One of the core ideas of the ACT model is getting clinicians out of buildings. Community mental health should be done in the community.
In my community an impressive building went up several years ago meant to be the centralized mental health crisis service. It cost more than 12 million dollars to build and will need millions more to maintain.
Lovely buildings are nice. I like a new office with a big window. But such structures come not only at a financial cost but can divert services away from being continuous, comprehensive and integrated (please see my previous blog R U CCISC?).
For much of the 19th century the focus of psychiatry was on building standalone psychiatric centers, AKA asylums. For much of the 20th century the focus was on building psychiatric units as part of general hospitals. For the 21st century hopefully there won’t be much to show architecturally.
In building human services the emphasis should be on the human and services and deemphasize the building. What we (potentially) save on bricks and mortar let’s put into the most valuable part of the equation.
If you haven’t seen David Eggers’ TED talk titled My wish: Once Upon a School, take 25 minutes and watch it. While he’s not talking about SPMI he is addressing issues like stigma. At one point, in talking about the Brooklyn Superhero Supply Company he comments “… same principle – one on one attention, complete devotion to the students work, a boundless sort of optimism and the possibility of creativity and ideas…”.
ACT is an evidence-based model and should be practiced true to basic ideas. It should also allow for creativity and innovation, if not in architecture than in facilitating recovery for individuals with life-changing illnesses.
And if David Eggers’ talk doesn’t make you smile at least twice I will gladly refund your time.
btw thanks to those who took the time to register their opinion on the issue of hospital days and ACT. More than 90% (of an admittedly small sample) voted that teams should look beyond just the number of hospital days.