Hospital Without Walls for Individuals With Chronic Mental Illness

McLean Hospital’s Chloe Pedalino, LICSW, says that individuals receive “wraparound care while they’re in the hospital, but they don’t always get that care after discharge.” This is one reason McLean is launching its new Program of Assertive Community Treatment (PACT). The program will bring coordinated, flexible, and customized mental health care to people with chronic and persistent psychotic disorders, such as schizophrenia, bipolar disorder, and related disorders. Working as a kind of “hospital without walls,” PACT will offer treatment and support services to help people manage their conditions and thrive in their homes and communities.

Pedalino, PACT’s program director, explained that in an inpatient setting “the goal is primarily stabilization, not rehabilitation, and many people do not receive the support that they need to progress towards rehabilitation and creating a meaningful life.” Without continued care and a focus on rehabilitation, she said, symptoms can reoccur, and many individuals are re-admitted to the hospital shortly after they return home. Moreover, the lack of care continuity means that many people do not receive the help they need to improve the way they function in the workplace and live on their own as adults.

“PACT will bridge these gaps in care,” Pedalino stated. Through PACT, she explained, members of McLean’s community-based crisis team can offer individual support, medication management, and many other treatments and supports to individuals right where they live. That means that individuals who come to McLean’s Schizophrenia and Bipolar Disorder Inpatient Program or Community Reintegration Unit can enroll in PACT and be reintegrated into their home setting sooner because they can receive a full range of care within their community.

PACT staff can also help individuals with “skills not learned through an inpatient environment,” Pedalino explained, such as how to manage money, utilize public transportation, or apply for advocacy services. Pedalino described PACT, with its wide range of services, as a “fluid and flexible” approach to care, one that “can help people live more independently and reduce the number of readmissions.”

The idea behind PACT was developed some 50 years ago as researchers in Wisconsin found that gains made by individuals with mental health conditions in inpatient settings often went away after discharge, and individuals were frequently readmitted to the hospital. Given the importance of care continuity, programs like PACT have been established in several states across the country—and have produced strong results. McLean’s PACT will draw inspiration from these programs by including open dialogue, a patient-centered approach focused on shared decision-making and peer support, and relatively low patient-to-staff ratios.

Pedalino said that other PACT programs are available in Massachusetts, but those who could benefit most may not always have access. She said that it can be challenging to enroll in appropriate wraparound care through state-run programs and that private PACT offerings can be cost prohibitive to many people with psychotic disorders. “We’re trying to bridge the socioeconomic gap and make PACT accessible to more people,” she said.

McLean is grateful to Monica Luke and the many donors who support the Living Assistance Fund at McLean for providing the resources to launch this innovative program. For more information on the Living Assistance Fund, whose mission is to break down financial barriers preventing people with severe mental illness from accessing the care and support they need, visit livingassistancefund.org.

PACT will officially launch on October 2, and the program is currently open for enrollment.