Assertive Community Treatment (ACT) is a form of outpatient mental health care for people with severe mental illness that affects their ability to live in the community, attend appointments with professionals in clinics and hospitals, and treat mental health symptoms.
If you or someone you know has been referred to an assertive community treatment program, you may be wondering if this is the best option and what it will mean. Rest assured that ACT is an evidence-based practice that has been studied for several decades and has likely been offered to you for some reason.
ACT is designed to provide mental health services that are person-centered and individual to meet the needs of each person.
Definition of ACT
The simple definition of assertive community care is an intense, integrated approach to the delivery of community mental health services. This means that mental health services are provided in a community setting (rather than in a more restrictive residential or hospital setting) for people with severe mental illness.
ACT’s mission is to help people become independent and integrate into the community as they recover.
Secondary goals are to reduce homelessness and unnecessary hospital stays. In this way, ACT offers “real world” treatment and the team of professionals offer help using a “whole team” approach.
Many people suffer from mental illness symptoms that affect their ability to function in daily life and that take them to the hospital emergency room for services. ACT aims to reduce this dependency on hospitals by providing 24/7 services to the people who need it most. In this way, assertive treatment in the community might be expected to help reduce preventable consequences of mental illness such as homelessness and substance abuse.
How did assertive community treatment begin? Go back to the 1970s and a picture of a move away from institutionalizing patients with severe mental illness will quickly emerge. At the same time, the community services were poorly set up to help these people who were no longer in institutional settings.
The founders of ACT were Leonard I. Stein, Mary Ann Test, Arnold J. Marx, Deborah J. Allness, William H. Knödler, and other colleagues from the Mendota Mental Health Insitute in Madison, Wisconsin (a state mental health clinic).
As unusual as it may sound, when assertive treatment was first launched in the community, it was viewed as a radical approach. However, since that time it has become one of the most important methods of administration for certain populations of people with mental illness.
In addition, the National Alliance for Mental Illness (NAMI) was on board, published a manual for ACT in 1998 and operated a training and advocacy center from 1998 to 2004.
Who is assertive community treatment for?
If you or a family member have been assigned ACT services, you may be wondering why you were selected to receive this type of service. Below is a list of the most common reasons a person is offered assertive community treatment services:
- People with severe symptoms of mental illness
- People with significant thought disorders such as schizophrenia
- Young adults with early-stage schizophrenia
- People with stigmatized mental illness
- People with high rates of substance abuse
- People with a significant history of trauma
- Those with frequent hospital stays
- People who are homeless due to a mental illness
- People with overlapping physical and mental illnesses (e.g. people who are hard of hearing with a mental illness)
- People with psychiatric crises
- People with mental illnesses in the criminal justice system
- Refugees with mental illness
- People who are unlikely to attend hospital or clinic appointments
- People who have not responded well to traditional outpatient care
In countries such as the United States, Canada, Australia and the United Kingdom, assertive community treatment has been carried out. For example, ACT was implemented nationwide by the Department of Veterans Affairs specifically in the United States.
Services are not provided in a clinic, but at the patient’s home, in community locations (such as a coffee shop, restaurant, or public park), in shelters for the homeless, or where it is best for the person using the service is suitable and comfortable.
If you are about to receive assertive community treatment, you are probably not sure what to expect. Most ACT programs have similar structures, so the following may guide you on what the program will provide.
- Your treatment plan will focus on your personal strengths, needs and wants for the future
- ACT is offered in the long term, but not indefinitely; The aim is to switch you to other services at some point or to maintain what you have learned yourself
- ACT’s focus is on integrating into the community and getting you back to a normal life
- ACT takes a holistic approach to treatment, meaning all areas of your life are goals for improvement
- ACT usually has a ratio of around 10: 1, which means one team member is assigned for every 10 customers
- Most customers have multiple contacts with team members each week
- ACT is offered 24 hours a day, 7 days a week to ensure you always have the help you need
- An ACT team generally consists of a psychiatrist, social workers, nurses, occupational therapists, peer support specialists, and much more
- ACT is viewed as a medically supervised non-residential service two steps away from the highest level of service (medically administered residential service).
- Team members develop long-term relationships with you whether you become homeless or imprisoned
- When you feel better, you will be removed from the ACT program
What specific services can you expect from the ACT team? Below is a list of some of the main services that assertive community treatment provides:If you.
- Initial and ongoing reviews
- Psychiatric services such as coping with psychotic episodes or crises
- Substance abuse services
- Help with employment and housing
- Educating family members and you about your mental illness
- Treatment planning and monitoring
- Accompaniment to medical and dentist appointments
- Representation in court hearings
- Help with finances (like managing money and paying bills)
- We’ll help you feel safe with housekeeping, shopping, cooking and transporting
- Employment support such as finding and maintaining a job
- Help with ordering and managing medicines
Key components of ACT
ACT is designed to provide treatment that is non-limiting and accessible. The Assertive Community Treatment Association (ACTA) has developed a number of basic principles that govern this form of treatment. These include:
- Absence treatment in a community or at home
- Act as the primary service provider for a range of treatment services
- Offering personalized treatments that are tailored to each person’s needs and help them achieve their goals
- Helping customers better integrate into their community and access the services they need
- Help meet the needs of family members who are also affected by assistance
- Providing psychoeducation so that people can better understand their condition
- Provides professional support to help people develop both life and professional skills
Because ACT is so adaptable, it can be used to meet a wide range of needs.
Overall, research on assertive treatment in the community has been positive with some caveats. A review of the evidence in 2016 found that ACT reduced self-reported psychiatric symptoms, hospital stays, and visits to the emergency room in people with mental illness and substance abuse...
In general, it can be concluded from the dozen of randomized controlled trials that have been conducted that ACT is more effective than standard services in reducing hospital use, but the results for other outcomes are less clear.
While studies have shown ACT improved in terms of housing, symptom management, and quality of life, these results were most apparent to people who tended to return to hospitals frequently.
It was found that ACT can be most helpful in communities with poorly coordinated mental health systems, leading to overuse of hospitals by people with severe mental illness.
For example, ACT may perform better in the US than the UK because the former has a poorly coordinated system of psychiatric care leading to more hospital stays, while the latter has a well-coordinated system that already encompasses many aspects of ACT in his standard care.
Other research has shown ACT to be more effective than standard care in reducing the risk of hospitalization and incarceration, especially in poor city centers, and in reducing alcohol use or incarceration in those with antisocial personality disorder.
In addition, it has been shown in the homeless that ACT leads to greater satisfaction with care and more stable living situations than standard care. This is easy to understand when you consider the ACT model: homeless people encounter service providers who are more convenient for them to benefit from services than those who have to travel to get help.
Finally, in a Cochrane review of 38 clinical studies from the US, Canada, Europe, and Australia, ACT was shown to be more effective than standard care in reducing time in hospitals and improving social functioning and independent living.If youAt the same time, it has not been shown that mental health and quality of life improve more than with standard care.
Overall, research suggests that ACT is most helpful for people with severe mental illness to keep them out of the hospital and community.
Another benefit that the ACT model can also have in reducing burnout in mental health professionals. Despite caring for people with intense needs, research has shown that ACT case managers report less work pressure and higher job satisfaction..The shared responsibility that comes from being on a health care team, the abundance of peer support, and clear job roles are possible reasons why those who work in assertive community care are less prone to burnout.
Criticism of ACT
Overall, there were some criticisms of the ACT program. For one thing, ACT is simply a coercive system whereby hospitals refuse to admit patients to the ACT program.
Isn’t it the goal of all mental health initiatives to stay in the community? That way, it seems that whether or not the tactic is compulsory, the benefits may be worthwhile, if patients can be treated, tracked through prison and homeless shelters and cared for 24/7 in the community they live in Disadvantage.
A word from Verywell
If you’ve been hired to receive assertive community treatment services, you may be nervous about what to expect or what kind of support to get. Know that your team is available to answer questions and provide long-term community support in locations that serve you best. As a person with severe mental illness, ACT is an effective long-term support that should serve you well.