Assertive community treatment (ACT)

Assertive community treatment (ACT) is a specific model of social psychological care. The model provides comprehensive treatment for people with serious mental health conditions. ACT is a type of treatment that depends on a team who works together to help an individual with a mental illness. ACT and similar treatment programs are meant to give patients access to many types of care that are available at any time—twenty-four hours per day, seven days per week. This model of care is meant to reduce the number of hospitalizations patients need and the amount of care that other people, such as family members, have to provide for patients with serious mental illnesses. The ACT method of care is undertaken by a team of professionals with various backgrounds who work together to provide comprehensive care that goes beyond the medical care that most patients receive under other models.

Background

ACT developed in the 1960s in Wisconsin. A group of doctors—including Arnold Marx, Leonard Stein, and Mary Ann Test—noticed that patients who received in-patient mental health services often responded very well to treatments. However, many patients did not maintain good mental health after they were released back into the community. Their mental health diminished when they had only outpatient mental health services. The doctors noticed that many patients, especially those with the most serious mental health conditions, would be hospitalized many times for the same issue. The doctors believed they could develop a new type of mental health service model that would give more patients the ability to stay well while still living in the community. They believed the reason patients did better in a hospital setting was in part because they had care and social support available twenty-four hours per day. These doctors created an ACT model of care to help patients who required more access and many interventions in daily life.

Before ACT and other psychosocial treatments were common, many medical professionals used a case management model of care. In this model, patients who require mental health services visit various medical professionals for each symptom or condition that needs treating. Often, however, the care individuals receive in this model is not integrated, meaning providers do not work together to understand all the different medical interventions a person is receiving. Although some patients benefit from the case management model, psychiatrists have found that some patients, especially those with the most serious conditions, benefit more from integrated care provided by various professionals with different backgrounds and specialties.

Overview

ACT programs are sometimes called programs of assertive community treatment (PACT), assertive outreach, or continuous treatment teams. ACT programs generally are implemented by ACT teams, who work together to provide integrated care for patients. Since an ACT team needs to fill many needs for many types of patients, an ideal ACT team has professionals from different fields and various backgrounds. All ACT teams have a psychiatrist. Other professionals on such teams usually include an employment specialist, a substance abuse specialist, a psychiatric nurse, and other mental health professionals. The team communicates every day about the statuses of the patients they care for. Usually ACT teams care for fewer patients than the same number of professionals using a case management model would care for. With fewer patients, however, an ACT team is able to focus more fully on the patients it does care for. Studies have shown that even though ACT models of care have a higher up-front cost, they cost less money in the end because they reduce hospitalization and incarceration, which are common among people who have serious mental health conditions.

Another important aspect of ACT programs is that the majority of medical care is provided by the core team so that the patient does not have to be referred to an outside provider. In the case management model of care, one worker might refer his or her patients to many other professionals. In the ACT model, the team members provide most of the mental health medical care so they can coordinate with one another. This is effective because all the medical care is integrated rather than carried out by many professionals who do not communicate with one another.

Medical professionals who are involved in an ACT program often are very involved in their patients' lives. Members of an ACT team might help a person shop for food, attend other doctor appointments, and find a job. These team members also do many tasks that ensure patients have necessities of everyday life, such as housing and health care. The team members take on these tasks because they realize that improving mental health often depends, as least in part, on a patient having a stable place to live and having other basic needs met.

Studies have been conducted to determine the effectiveness of ACT models of care. Many of these studies have shown that patients have better outcomes in a number of areas, including maintaining housing, finding employment, and attending health care appointments. Although ACT models of care can be very effective, this model of health care is not effective for all patients. Patients who actively seek out mental health care, take medications, and attend medical appointments regularly generally do not benefit from the comprehensive care of an ACT team. ACT models of care are most effective for patients who have the most severe mental health conditions and for whom everyday tasks, such as maintaining a job and taking medication, might be difficult. For example, patients with mental health conditions such as schizophrenia and mood disorders with psychotic features may benefit from an ACT model of care because they may not realize that they have health conditions and therefore might not seek or accept treatment.

Bibliography

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"Assertive Community Treatment." Center for Evidence-Based Practices, Case Western Reserve University, www.centerforebp.case.edu/practices/act. Accessed 24 Feb. 2018.

"Assertive Community Treatment (ACT)." National Alliance on Mental Illness, Minnesota, www.namihelps.org/assets/PDFs/fact-sheets/General/Assertive-Community-Treatment.pdf. Accessed 24 Feb. 2018.

Bond, Gary R., and Robert E Drake. "The Critical Ingredients of Assertive Community Treatment." World Psychiatry, vol. 14, no. 2, 2015, pp. 240–2.

Drake, R. E. "Brief History, Current Status, and Future Place of Assertive Community Treatment." American Journal of Orthopsychiatry, vol. 68, no. 2, 1998, pp. 172–5.

"Psychosocial Treatments." National Alliance on Mental Illness, www.nami.org/learn-more/treatment/psychosocial-treatments. Accessed 24 Feb. 2018.

"Team Based Services: Assertive Community Treatment (ACT)." Illinois Mental Health Collaborative, www.illinoismentalhealthcollaborative.com/provider/manual/section3/Team‗Based‗Services‗ACT.pdf. Accessed 24 Feb. 2018.

"What Is Assertive Community Treatment?" DualDiagnosis.org, www.dualdiagnosis.org/co-occurring-disorders-treatment/assertive-community-treatment/. Accessed 24 Feb. 2018.