People with serious mental illnesses (SMIs) (e.g., schizophrenia, major depressive disorder, bipolar disorder) receive inadequate medical care, which is associated with high rates of avoidable morbidity and premature mortality. Assertive Community Treatment (ACT) is an evidence-based service delivery model that provides intensive mental and social health support to clients with SMI. It has been suggested that ACT should provide primary care services to address client physical health, however, initiatives towards this and their implications are not well understood. I used a case study approach and semi-structured interviews to explore five ACT teams in the Ottawa region to discover team members’ mental models of primary care, relationships with external primary care providers, and the perceived impact COVID-19 has had on these mental models. I used Shared Mental Model (SMM) theory to frame data collection and a thematic analysis. The results showed that ACT team members similarly perceived primary care as important for the holistic health of their clients. They described ACT’s psychosocial scope and how they support clients’ access to external primary care services and their work to mitigate barriers. Teams did not share mental models about the basic primary care services they provided or which roles delivered them, due to differences in context and team members’ comfort. Team members also did not share beliefs about the future of ACT and primary care integration. Finally, the COVID-19 pandemic changed and challenged primary care delivery, with beliefs becoming more negative overall. This thesis provides insight into how primary care could be delivered to ACT clients and where challenges and improvements can be addressed.

Formålet: Psykiatriens udvikling er konstant præget af ønsket om effektive behandlings-metoder. Etablering af ACT (Assertive Community Treatment) -er skabt i erkendelse af, at psykiatrien i hospitalerne ikke i tilstrækkelig grad har evnet at helbrede. Med afsæt i de kronisk psykisk syge, vil dette MPH arbejde fokusere på denne gruppes sundhedstilstand, ved at studere arbejdsmetoden ACT. En arbejdsmetode som sundheds-og socialvæsenet i stigende grad accepterer som organisation og funktion til forebyggelse og sundhedsfremme. Der er i de sindslidendes liv brug for en arbejdsmodel, hvor en kompetent hjælper kan støtte den sindslidende i at begribe hverdagen, så der dannes et meningsfuldt grundlag for at håndtere livet. Formålet med studiet er, at få mere viden om, hvordan de danske ACT teams fungerer i en hektisk hverdag. Modellen har i udlandet vist, at have god effekt på reduktion af kompleksitet og sikre en bedre sammenhæng i det psykiatriske arbejde. Studiet er ligeledes en efterprøvning af, om der arbejdes modeltrofast overfor ACT i Danmark. Metode: Studiet belyser ACT interventionen ved hjælp af en struktureret elektronisk spørgeundersøgelse og efterfølgende kvalitativ indholdsanalyse. Efterfølgende fravalg af størstedelen af den indsamlede kvantitative data, grundet lav svarprocent. Resultat: I undersøgelsen deltog 72 respondenter fordelt på 31 respondenter fra Region Hovedstaden (43 %),12 respondenter fra Region Sjælland (17%), 11 respondenter fra Region Syddanmark (15 %), 2 respondenter fra Region Midtjylland (3%) og endelig 16 respondenter fra Region Nordjylland (22%). Antal ACT teams i Danmark er fordelt med 33 teams i Region Hovedstaden, et team i Region Sjælland, otte teams i Region Syddanmark, 11 teams i Region Midtjylland og endelig fire teams i Region Nordjylland. Danske ACT teams arbejder anderledes og med en anden sammensætning / funktion end den oprindelige model fra USA. ACT har vist sin funktionsdygtighed gennem mere end de sidste 10 år i Danmark. ACT teams indtænker salutogenitet i sin arbejdsform og fokuserer på ressourcer og på at forbedre sundhedstilstanden. ACT er opsøgende og assertivt i sin kontakt til klienterne. Konklusion: ACT har med sit indtog i Danmark vist,at tilgodese et behov hos både klienter, den arbejdende psykiatri og samfundet. Psykiatrien skal behandle klienterne, der hvor de er – i deres eget liv. Med tilbud som er tilgængelige, sammenhængende og meningsfulde for den enkeltes vej mod et godt liv uden eller på trods af sygdom. Arbejdsmetoden er effektiv i reduktion af sundhedsfaglig og socialfaglig kompleksitet og teammedlemmerne udtrykker stor arbejdstilfredshed ved metoden. Teammedlemmerne i danske ACT-teams evner at arbejde i teams. Det tværfaglige samarbejde opleves meningsfuldt og håndterbart. ACT arbejdet er attraktivt og kan rekruttere kompetente medlemmer. Kvaliteten af de ydelser som ACT teams leverer, inkluderer forebyggelse, pleje, behandling, rehabilitering samt en øget oplevelse af tilgængelighed, koordination, kontinuitet og reduktion af kompleksitet. De danske ACT teams er ikke modeltro mod ACT –men tilpasset danske forhold og begrænsninger. ACT team har ikke fuldstændig myndighedsfunktion. ACT som model er under udvikling og tillempes mere og mere i en dansk kontekst / Background: Inpsychiatry, development is characterized by a desire for efficient treatment. Establishment of Assertive Community Treatment (ACT) was created in recognition that psychiatric hospitals have not adequately been able to restore health. Based on the chronic mentally ill, this study focused on the Outreach Psychosis Team by studying the working method ACT. Health and social services are increasingly willing to accept ACT as an organized and functional method for prevention and health promotion. Mentally ill people need a working model in which a competent assistant can support the patient in comprehending everyday life and form a meaningful basis for dealing with life. Aim: This study aimed to gain more knowledge about how ACT teams in Denmark operate in a hectic schedule, and determine whether teams adhere to the ACT model. Method: The study highlighted ACT intervention using a structured electronic survey and subsequent qualitative content analysis. However, most of the collected quantitative data was rejected due to a low response rate . Results:The study included 72 respondents, 31 working in Region Hovedstaden, 12 in Region Sjælland 11 in Region Syddanmark, 2 in Region Midtjylland, and 16 in Region Nordjylland. ACT teams in Denmark include 33 teams in Region Hovedstaden, 1 in Region Sjælland, 8 in Region Syddanmark, 11 in Region Midtjylland, and 4 in Region Nordjylland. The teams work differently and with a different composition and function than the original US model, but they have proven their functionality for more than 10 years. ACT includes salutogenesis in its working methods, and focuses on resources and on improving health. Moreover, ACT is proactive and assertive in dealing with clients. Conclusion: Psychiatry must treat clients wherever they are intheir own lives with offers that are available, consistent, and meaningful to each person on his way to a good life without or in spite of illness. ACT in Denmark has shown that it considers the needs of both clients (i.e., working psychiatry and society), and the working method efficiently reduces the complexity of health care and social work. Team members appreciate the working method. Members of Danish ACT teams are capable of working in teams, and they experience interdisciplinary collaboration as meaningful and manageable. Because working in an ACT team is attractive, it is possible to recruit competent members. Services provided by ACT teams include prevention, care, treatment, rehabilitation, an increased sense of accessibility, coordination and continuity, and decreased complexity. The Danish ACT teams do not strictly adhere to the original ACT model, but rather have adapted to Danish conditions and limitations. Abroad, ACT reduces complexity and ensures greater consistency in mental health work. They do not have complete authority. Currently, ACT is being developed and adjusted to a Danish context / <p>ISBN 978-91-982280-3-6</p>

Inledning Alltsedan psykiatrins avinstitutionalisering tog fart under 1980- och 1990-talen har en utveckling av samhällsbaserade psykosociala insatser förespråkats för att erbjuda vård och stöd till personer med psykisk funktionsnedsättning. Insatserna förväntas bidra till att brukarna får tillgång till effektiv vård och stöd, samtidigt som de inkluderas i samhället. Vidare förutsätts insatserna baseras på kunskap och evidens, samt bygga på brukarens delaktighet och stödja dennes återhämtning. En annan målsättning är att vissa insatser ges i form av integrerade modeller, så att personer ur målgruppen får tillgång till sammanhållet stöd från inblandade myndigheter. Även om Sverige räknas som ett resursstarkt land som har kommit långt på området, så förekommer kritik mot utvecklingen. Kritiken har berört både planering och styrning på politisk nivå, men även utförandet av de insatser som erbjuds till brukarna. Kritiken har bland annat handlat om bristande samverkan mellan landsting och kommuner, och om stora lokala variationer i den erbjudna servicens kvalitet. I den här avhandlingen studeras dels utformningen av policy på området, dels implementering av specifika insatser. Syftet med avhandlingen är att undersöka hur svenska policymakare på nationell nivå har hanterat utvecklingen av psykosociala insatser för personer med psykisk funktionsnedsättning, samt att analysera möjligheter och svårigheter för organisationer och personal när det gäller att implementera de insatser som förespråkas av beslutsfattare. De frågeställningar som avhandlingen söker besvara är följande: Hur formuleras policy som syftar till att införa samhällsbaserade psykosociala insatser, och vad kan policyns egenskaper innebära för genomförandet av den? Vilka styrstrategier uttrycks i statliga policydokument? Vad hämmar respektive underlättar implementeringen av föreslagna integrerade psykosociala insatser? Hur kan vi förstå vad som påverkar möjligheten att erbjuda integrerade psykosociala insatser, i termer av lokala förutsättningar och strategier för implementering? Metod Policy på området studerades genom en studie av tre av de övergripande dokument som beslutats på regeringsnivå de senaste 20 åren. Riktade kvalitativa innehållsanalyser baserade på relevant litteratur genomfördes. Implementering av insatser studerades genom att 15 program följdes under 3 års tid. 14 av dessa arbetade med att implementera arbetsrehabiliteringsprogram utifrån modellen Individual Placement and Support (IPS). Under samma tidsperiod följdes ett team som implementerade den intensiva samordnings-, vård- och stödmodellen Assertive Community Treatment (ACT). För att bedöma verksamheternas följsamhet till modellerna genomfördes programtrohetsskattningar av samtliga program. Data avseende programmens målgrupp samlades också in. Tre IPS-program deltog i en fördjupningsstudie där kvalitativa intervjuer genomfördes med ledare, personal och samverkanspartners. Implementeringen av dessa program analyserades utifrån implementeringsramverket the Consolidated Framework for Implementation Research. Implementeringen av samtliga 14 IPS-program studerades med hjälp av skattningsskalan the Sustainable Implementation Scale (SIS). När det gäller ACT-teamet genomfördes dels kvalitativa innehållsanalyser av djupintervjuer, och dels skattningar av implementeringskomponenter med hjälp av SIS. Resultat Policy på området har innehållit stora mått av otydlighet och konflikt, både gällande de mål och medel som har formulerats. Regeringen har främst förespråkat så kallade mjuka styrstrategier, vanligen i form av statliga stimulansbidrag. Vissa förtydliganden och konkretioner har skett under tid, vilka ibland går i linje med de internationella rörelserna New Public Management och evidensbaserad praktik. Exempel på försök att strama upp styrningen är målformuleringar som förespråkar riktade och prestationsbaserade stimulansbidrag, samt nationella riktlinjer för att styra utvecklingen mot utvalda specificerade insatser. Trots detta är det fortfarande de berörda myndigheterna som är ansvariga för att välja ut, utforma och implementera psykosociala insatser. På verksamhetsnivå leder detta till att många otydligheter består, vilka ibland är relaterade till svårigheter att avgränsa ansvarsområden och att förändra hindrande regelverk och traditioner. Dessutom förekommer konflikter, exempelvis i form av konkurrerande målsättningar och ojämn resurstilldelning. Studierna av de integrerade modellerna IPS och ACT visar att implementering av dessa är möjlig, även i en sektoriserad välfärdskontext som den svenska. Det finns dock en rad faktorer på såväl organisationsnivå som teamnivå, som försvårar implementeringen. Exempel på dessa är de involverade organisationernas varierande målsättningar och traditioner, regelverkens utformning, samt svårigheter att erhålla långsiktig finansiering. I en del fall beskrivs de arbetssätt som modellerna förespråkar som försvårande, då de upplevs som annorlunda och utmanande för existerande rutiner och uppfattningar om stöd till målgruppen. Ett stort hinder för effektiv implementering är svårigheter att samverka, främst mellan, men även inom inblandade organisationer. De flesta program som lyckades genomföra en hållbar implementering hade personal som var duktiga på att navigera förbi de hinder som orsakades av ogynnsamma regler, och de lyckades även hitta vägar för att etablera samverkan, både horisontellt (med samarbetspartners på samma hierarkiska nivå) och vertikalt (mellan ledning och personal). En verksamhetsledare som har möjlighet att påverka samverkansrelationer i både horisontell och vertikal riktning är gynnande för implementeringen. Andra betydelsefulla komponenter som underlättar implementering är en noggrann planering innan ett program startas, medveten rekrytering av personal, formering av ändamålsenliga styrgrupper, samt att tidigt i processen arbeta strategiskt för att lösa finansieringsfrågan. Även programtrohetsskattningar var betydelsefulla, då de både fungerade som instrument för att identifiera förbättringsområden för programmen, men också hade en legitimerande funktion vid återkoppling till ledningen. Slutsatser Det råder en samstämmighet i övergripande målsättningar som syftar till att utveckla området integrerade psykosociala insatser. På en mer konkret nivå är läget betydligt oklarare, både gällande målsättningar i policy och av vem och hur insatserna ska implementeras. Även om vissa förändringar skett, står regeringen fortsatt för en mjuk styrning vilken lämnar ett stort ansvar till de myndigheter som ska implementera valda insatser. Detta innebär en rad svårigheter för frontlinjepersonalen, vilket leder till att de ofta behöver lägga mycket tid och energi på att hitta vägar för att överkomma dessa svårigheter. I många fall har ledare och personal goda möjligheter att uppnå en hög programtrohet på teamnivå, men för en hållbar implementering krävs det att ett program är väl förankrat både vertikalt och horisontellt. Därför finns ett behov av att forskare och beslutsfattare tar ett tydligare helhetsgrepp, både på området policy och implementering av specifika insatser. Skattningar av programtrohet och implementering kan vara ett stöd i att identifiera vad som fungerar samt vad som behöver förändras i och mellan organisationer. Men för att programmen ska lyckas med en effektiv implementering på organisationsnivå behöver deras legitimitet stärkas vertikalt, och planering för långsiktig lokal finansiering behöver göras i ett tidigt skede. / Introduction Since the deinstitutionalization of psychiatry started in the 1980’s, the field of psychiatry has moved in the direction of community-based psychosocial interventions for people with mental illnesses. The interventions selected should be based on knowledge and evidence, and support the users’ empowerment and recovery. In addition, some of the services should be provided in forms of integrated models, meaning that all agencies involved should provide cohesive care and support. Two examples of such interventions are the occupational rehabilitation program Individual Placement and Support (IPS) and the intensive case management model Assertive Community Treatment (ACT). Although Sweden is considered a high-resource country, the availability of psychosocial services has been criticized. This criticism has been related to policymaking as well as the quality of the services provided. Examples of areas considered problematic include collaboration deficiencies among disparate human service organizations and substantial local variations in available types of services. This thesis aims to examine how national-level policymakers in Sweden have handled the development of psychosocial support and to analyze facilitators and barriers experienced by these organizations in their implementation of community-based and integrated models. The research questions are as follows: -       How have policies concerning community-based psychosocial interventions been formulated and how do the characteristics of these policies affect the implementation of its goals? -       How do different types of steering strategies influence national-level policy implementation proposals? -       Which facilitators and barriers to effective implementation of proposed integrated interventions can be identified? -       How can the ability to provide integrated psychosocial interventions be explained in terms of local conditions and strategies used for implementation? Methods A study of community mental health policy covering three of the major documents published at the national level from the last 20 years was performed. Directed content analysis based on literature relevant for the research area was used. In order to study the implementation of the selected interventions, 15 programs were followed for a three-year period. 14 of these programs were implementing IPS and the other one implemented ACT. In order to monitor the programs’ adherence to the selected models, program fidelity assessments were performed. Data on the programs’ target groups were collected. Three of the IPS-programs participated in an in-depth study where qualitative interviews with leaders, staff, and collaboration partners were performed. The implementation of the three programs were analyzed utilizing the Consolidated Framework for Implementation Research. All of the 14 IPS programs were included in an implementation study where the Sustainable Implementation Scale (SIS) was used to identify facilitators and barriers to implementation. In the study of the ACT team, qualitative directed content analysis of in-depth interviews and SIS-assessments were performed. After three years, the sustainability of all programs was assessed. Results Mental health policies have involved high levels of ambiguity and conflict in relation to both the goals and the means. The government has prioritized soft steering strategies, usually in the form of financial stimulus grants. Over time, these policies have (at least to some degree) been clearer when psychosocial interventions are being described. In addition, the development of policy has led to harder steering strategies, illustrated by targeted and performance-based grants and the advocacy of national guidelines to steer agencies towards preferred interventions. Despite these changes, independent agencies are still responsible for selection, framing, and implementation of the interventions. Implementation of the integrated models IPS and ACT is possible, even in the context of a sectored welfare system such as Sweden.  However, there are a number of implementation barriers at the organizational and team levels. Obstructive factions include involved agencies disparate traditions and regulations, as well as the programs’ difficulties in securing long-term funding. Some of the staff interviewed considered the characteristics of the interventions as problematic since they challenged existing routines and views about support of the target group. Another critical component was the ability to establish collaboration, both horizontally (with partners at the same hierarchical level), and vertically (between management and staff). A team leader with the mandate to influence interactions horizontally and vertically is therefore a facilitating factor. In most of the programs that managed to perform a sustainable implementation of the models, a critical success factor was found to be staffs’ ability to navigate around a variety of barriers. Additional facilitators to successful implementation was careful planning before the start-up of a program, effective staff recruitment, the formation of a dedicated steering group, and a plan for local funding early in the implementation process. Regularly-performed program fidelity assessments were also noted as an important means to identify improvement opportunities for the programs. Collectively, these components served as tools to increase the programs’ legitimacy since the team leaders used them to provide feedback to the local decision makers. Conclusions At an abstract level, there is general agreement of the overarching needs in the area of integrated psychosocial interventions, but there are discrepancies when it comes to how to best convert this shared definition of need into concrete psychosocial interventions. The majority of steering strategies used are still considered ‘soft’, which leaves much of the responsibility to the implementing agencies.  At a grass-root level this leads to several difficulties, including unclear responsibility definitions and collaboration challenges between agencies. Instead of prioritizing the work with their clients, the staff are forced to put a lot of time and energy into solving these problems. In most cases, team leaders and staff are able to reach high program fidelity at a team level. However, a sustainable implementation demands that a program has been anchored both vertically and horizontally. There is a need for a holistic approach by researchers and decision makers, both in the area of policymaking and implementation of selected psychosocial interventions. Assessments of program fidelity and implementation have the potential to help agencies identify strengths and opportunities for growth both within each entity and between involved organizations. In order to implement the selected models successfully at an organizational level, the programs´ vertical legitimacy has to increase, and plans for long-term local funding strategies have to be initiated early in the implementation process.

Research shows that people with severe mental illness (SMI) have extensive trauma histories and higher rates of post-traumatic stress disorder (PTSD) than the general population. However, research also shows that both the trauma history and PTSD in people with SMIs are vastly unrecognized and untreated. Additionally, the relationships between SMI, trauma, PTSD, substance use, and other psychosocial factors is still not well understood, as there has been limited experimental research examining these relationships despite an awareness of their connections. The SMI-PTSD descriptive model was originally proposed by Mueser et al. (2002) to better understand these variables, and is often referenced in the literature, yet there is very little empirical evidence and understanding of how this model may differ by gender in people with SMI. Assertive Community Treatment (ACT) is an evidence-based treatment for those with SMI, yet the extent to which trauma is addressed within the ACT model is not consistently known, nor how the team’s practitioners work with their clients on trauma-related issues and PTSD. By definition, all ACT clients have an SMI and represent a population with complex and intensive needs; therefore, a better understanding the population ACT serves, as well as how the teams work with the trauma present in their clients, will aid in providing better and more consistent treatment and care. This dissertation examines gender differences in the relationship between SMI, substance use, trauma, PTSD, psychosocial factors, the SMI-PTSD descriptive model, and attempts to ascertain the perspectives of ACT providers in working with trauma and PTSD in clients. In Study 1, I conducted retrospective chart reviews to extract information on trauma histories, PTSD, substance use, and psychosocial factors in 282 clients from four ACT teams (178 men, 104 women) to assess the gender differences in types of trauma, instances of PTSD, substances of choice, problematic substance use, and the SMI-PTSD model. Findings indicate that rates of sexual trauma, emotional abuse, serious suicide attempts, rates of trauma in adulthood, and PTSD are higher among women, whereas rates of alcohol, marijuana, and stimulant use as well as lifetime problematic substance use are higher among men. For the SMI-PTSD model, results suggest that the model better corresponds to the experiences and possible trajectory of men with SMI. In Study 2, I employed thematic analysis through interviewing ACT providers to better understand their perspectives on working with trauma and PTSD in clients. Five overarching themes with 21 sub-themes emerged. The five themes were the role and scope of ACT teams and model regarding trauma; discussions of trauma with clients; current treatment of trauma; barriers to working with trauma; and recommendations for enabling trauma discussions and treatment. These two studies have important implications for further research. Research should take gender identity into consideration when proposing and testing models, as Study 1 has demonstrated that two genders experience a well-accepted proposed model differently; this finding may be applicable to people of all genders, as well as other models. Further research could be done to gather perspectives from workers on the strengths and challenges of the ACT model. Future work should also include the views of ACT clients to get a fuller picture of their experience with receiving care for their trauma experiences. Clinically, health care providers should better recognize and treat PTSD and traumatic-stress symptoms of people with SMI. Doing so will ensure that health-care is moving towards trauma-informed practice on a systemic level.

No description available.

Systems-level homelessness report cards are an intricate part of managing and resolving homelessness within a community. Homelessness report cards can be used to both educate communities around the complexities of homelessness and capture pertinent data required to formulate evidence-based strategies towards ending (rather than managing) homelessness. The process of developing and implementing homelessness report cards can be fraught with challenges relating to: limited resources; fragmented information; and political roadblocks. To help reduce the potential of these roadblocks, a system-level Homelessness Outcome Reporting Normative framework (the “HORN Framework”) was developed. The HORN Framework is based on a literature review and synthesis of the best-practice, systems-level homelessness report card development and implementation methods. The framework was then tested in a case study with the Greater Victoria Coalition to End Homelessness (GVCEH), through the creation of their 2010 Greater Victoria Homelessness Report Card. The framework and case study results are presented in this thesis.

Indiana University-Purdue University Indianapolis (IUPUI) / Stigma is a barrier to recovery for people with mental illness. Problematically, stigma also has been documented among mental health practitioners. To date, however, most research has focused on explicit attitudes regarding mental illness. Little research has examined implicit attitudes, which has the potential to reveal evaluations residing outside of conscious control or awareness. Moreover, research has tended to use a mixed sample of practitioners and programs. The extent to which both explicit and implicit stigma is endorsed by mental health practitioners utilizing evidence-based practices is unknown. The purposes of the current study were to 1) carefully examine implicit and explicit stigmatizing attitudes, or biases, among Assertive Community Treatment (ACT) staff and 2) explore the extent to which explicit and implicit biases predicted the use of treatment control mechanisms. Participants were 154 ACT staff from nine states. They completed implicit (Implicit Association Test) and explicit measures of stigma. Overall, participants exhibited positive explicit and implicit attitudes towards people with mental illness. When modeled using latent factors, implicit, but not explicit bias significantly predicted the endorsement of restrictive or controlling clinical interventions. Practitioners who perceived individuals with mental illness as relatively more dangerous and helpless (both explicit and implicit), as well as participants from Indiana and those with less education were more likely to endorse use of control mechanisms. Thus, despite overall positive attitudes toward those with mental illness for the sample as a whole, even low levels of stigma at the individual level were found to affect clinical care. Mental health professionals, and specifically ACT clinicians, should work to be aware of ways in which their biases influence how they intervene with consumers.

Indiana University-Purdue University Indianapolis (IUPUI) / Assertive Community Treatment (ACT) represents an effective treatment for individuals with severe mental illness. Though studies estimate that as many as half of all people with severe mental illness are parents, little is known about consumers receiving ACT services who are parents. Thus, the purpose of the present study was to 1) estimate the prevalence of parent ACT consumers, 2) identify current ACT team policies and practices for treating parent consumers, and 3) examine the perspective of parent consumers served by ACT teams. Quantitative and qualitative data were collected and analyzed via two separate studies. In study 1, eighty-two ACT providers from 76 teams across the United States and Canada were surveyed to determine the prevalence of parent ACT consumers, ACT team policies for identifying the parental status of consumers, treatment services available for parent consumers, and provider attitudes about parent consumers. Providers estimated roughly 21.6% of ACT consumers were parents. Less than half of providers (46.3%) reported formally asking about parental status during intake and only 20.7% providers belonged to ACT teams that provide special programs/services designed for parent consumers. The majority of providers (75.6%) reported negative or mixed attitudes about parents with severe mental illness. In study 2, seventeen parents with severe mental illness being served by ACT teams were interviewed about parenting, the relationship between parenting and severe mental illness, parenting needs, and suggestions for improved treatment services for parents. All parents were able to identify at least one positive aspect of parenting and most parents (76.5%) also identified negative aspects of parenting. Loss of custody emerged as a significant parenting problem, with the majority of parents (88.2%) experiencing loss of custody at least once. Given the difficulties of being a parent and having to manage a severe mental illness, parents expressed interest in several parent-focused treatment services, including family therapy, parenting skills, communication skills training, resources/finances for children, and social support groups with peers. When asked about overall satisfaction with ACT services, most participants with adult children (87.5%) reported having no unmet parent-related needs and high satisfaction (4.63 out of 5) with ACT services, whereas parents with young children (77.8%) reported having numerous unmet parenting needs and low satisfaction (3.78 out of 5) with ACT services. Thus, the age of participants’ children was a significant factor, indicating that the ACT treatment model may not be adequately serving parents of young, dependent children. Overall, findings suggest the need for more attention and focus on parent consumers, including formal identification of consumers’ parental status and improved parent-related treatment services and support