National Alliance on Mental Illness
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Assertive Community Treatment
What is assertive community treatment?
Assertive community treatment (ACT) is a model of psychiatric care that can be very effective in the treatment of severe mental illness. Also referred to as PACT—program of assertive community treatment—ACT is a program that has been in development since the 1960s and is aimed at providing comprehensive multidisciplinary care to the people who need it the most. Similar to the “treatment team” model of an inpatient psychiatric unit, which includes nurses, psychiatrists, social workers, case managers, occupational therapists and other trained professionals, ACT is based around the premise that people receive better care when their mental health care providers are working together. All too often, people can become lost in the system following discharge from in inpatient psychiatric hospitalization. ACT aims to provide the same level of thorough, round-the-clock, psychiatric care for people once they leave the inpatient unit. Therefore, similar to the consistency provided by an inpatient unit, members of the treatment team are available for care 24/7—every day, every hour—to provide the most comprehensive care for mental illness.
What are the primary goals of ACT?
ACT strives to decrease the debilitating symptoms of severe mental illness that affect each individual in different ways. By developing individual treatment plans with a multidisciplinary team, the primary goals of preventing acute relapse and psychiatric hospitalization are emphasized so that an individual has the opportunity to live more independently in an outpatient setting. Increased ability to function independently—through improved social relationships, finding and maintaining employment and family support—remains a primary goal of ACT. An individual with ACT can also expect to have support with medication adherence, which is a cornerstone of treatment for severe mental illness.
What are the key features of ACT?
Approximately 50 percent of individuals with recent hospitalization for severe mental illness will have difficulty connecting with their outpatient treatment team. One of the most powerful things that ACT has to offer is the treatment teamís expectation to seek out their patients for appointments. Rather than have a patient meet at a hospital or another office, ACT visits usually occur at the patientís place of residence. ACT is also more fluid and accessible to patients with the opportunity to change appointment days and times in order to meet an individualís immediate needs. While one of the main goals of ACT is to decrease the need for emergency psychiatric services—including both ER visits and inpatient hospitalizations—ACT team members are also well-connected with local hospitals and have the ability to work with hospital and emergency room staff. ACT teams are regularly in touch with a patientís hospital team members and frequently visit inpatient psychiatric hospitals to aid in treatment plan and discharge arrangements. Following discharge, ACT team case managers frequently assist in helping patients to attend any follow up appointments or meetings they might have in the community setting.
ACT has a unique focus on rehabilitation and recovery that serves as a guiding philosophy for treatment. Patients will usually have individual therapy as part of their involvement with ACT, and a solution-focused, cognitive behavioral therapy mode of treatment is frequently used. ACT will involve aiding the individual in resuming educational pursuits (e.g., GED, high school diploma, college courses) or finding regular employment—both paid and volunteer—to help the patient become more involved in their community. ACT team members will also support the individual in returning to work/school in order to increase daily structure and provide self-esteem. ACT can also help patients with other necessary supports such as coordinating legal services and financial/money-management.
ACT clinicians will also invest significant resources in supporting and educating the family members of their patients. This can involve family meetings, individual family support and connecting family members with other resources in the community (such as NAMIís Family-to-Family).
Who benefits from the ACT model?
ACT is indicated for all sorts of people—individuals of all ages, gender and ethnicity—with severe and persistent mental illness. People who receive ACT services are usually people living with schizophrenia and other psychotic disorders (e.g., schizoaffective disorder or severe bipolar disorder), although multiple psychiatric illnesses have been successfully treated with ACT. Most people with ACT experience significant disability from their mental illnesses and have not been adequately served by traditional outpatient models. This can include people who have difficulty getting to appointments on their own, those who have had bad experiences in the traditional system or those who have limited understanding of their need for help (e.g., people with anosognosia).
How does ACT compare with traditional treatment?
Multiple large research studies have shown that ACT is an effective treatment model for people with severe mental illness. In general, people receiving ACT services spend significantly less time in hospitals, are more likely to remain employed, experience more positive social relationships, have greater satisfaction with life and experience less debilitating symptoms from their mental illness. A prominent study suggests that patients receiving ACT were hospitalized less than 20 percent as often when compared with individuals who did not receive these services. Furthermore, people receiving ACT were hospitalized for shorter periods of time before returning to their homes. Patients receiving ACT services spend more time in the community and are better connected with local resources, which places fewer burdens on family members and allows for improved relationships.
In previous decades, ACT was not available in all areas, even for people with the most complicated mental illnesses. As multiple studies have suggested that ACT is less expensive for taxpayers than institutional care, more communities and government agencies are developing the resources to bring ACT to the people that need it most. Family members and loved ones should feel empowered to discuss the possibilities of ACT services with their loved oneís treatment team. If it is clinically indicated, ACT services can be very helpful in the treatment of chronic mental illness.
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., February 2013