Justin Ray on ACT Teams: Hospitals Without Walls

Justin Ray, MSN, PMHNP-BC, founder of South Chesapeake Psychiatry, was the guest on Holding It Together (Kinda) (Season 1, Episode 31), a podcast about the mental health system hosted by Michael Mackniak, author of Saving Melissa. In the episode, released September 3, 2026, Justin draws on his work as the psychiatric provider on an Assertive Community Treatment (ACT) team, a mobile team that brings psychiatric care to people with severe mental illness wherever they live. He explains why ACT teams call themselves “hospitals without walls” and where the system still leaves people behind.

What They Talked About

• From Navy corpsman to psychiatric nurse practitioner. How Justin started in psychiatry as a Navy hospital corpsman, and how seeing Marines come home from combat with untreated trauma pushed him toward advanced training. Related: our care for veterans and military families.
• Why ACT teams are “hospitals without walls.” ACT teams bring medications, treatment, and support to clients in their homes, in shelters, and on the street, for people whose illness, homelessness, or lack of transportation makes office visits unrealistic.
• When someone doesn’t believe they’re ill. Anosognosia, the limits of court orders once someone leaves the hospital, and Justin’s idea of a review board that would decide when treatment in the community can be required.
• A case from the field. How a person can be clearly unwell and still not “qualify” for emergency help, and what happens when a hospital stay ends with no follow-through in the community.
• Long-acting injectables, clozapine, and newer medications. Why long-acting injectable antipsychotics can help when daily pills are hard to keep up with, where clozapine fits despite its side effects, and newer schizophrenia medications that work in different ways. Related: Optimizing the Use of Long-Acting Injectables and Schizophrenia: A History of Treatment Challenges.
• Housing, supervision, and pragmatism. Why housing alone often isn’t enough without structure and supervision, and Justin’s vision of a supervised community setting built around daily routines, a garden, and animals.
• Jail as a backstop. Why Justin calls incarceration “a double-edged sword”: it can stabilize some people, but long stays and isolation can make psychosis worse, and handoffs back to community teams are often missing.
• Families as allies. Coordinating care across hospitals, jails, and community teams, and why Justin gives clients and families a direct way to reach him. That same commitment to availability is one of the five pillars of care at South Chesapeake Psychiatry.

Justin’s ACT work is separate from his outpatient practice. If you’re looking for outpatient psychiatric care in Chesapeake, you can schedule an appointment or read about medication management at South Chesapeake Psychiatry. Justin also writes about schizophrenia care and new treatments in The Neuropsychiatry Brief. Listen to the full episode and find the show’s resources on the Holding It Together (Kinda) website.

If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline), or call 911 in an emergency.