Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
Table of Contents Table of ContentsAssertive community treatment (ACT) is a form of community-based mental health care. It is designed to help individuals experiencing serious mental illnesses that interfere with their ability to live in the community, attend appointments with professionals in clinics and hospitals, and manage mental health symptoms.
ACT is designed to deliver mental health services that are person-centered and individualized to address each person's needs.
If you or someone you know has been referred to an assertive community treatment program, you may wonder whether this is the best option and what it will entail. Rest assured that ACT is an evidence-based practice that has been studied for several decades. It has likely been offered to you for specific reasons.
Assertive community treatment takes a holistic approach that offers multidisciplinary care to people experiencing severe mental illness. The goal is to improve functioning and help people in their communities and out of inpatient treatment. Keep reading to learn more about how ACT works and what you can expect from this type of treatment.
The simple definition of assertive community treatment is an intensive, integrated approach to community mental health service delivery. What this means is that mental health services are provided in a community setting (rather than a more restrictive residential or hospital setting) to people experiencing serious mental illness.
The mission of ACT is to help people become independent and integrate into the community as they experience recovery.
Secondary goals include reducing homelessness and unnecessary hospital stays. In this way, ACT offers treatment in the "real world," and the team of professionals provides help using a "whole team" approach.
Many people have symptoms of mental illness that impact their ability to function in daily life and that land them in the hospital emergency department seeking services. ACT aims to reduce this reliance on hospitals by providing round-the-clock services to the people who need it most.
In this way, assertive community treatment could be expected to help to reduce preventable outcomes of mental illness, such as homelessness and substance abuse.
How did assertive community treatment get its start? If you look back to the 1970s, a picture will quickly emerge of a shift away from the institutionalization of patients with severe mental illness. At the same time, community services were poorly set up to help these people who were no longer living in institutional settings.
Leonard I. Stein, Mary Ann Test, Arnold J. Marx, Deborah J. Allness, William H. Knoedler, and other colleagues at Mendota Mental Health Institute in Madison, Wisconsin (a state psychiatric hospital), founded ACT.
When it was first introduced, assertive community treatment was considered a radical approach. Since then, however, it has become one of the most important delivery methods for specific populations of those with mental illness.
Moreover, the National Alliance on Mental Illness (NAMI) has been on board, publishing a manual for ACT in 1998 and operating a training and advocacy center from 1998 to 2004.
If you or a family member has been assigned ACT services, you might wonder why you were chosen to receive this type of service. Below is a list of the most common reasons a person will be offered assertive community treatment services:
Assertive community treatment has been implemented in countries such as the United States, Canada, Australia, and the United Kingdom. For example, specifically in the United States, ACT was implemented across the country by the Department of Veterans Affairs.
Services are not provided in a clinic, but rather in the patient's home, in community locations (such as a coffee shop, restaurant, or public park), in homeless shelters, or wherever is most appropriate and convenient for the person using the service.
If you are about to enter assertive community treatment, you are probably unsure of what to expect. Most ACT programs have similar structures, so the following may give you some guidance on what the program will offer.
When you are doing better, you will be transitioned out of the ACT program. This does not mean you will no longer receive any type of treatment or care; it just means that you can move to a lower level of treatment.
What are the specific services that you can expect to receive from the ACT team? The following is a list of some of the primary services that assertive community treatment offers:
ACT is designed to provide treatment that is not restrictive and accessible. The Assertive Community Treatment Association (ACTA) has developed a number of key principles that guide this form of treatment. These include:
Because ACT is so adaptable, it can be utilized to address a wide range of needs.
Overall, research evidence on assertive community treatment has been positive with some caveats. A 2016 evidence review showed that ACT reduced self-reported psychiatric symptoms, hospital stays, and emergency department visits among people with mental illness and substance abuse.
In general, from the dozens of randomized controlled trials that have been conducted, it can be concluded that ACT is more effective than standard services in reducing hospital use. However, findings for other outcomes are less clear.
While studies have shown improvements in housing, symptom management, and quality of life for ACT, these findings were most evident for people who tended to return to hospitals often.
It has been noted that assertive community treatment may be most helpful in communities that do not have well-coordinated mental health care systems, which results in the overuse of hospitals by those with serious mental illness.
For example, ACT may show better outcomes in the United States than in the United Kingdom, because the former has a poorly coordinated system for mental health care that results in more hospital stays. In contrast, the latter has a well-coordinated system that already includes many aspects of ACT in its standard care.
A 2019 study found that assertive community treatment significantly improved contact with treatment services. For those with serious mental illness, staying in contact with treatment services may play a important role in improving outcomes.
Other research has shown ACT to be more effective than standard care in reducing the risk of hospital stays and incarceration, specifically in poor inner-city neighborhoods, and reducing alcohol use or incarceration among those with antisocial personality disorder.
Furthermore, among the unhoused population, it has been shown that ACT results in more satisfaction with care and more stable housing situations than standard care. This is easy to understand when you consider the ACT model—unhoused individuals who meet service providers where it is convenient for them are more likely to benefit from services than those who must travel to receive help.
Finally, a Cochrane review of 38 clinical trials from the United States, Canada, Europe, and Australia showed that ACT was more effective than standard care in lowering hospital stays and improving social functioning and independent living. At the same time, mental health and quality of life were not shown to improve more than when standard care was offered.
Overall, the research evidence suggests that ACT is most helpful for people with serious mental illness as a method to keep them out of the hospital and in the community.
Another benefit is that the ACT model may also be helpful for reducing burnout among mental health professionals. Despite serving individuals with intensive needs, research has found that ACT case managers report less work pressure and greater job satisfaction.
The shared responsibility that comes from being part of a healthcare team, the abundance of peer support, and clear job roles are possible reasons why those who work in assertive community treatment are less prone to burnout.
It is important to note that assertive community treatment is not without some criticism. One is that ACT is simply a system of coercion in which hospitals deny admission to patients based on their enrollment in the ACT program.
At the same time, isn't staying in the community the goal of all mental health initiatives? Regardless of whether the tactics are coercive, if patients can be treated in the community where they live, tracked through prison and homeless shelters, and offered 24/7 care at their convenience, then the benefits may be worth the drawbacks.
If you have been assigned to receive assertive community treatment services, you may feel nervous about what to expect or what sort of support you will receive. Know that your team will be available to answer questions and offer support to you long-term in the community at locations that serve you best. As a person living with serious mental illness, ACT is an effective long-term support that should serve you well.
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
By Arlin Cuncic, MA
Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.