Team Dynamics

Psychiatry in ACT-ion

We are delighted to have Dr. Lorna Moser as a guest contributor to the interACT blog. 

Lorna Moser, Ph.D. is the Director of the North Carolina ACT Technical Assistance Center at UNC-Chapel Hill’s Center for Excellence in Community Mental Health. Lorna is the co-developer of the Tool for Measurement of ACT (TMACT), a comprehensive fidelity assessment tool, and has been working on, researching, evaluating, and/or training ACT teams for the past 16 years.

I’ve met many psychiatrists on ACT and have come to appreciate there’s a difference between a psychiatrist assigned to work with ACT, and an “ACT psychiatrist.”

High Five to those “ACT psychiatrists” I’ve met this past year who:

– Don’t wince at the idea of going into the community – in people’s home, or other places not in an office or hospital – to see people, and in fact, embrace it. They appreciate how much more they get to understand the person when they meet them in their own environment, as well as how it can help level that playing field, if only just a bit (“I’m a guest in their house.”)

– Like our awesome nurses, understand the importance of whole healthcare, and the barriers for many to getting access to physical health treatment (“We did go to medical school … I think some psychiatrists are too narrow in their idea of our scope of practice”). Not only will they help connect people to primary care doctors and specialists, they will address many issues as an interim (bridging medication orders; taking out stitches for the guy who is paranoid and unwilling to go back to doctor)

– Get their hands dirty, quite literally! I’ve met several ACT psychiatrists who have helped with moving an individual into a new place, including pitching in to help the team frantically gather a person’s belongings from an apt to put in storage while the landlord threatened lock changes in an hour. Or the psychiatrist who helped fix a person’s car, or another who “showed up at my house on Saturday with some kids from church, and helped lay my kitchen floors.”

– Really embrace the idea of being a “team player,” such as helping someone fill out job applications, or sit with someone at Social Security office for over two hours (“That gave me an appreciation of the many frustrations our folks deal with on a day-to-day basis”).

– Are willing and wanting to tap into their clinical training, and make it a point to provide therapy (as opposed to symptom, side effect, med checks).

– Operate with a value that they are a consultant to the person, offering ideas and thinking through options – “It’s their body and ultimately their decision what they put in their body.” These same psychiatrists understand that choosing not to take a medication is within a person’s right, and may be well-reasoned (“people have different margins of tolerance and ability to do fine without meds – some start becoming quite sick after three days of no meds, some have gone years managing their symptoms without meds”)

– Care. It bothers them when they see people have set-backs, and cheer when people make gains — you’d think this should just come with the job, but it doesn’t, likely because “ACT psychiatrists” see their role as more than a “job.”

Lorna Moser