Harm Reduction can be a useful tool to help address potentially risky, dangerous, or self-destructive behaviors, including drug addiction, unsafe sexual activities, self-harm, and binge eating. The goal of harm reduction is to make dangerous behaviors safer, and to reduce the level of harmful consequences caused by the risky behavior. There is persuasive evidence that harm reduction approaches can reduce morbidity and mortality associated with these behaviors.
An important service supported by the NYS Office of Mental Health (OMH) which utilizes harm reduction techniques is our Assertive Community Treatment (ACT) program. ACT utilizes a broad array of services, including harm reduction, to help vulnerable individuals build the skills needed for integration into their communities. ACT teams deliver comprehensive and effective services to individuals who are diagnosed with severe mental illness and whose needs have not been well-met by more traditional service delivery approaches.
Typically, recipients served by ACT have a serious and persistent psychiatric disorder and a treatment history that has been characterized by alcohol/substance abuse, frequent use of psychiatric hospitalization and emergency rooms, involvement with the criminal justice system, and lack of engagement in traditional outpatient services. The population served by ACT comprises a small subset of persons with serious mental illness. Most people will not need the intense service an ACT program offers.
The ACT team-based treatment model provides multidisciplinary, flexible treatment and support to people with mental illness 24 hours a day, 7 days a week. ACT is built around the idea that people receive better care when their mental health care providers work together. It supports recipient recovery through a highly-individualized approach that provides recipients with the tools needed to live independently. ACT team members help the person address every aspect of life, from managing symptoms, to getting a job, securing and keeping housing, reducing substance use, and maintaining relationships with family and friends. They can assist with the development of a wide range of skills including grocery shopping, cooking, cleaning, budgeting, banking and other everyday living skills.
ACT also integrates the principles of cultural competence, addressing the impact of discrimination/stigma, and inter-system collaboration into its service philosophy. ACT will provide services with consideration of linguistic preference. An essential aspect of ACT is recognizing the importance of family, community-based, and faith-based supports.
Persons are usually referred to ACT through a Single Point of Access (SPOA) process within a county and are designated by that process as a high-priority candidate for an intensive level of service. These referrals could also include persons under a court order for Assisted Outpatient Treatment (AOT).
The nature and intensity of ACT services are developed through the person-centered service planning process and adjusted over time. Treatment plans are established collaboratively by the ACT team and client, based on the individual’s strengths, needs, desires, goals and culture. Treatment plans are modified, as needed, through ongoing assessment and goal setting. ACT teams meet daily to discuss each client’s progress, allowing the team to plan or quickly adjust the services to meet clients’ needs.
ACT teams utilize harm reduction techniques to assist clients with co-occurring issues. All ACT teams include a substance- use specialist, and providers collaborate and coordinate with NYS Office of Alcoholism and Substance Abuse Services (OASAS) licensed and/or designated programs to ensure warm hand offs. These programs include Chemical Dependence, Inpatient Rehabilitation, Medically Managed Detoxification, Chemical Dependence Medically Supervised Inpatient and Outpatient Withdrawal. ACT providers serve the Substance Use Disorder population and are expected to utilize resources available in the community to enhance their SUD treatment including Medication Assisted Treatment (MAT) training for prescribers and Harm Reduction.
Overall, studies show ACT improves health outcomes and reduces several aspects of harmful behavior. ACT recipients experience greater reductions in psychiatric hospitalization rates and emergency room visits and increased levels of housing stability after receiving ACT services. The multidisciplinary, flexible treatment approach is an important factor in ACT’s success, and harm reduction is an important facet of the array of services provided by our ACT teams.
