The assertive community treatment model aims to provide mental health care to individuals with serious mental illnesses that impair their capability to live in the community. When conventional outpatient treatment fails to help an individual with a severe mental disorder, other medicines may be required to provide the best care. Dual Diagnosis patients have a range of treatment choices, but often they need all-encompassing care that addresses more than just the disease and addiction.
Assertive community treatment (ACT) does the same thing as integrated treatment but goes a step further. ACT aids an individual outside of a hospital or recovery facility by combining the interdisciplinary fields of mental illness and drug abuse. People with severe mental illnesses and addictions and those who have not responded well to outpatient therapy in the past could benefit from this method of assertive community treatment.
What You Need to Know About ACT
Every day of the year, assertive community treatment provides highly specialized and personalized care to the client. Professionals with backgrounds in social care, nursing, psychology, drug abuse recovery, and case management are available to the patient 24 hours a day, seven days a week, to assist them in all aspects of their lives. Treatment occurs in the patient’s home or neighborhood, providing a comfort level that many mentally ill people do not receive in conventional inpatient therapy. The aim is to provide thorough care that is as successful as possible.
ACT aims to remove or minimize severe mental illness symptoms while also improving the person’s quality of life.
In effect, when properly applied, ACT will minimize hospital stays and prison time for individuals by teaching coping and life skills when functioning in accordance with the mental disorder. According to reports, states that have adopted assertive community treatment systems have seen substantial decreases in the duration of hospital stays and prison time.
When implemented effectively, ACT programs can reduce hospital stays and prison time by instructing coping and life skills in tandem with mental illness. Studies have shown that ACT programs reduce the length of sentence for individuals with mental illnesses while at the same time reducing the size of jail time as well.
The Program is Very Adequate as Long as it Lasts
Since the early 1980s, scholars in the United States and abroad have paid careful attention to the ACT program. ACT has been shown in many randomized trials to minimize the need for psychiatric hospitalization and emergency medical treatment. Patients who participate in the program are more likely to find jobs, are less likely to be incarcerated, and typically report the assertive community treatment is more successful than other types of community care. ACT also tends to be especially successful for patients who are generally thought to be the most difficult to treat.
In one study conducted by researchers at Mount Sinai School of Medicine and the University of Connecticut, 198 individuals with alcoholism and severe mental illness (dual diagnosis) were tracked over three years in one sample.
Half of the participants were enrolled in assertive community treatment, while the other half were treated as usual. Psychiatric symptoms and alcohol issues increased in both classes, and patients were more optimistic about their lives. On the other hand, ACT was more effective than traditional care management in lowering the risk of hospitalization and incarceration in disadvantaged inner-city communities.
These very same researchers contrasted ACT and standard care treatment effects in subgroups of patients with personality disorders. This disorder raises the risk of drug abuse and criminal justice involvement. They discovered that people with antisocial personality disorder assigned to ACT were less likely to use alcohol or end up in prison than those who received chronic care management. The efficacy of assertive community treatment was also tested in a group of patients with a dual diagnosis by researchers at the University of Missouri.
One hundred ninety-one homeless people received one of three therapies over 30 months: ACT, comprehensive ACT (combining ACT with drug abuse services), or standard care. Patients who received ACT — either as a stand-alone intervention or as part of an integrated program — were happier with their treatment and had more secure living conditions than those who received standard care. However, there were no differences between the groups in terms of psychological symptoms or the seriousness of drug abuse. The authors speculate that one explanation for the intervention’s failure to boost sobriety symptoms was service providers’ inadequate adherence to ACT models.
In 120 patients with schizophrenia spectrum disorders, German researchers assessed the efficacy of ACT. Patients who received assertive community treatment were more likely than those who received standard treatment to improve after a year. They were much more likely to work, live independently, and take medicine. It’s also uncertain if these results will hold up over time. Danish researchers compared the efficacy of ACT with routine community care in more than 500 patients recovering from the first episode of mania.
The goal was to see if early intervention made a difference in long-term outcomes. Those who received ACT had more symptom progress, were more likely to follow treatment recommendations, and were less likely to be homeless or misuse alcohol or drugs after two years of treatment than those who received standard care. However, three years after ACT programs were withdrawn, many of these early achievements vanished. The symptoms, drug abuse rates, and ability to work were identical in both study arms. On the plus side, patients who were initially assigned to assertive community treatment were more likely than the others to live comfortably and were less likely to be readmitted to the hospital.
The Difference Between ACT and Traditional Care
The majority of people in care for severe mental disorders are part of a linkage or brokerage case management network, which links them to services from various mental health, housing, or recovery providers or programs in the community. A person with a mental disorder is handled in this conventional environment by a network of individual case managers who work in a case management program and are solely responsible for their caseloads.
The ACT multidisciplinary team, on the other hand, works as a unit. The ACT team works together to provide the bulk of the care, recovery, and support services that each client requires to remain in the community. A psychiatrist is a member of the team, not a consultant. The customer is a client of the group, not a single employee. The conventional outpatient model, which refers patients to different facilities that they must then handle on their own, is usually inadequate for people with the most severe mental illnesses. ACT responds to the needs of the user whenever and wherever they occur. The patient is not obligated to conform to or obey the care professional’s prescriptive guidelines.
According to the National Alliance on Mental Illness, assertive community treatment services cost between $10,000 and $15,000 per person annually. However, some evidence indicates that the benefits associated with decreased hospitalization or incarceration outweigh these expenses.
ACT services can be found in dozens of American cities and many other countries. Such services are also administered by the United States Department of Veterans Affairs. The National Alliance on Mental Illness and the Surgeon General’s Report on Mental Health strongly advocate ACT. The federal government’s Drug Addiction and Mental Health Services Administration has endorsed it. Medicaid pays for the service in several states.
Assertive community treatment is currently used as a last option for patients who have been repeatedly hospitalized or incarcerated, who have used a large amount of emergency medical and psychological services, who are homeless, addicted to narcotics or alcohol, isolated, chronically unable to meet their basic needs, and who have not responded to conventional case management. While not all patients with mental illnesses need ACT care, some experts believe that the facilities available will only serve a small percentage of those who may benefit. ACT may be a promising option for people with chronic mental illness who aren’t well-served by conventional services, considering the mixed results of research around the world about its benefits.
The Principles of ACT
The Assertive Community Care Association (ACTA) designed specialized tenants for this form of therapy and offered the least invasive and well-rounded treatment for the client.
Primary Service Provider. All Aspects of Care, Including Substance Abuse, Mental Wellbeing, and Vocational Skills, are Covered by Act Practitioners Who are Highly Educated and Knowledgeable.
- Their small professional-to-patient ratio of 1:10 ensures that patients receive the most personalized care possible.
- Care that Takes Place Outside of the Office: Treatment occurs in the person’s home or a local community setting, such as a park or library.
- Treatment Customized to the Client: Person’s disease and addiction are particular. As a consequence, ACT recognizes this and tailors care to the person.
- Long-Term Supports are Available: Staff members are available at all times to assist those seeking care, and they recognize that rehabilitation is a lifetime commitment.
- Expectations in the Workplace: Trained workers facilitate a patient’s work placement and career prospects to teach vocational and life skills.
- Psychoeducational Programs Are Available: Clients are educated about their condition, and they and the practitioner work together to find ways to deal with severe mental illness challenges.
- Support from Family: Families are often affected in ways that we are unaware of. Families are educated about the condition, and support services are provided to make coping with it a little easier.
- Integration of The Culture: Since many comorbid patients are socially disconnected or have difficulty interacting, ACT clinicians work with them on social integration to help them feel more at ease in their surroundings.
Assertive group care could be a reasonable choice if you have a mental condition or a family member or acquaintance with a severe mental disorder. Assertive community treatment could be an excellent fit for your health care needs because it is incredibly adaptable to current mental health services. Foundations Recovery Network is a network of care and rehabilitation centres dedicated to the overall wellbeing and recovery. Please send us a call today at 615-490-9376 to learn more about assertive community treatment.
Ben Lesser is one of the most sought-after experts in health, fitness and medicine. His articles impress with unique research work as well as field-tested skills. He is a freelance medical writer specializing in creating content to improve public awareness of health topics. We are honored to have Ben writing exclusively for Dualdiagnosis.org.