Assertive Community Treatment (ACT) Background

Assertive community treatment (also called PACT, or program for assertive community treatment) is a comprehensive community-based model for delivering treatment, support, and rehabilitation services to adults with severe mental illness.

Assertive community treatment (ACT) originated almost 30 years ago when a group of mental health professionals in Wisconsin realized that many individuals with a severe mental illness were being discharged from inpatient care in stable condition, only to return after a relatively short time. Rather than accept the inevitability of repeated hospitalizations, these professionals looked at how mental health services were being delivered and tried to determine what could be done to help persons with mental illness live more stable lives in the community.

They designed a service delivery model in which a team of professionals assumes direct responsibility for providing the specific mix of services needed by a consumer, for as long as they are needed. The team ensures that services are available 24 hours a day, seven days a week. Rather than teaching skills or providing services in clinical settings and expecting them to be generalized to "real-life" situations, services are provided in vivo-that is, in the settings and context in which problems arise and support or skills are needed.

Team members collaborate to integrate the various interventions, and each consumer's response is carefully monitored so that interventions can be adjusted quickly to meet changing needs. Services are not limited to a predetermined set of interventions-they include any that are needed to support the consumer's optimal integration into the community. Rather than brokering services, the team itself is the service delivery vehicle in the model.

An assertive community treatment team consists of about ten to 12 staff members from the fields of psychiatry, nursing, and social work and professionals with other types of expertise, such as substance abuse treatment and vocational rehabilitation. Although the number of members may vary, the operating principle of the team is that it must be large enough to include representatives from the required disciplines and to provide coverage seven days a week, yet small enough so that each member is familiar with all the consumers served by the team. A staff-to-consumer ratio of one to ten is recommended, although teams that serve populations that have particularly intensive needs may find that a lower ratio is necessary initially. As the consumer population stabilizes, a higher ratio can be tolerated. A lower ratio may be appropriate in rural areas where considerable distances must be covered.

Team members are cross-trained in each other's areas of expertise to the maximum extent feasible, and they are readily available to assist and consult with each other. This team approach is facilitated by a daily review of each consumer's status and joint planning of the team members' daily activities.