Assertive Community Treatment, or ACT, is one of many evidence-based practices used to treat people suffering from mental illness. This article provides an overview of ACT and its history, present, and future directions. This article is the first in a series of three articles about ACT.

Assertive Community Treatment, or ACT, is one of many evidence-based practices used to treat people suffering from Severe Mental Illness (SMI).

What is ACT?

ACT is a community-based team treatment approach for underserved people with Severe Mental Illness (SMI). The teams that care for clients are made up of experts like psychiatrists, nurses, social workers, counselors, and rehabilitation workers. ACT interventions are paced and ongoing. Services are tailored to each individual and are available around the clock, and the client-to-staff ratio is low. All of these elements support one of ACT’s core guiding principles: to support the right of people with SMI to remain in their own communities.

History of ACT

ACT’s community-based approach was a response to changes in mental health care during the 1960s. In 1963, President Kennedy described a new vision for mental health care. His plan would return people with mental illness from state institutions back to their communities. In the decades after he signed the Community Mental Health Act of 1963, hundreds of thousands of patients were discharged from psychiatric institutions. Community mental health centers were built, but they were not able to care for the large number of patients. And former patients were often not able to access services there to begin with.

Treating people in these centers was not working, and by the late 1960s, a new model of community-based outreach had been developed. This model appeared under a variety of names at first, including Community Support Programs (CSP), Mobile Community Treatment (MCT), or Training in Community Living (TCL). Soon, though, they became uniformly known as Assertive Community Treatment.

In the years before this, a common belief had developed that psychiatric institutions actually made patients’ symptoms worse, not better. The original concept for ACT was a response to that. It grew out of a medical, not psychiatric, model of treatment. Patients were expected to “graduate” from the ACT program within a certain time frame (usually, one year). This idea mirrored the treatment of physical symptoms, which were expected to have a definite end point. But early findings showed that putting a time limit on mental health treatment was causing patients to lose any benefits they had initially gained. After that, a long-term model of ACT care was adopted, although the concerns about a lack of timeline for treatment lingered.

ACT Today

In many cases, people with very severe cases of mental illness have had better outcomes from ACT than from standard case management. And for certain outcomes, the ACT model has been widely successful for people with SMI. Such positive outcomes include fewer hospitalizations and less need for emergency housing and medical services. The initially higher cost of ACT compared to other forms of treatment is often offset by these benefits, which reduce costs in the long run.

Success is not universal and depends on many other factors. ACT is most effective when the model is followed as closely as possible. At the same time, it is critical for ACT programs to be open to new and innovative services. The therapeutic relationship between consumers and their care providers is important in any kind of treatment. For ACT, there are still questions about how best to develop that relationship so consumers can benefit the most.

Future of ACT

What are the next steps for the ACT model? The Recovery Model is one mental health treatment that has become more common in office-based care. It is an innovative practice that focuses on each individual’s ability to recover from mental illness or substance abuse. Now, providers have started to look at how the Recovery Model can be useful in ACT. It has been helpful in giving fresh perspective to parts of the ACT model that had not been questioned before. For instance, it helps ACT providers focus more on the defined goals of the “consumer” (as clients are called in the Recovery Model). It also brings up the question of whether peer recovery specialists could improve delivery of ACT treatment.

Beyond the Recovery Model, many questions exist for the future of ACT. Will it continue to shift away from practices that some deem to be paternalistic and coercive practices? Will it move toward a peer recovery model? And will it allow for more active participation by clients? These are issues to explore as ACT continues to evolve.