medical appointment.

Federici, who herself was once homeless and addicted to drugs, said the ACT team believes strongly that “everybody deserves a chance.

“Given the right supports, people will make the right choices. We don’t give up.”

* * * *

Shawn had been living on the streets of Abbotsford for about six months when a doctor referred him to ACT.

He met with Cooke and another staff member for an assessment and, during their conversation, he fell asleep at the table. Shawn’s priority at the time was housing.

ACT works in partnership with an organization called the Motivation, Power and Achievement (MPA) Society, which is contracted by Fraser Health to find market-level apartments for ACT clients. MPA also provides a rental subsidy for clients in addition to what they receive through social assistance.

An apartment became available the next day, and the ACT staff took Shawn to view it. He has lived there ever since.

He loved it immediately.

“I just couldn’t believe that apartment was going to be mine and that the furnishings were going to be staying there. It was so overwhelming … I slept a lot. I’d get up and walk around. I’d look out the window. I’d sit on the sofa.”

Shawn initially received the MPA subsidy but, after about four months, he said he didn’t need it anymore and it should go to somebody who did.

He no longer uses drugs, receives regular medical care, takes his medication daily, attends group sessions at the ACT office on Simon Avenue, participates in social activities, and volunteers at the humane shelter in Mission, caring for cats.

Shawn credits ACT with the transformation in his life.

“If you need to talk to someone or if you need some guidance, they’re always there, and I’ve never had that before.

“They helped me change my life through just being there.”

ACT efforts show savings in hospital visits, police resources

Recent statistics compiled by Fraser Health show that the ACT (Assertive Community Treatment) program is having dramatic results in the communities it serves and with the clients who are involved.

Stan Kuperis, Fraser Health director of mental health and substance use, said the program has shown drops in key areas such as emergency room visits and hospital admissions for psychiatric reasons.

Meanwhile, the program has shown hikes in areas such as the number of clients with stable housing, and those with a regular doctor.

“ACT does provide improvements for clients with very serious mental illnesses or substance use issues. It really provides improvements to their quality of life,” Kuperis said.

The program began with a team in Surrey in 2012 and expanded to include New Westminster and the Tri-Cities one year later.

Teams in Surrey-North Delta and Abbotsford-Mission were added in 2014.

Kuperis said ACT, which originated in Ontario, was selected for these communities because statistics showed they had high numbers of people who would best benefit, with the program addressing individuals who have persistent and severe mental health and substance use disorders.

ACT currently serves 74 clients in Abbotsford-Mission, while the other teams serve between 75 and 90 clients each.

Kuperis said these individuals have “very challenging barriers,” and without ACT, they would continue to live on the streets, be in trouble with the law, and be in and out of the medical system without appropriate long-term care.

“We know very well, with the right support, these clients can recover and become productive citizens in our community.”

* * * *

ACT alone won’t solve homelessness and addiction issues in Abbotsford, however. Local service providers have urged the province to expand access to shelter for the city’s homeless population, and earlier this month, the city’s Homelessness Action Advisory Committee heard that “the immediate need for an increase in adequate and attainable permanent housing options persists, as well as the provision of housing retention services …”

While housing subsidies are available, those who deal with homeless men and women say there aren’t enough to ensure that everybody can afford a permanent house.

The same meeting heard that the ACT Team is the only service where clients received formalized referral or case management, although work is currently underway to create an integrated system that can link services for all homeless men and women.

* * * *

Kuperis said that although ACT is expensive to operate – the annual cost is approximately $1.2 million in each community – those costs are alleviated by the savings in hospital stays, emergency room visits and police resources.

“Those are all significant savings.”

A 2008 report titled Housing and Support for Adults with Severe Addictions and/or Mental Illness in British Columbia, prepared by Simon Fraser University, addressed the cost savings of intervention, including providing housing.

The report estimated that non-housing service costs amount to about $644 million each year across the province, which can be broken down to about $55,000 for the average homeless adult.

Provision of adequate housing and supports is estimated to reduce this per-person cost to $37,000 per year – or an overall savings of about $211 million annually.

Statistics from May 2016 specifically related to ACT show that in Abbotsford-Mission:

– clients visited the emergency room a total of 111 times for psychiatric reasons during a six-month period before their involvement with ACT, but six months afterwards, the number of visits had dropped to 26.

– the number of admissions for psychiatric reasons dropped from 56 to 18.

– every client who previously had unstable housing obtained stable housing within six months of becoming involved with ACT.

– 62 per cent of clients obtained a regular doctor within two years.

“The ACT team has been very successful in Abbotsford,” Kuperis said. “It does provide an improved quality of life for individuals who are extremely challenged … to me, that’s just so rewarding.”