Assertive Community Treatment (ACT)

Assertive Community Treatment (ACT) is an inclusive array of community-based rehabilitative mental health services. It is provided primarily to individuals with serious mental illness who have a history of high use of psychiatric hospitalization and/or crisis stabilization, and who often require a well-coordinated and integrated package of services provided over an extended period of time. ACT is a specialized model of treatment/service delivery in which a multi-disciplinary team assumes ultimate accountability for a small, defined caseload of individuals with serious mental illness and becomes the single point of responsibility for that caseload. ACT models vary somewhat between states, specifics to Michigan can be found in the Medicaid Manual or the Michigan Field Guide to ACT.  The key elements of the ACT model (Phillips, et al., 2001) are:

• Services are targeted to a specific group of persons with serious mental illness (currently called ‘consumers’)
• Services are provided directly by the ACT team rather than being brokered as in case management; sometimes specialty services may be obtained by the ACT team for a consumer
• Team members share responsibility for all consumers served by the team
• Staff to consumer ratio is small (ideally 1:10)
• No arbitrary time limit on how long a consumer is served by the team
• Services are available 24 hours a day, 7 days a week (24/7)
• Interventions are provided in the location where the need occurs rather than in the clinic or office
• Treatments and services are comprehensive and flexible
• Treatment and supports are individualized 
• Team members are assertive in engaging individuals in treatment

The goals of ACT are to keep persons with serious mental illness in contact with services in the community, reduce hospitalizations and costs, and improve outcomes, specifically social functioning and quality of life (Marshall & Lockwood, 2003). In accordance with the 2006 Substance Abuse and Mental Health Services Administration's Consensus Statement on Mental Health Recovery, ACT teams provide mental health recovery services that are individualized, holistic, and strengths-based.

ACT consumers are empowered to make decisions regarding their treatment, and given responsibility for their respective recovery journeys!

ACT goals for consumers working toward mental health recovery can include:

• To live independently in a place called home
• To gain an education, whether for career enhancement or personal growth
• To have a job that enhances income, provides a means to make a contribution, or enables recognition
• To have meaningful relationships
• To avoid the spirit-breaking experiences of hospitalization, incarceration or substance abuse

Who is Assertive Community Treatment (ACT) for?

ACT is an intensive mental health service for people who experience the most severe and persistent symptoms of serious mental illness. It is for individuals whose symptoms are difficult to manage, who have frequent episodes of severe symptoms, or in some instances, symptoms that never fully go away.

Because of the severe nature of these symptoms, people often have a lot of trouble taking care of their basic needs, protecting themselves, keeping safe and adequate housing, or staying employed.

Before ACT, people have often spent a lot of time in psychiatric hospitals or living on the streets because of their mental illnesses. They often struggled with drugs or alcohol, or encountered difficulties with the legal system because of their disorders.

How is ACT different than other mental health services?

ACT takes a very personalized team approach to treatment. The ACT team is there to help individuals along their journey toward recovery. There is at least one ACT staff person for every 10 people receiving ACT services. Frequently another person with lived experience, called a Peer, works as part of the ACT team, which works closely with each service recipient. The care is continuous so there isn’t a need to keep ‘breaking in’ new providers, and one or two ACT staff at a time can visit individuals in their homes or in the communities where they live. The whole team is available to each person served, and the care is flexible. If more frequent or more severe symptoms develop, the frequency of visits can be adjusted for increased support.

This means that if someone is experiencing significant symptoms, and is having trouble getting organized to get out and around, or it is just too overwhelmed to make it to the clinic on their own, staff on the ACT team will come to the person in need. The team can help each individual they serve to work toward recovery according to each unique person-centered plan.

ACT services are available for as long as this intensive level of support and care is needed. Individuals are not discharged because of being ‘too difficult’ or ’not making progress.’ The team provides support over the long haul, no matter what.

Areas in which ACT teams provide assistance:

Daily Activities

• Grocery shopping and cooking
• Purchasing and caring for clothing
• Using transportation
• Social and family relationships

Family Life

• Crisis management
• Counseling and psychoeducation for family members
• Coordination with child welfare and family service agencies
• Supporting people in carrying out their roles as parents

Housing Assistance

• Finding suitable housing
• Helping negotiate leases and pay rent
• Purchasing and repairing household items
• Developing relationships with landlords
• Improving housekeeping skills

Financial Management

• Planning a budget
• Troubleshooting financial problems (e.g., disability payments)
• Assisting with bills
• Increasing independence in money management

Counseling

• Oriented toward problem-solving
• Built into all activities
• Goals addressed by all team members
• Includes development of illness-management skills

Health

• Education to prevent health problems
• Medical screening
• Scheduling routine visits
• Linking people with medical providers for acute care
• Sex education and counseling on reproductive health

Medication Support

• Ordering medications from pharmacies
• Delivering medications, if needed
• Educating consumers about medications
• Reminding individuals to take medications
• Monitoring side effects

Employment

• Work opportunities
• Educating employers about serious mental illness
• Helping prepare for employment
• Helping to find and keep employment
• Employment support

Entitlements

• Assisting with applications
• Accompanying consumers to entitlement offices
• Managing food stamps if needed
• Assisting with redetermination of benefits

Substance Abuse Treatment

• Substance abuse treatment provided by the team