Assertive Community Treatment (ACT)

Assertive Community Treatment (ACT) is provided by community-based, mobile mental health treatment teams. The ACT team approach is designed to provide comprehensive psychiatric treatment, rehabilitation, and support to persons to live independently in the community. Individuals typically served by ACT teams are those with serious and persistent mental illness or personality disorders, with severe functional impairments, who have avoided or not responded well to traditional outpatient mental health care and psychiatric rehabilitation services. Persons served by ACT often have co-existing problems such as homelessness, substance abuse problems, or involvement with the judicial system. This model began in the late 1960’s, noting that the gains made by clients in the hospital often did not transfer to the community, it was hypothesized that the hospital’s round-the-clock care that helped clients lessen their symptoms of mental illness was just as important after discharge. ACT re-conceptualizes the type of services needed by persons with severe mental illnesses to live in the community and the way in which services are organized and delivered to reach them in a timely manner. ACT has proven (1) to decrease the time persons with severe and persistent mental illness spend in hospitals and (2) to facilitate the community living and psychosocial rehabilitation of these individuals.

The Team Approach

Inspiring Lives provides a multidisciplinary mental health ACT team organized as accountable, mobile services. The team is the single point of clinical responsibility and is accountable for assisting the person served to meet his or her needs and to achieve his or her goals for recovery. The ACT team function interchangeably to provide the treatment, rehabilitation and support services that persons with severe mental illnesses need to live successfully in the community. The primary goals of ACT treatment are

• To lessen or eliminate the debilitating symptoms of mental illness each client experiences and to minimize or prevent recurrent acute episodes of the illness
• To meet basic needs and enhance quality of life
• To improve functioning in social and employment roles and activities
• To increase community tenure
• To lessen the family’s burden of providing care

Having one team provide all key services minimizes the “fragmentation” and time-consuming coordination characteristic of traditional mental health systems in which there are multiple agencies and programs, each addressing only part of a client’s needs for housing, employment services, or therapy. With the same team providing both “treatment” and “rehabilitation” services, the complex interaction of symptoms and psychosocial functioning can also be more efficiently and effectively addressed across time.

Services Provided Out of Office

The majority of ACT’s treatment and rehabilitation interventions take place in the community, that is, in the client’s own residence and neighborhood, at employment sites in the community, and in the same places most people spend their leisure time. This mobile approach minimizes dropout of clients, enables the provision of psychosocial services wherever clients need to use them, and eliminates the need for transfer of learning from a clinical setting to a community setting.

Highly Individualized Services

Individualization of treatment across clients and across time is fundamental to the ACT model given the great diversity among persons with severe mental illnesses and the fact that both clients and psychiatric conditions change. Treatment interventions are tailored to address the current needs and preferences of each individual. The ACT team works to adapt the environment and themselves to meet the client’s needs rather than requiring the client to adapt to or follow the rules of the treatment program. Services vary in intensity based on the needs of the clients. Desired outcomes specific to ACT services may include positive change in the following areas: independent living, functioning in work and social domains, community integration, psychological condition, subjective well-being, and the ability to manage his or her own healthcare. The ACT team provides assistance to clients to maximize their recovery, ensure individual-directed goal setting, and assist the individual served to gain hope and a sense of empowerment.

Continuous Mobile Services

ACT services are delivered in a continuous rather than time-limited framework. Clients vary greatly in their course of illness. Effective treatment and rehabilitation provided in a coordinated and continuous manner can have positive impact on the course of mental illness so that episodes are less frequent and prolonged functioning between episodes is improved.