CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 33ASSERTIVE COMMUNITYTREATMENTNATALIE L. DELUCALORNA L. MOSERGARY R. BONDAssertive community treatment (ACT) is an approach to integrated, community-basedcare for people with severe mental illness (SMI) who, for a variety of reasons, may not engagein traditional mental health services. ACT was developed in the 1970s by LeonardStein and Mary Ann Test and their colleagues in Madison, Wisconsin. The original program,Training in Community Living, was later named Program of Assertive CommunityTreatment (PACT). For nearly three decades, PACT has been regarded as a model of exemplarymental health practice. Over that time, service models adopting some PACTprinciples have proliferated worldwide, with a variety of different names, such as the fullservice model, assertive outreach, mobile treatment teams, and continuous treatmentteams. ACT is the most widely used label for programs that share core ingredients withPACT.ACT is not a clinical intervention itself; rather, it is a way of organizing services toprovide concrete help essential for the community integration of clients with SMI. Thisdistinction is important, because it suggests that implementing the structural elements ofthe model alone does not ensure that high-quality clinical interventions will occur; rather,ACT programs must attend to both clinical skills development and the more familiarmodel specifications.Over time, a consensus view of ACT’s critical elements has been established, the majorityof which distinguish ACT from traditional services. ACT relies on a multidisciplinarygroup of mental health professionals who employ a team approach in providing afull range of clinical and rehabilitation services to individuals with SMI living within thecommunity. Furthermore, ACT is designed to treat individuals with SMI who have notbenefited from office-based outpatient treatment. On admission to ACT programs, ACTclients typically have experienced recurring difficulties in successful community living, indicatedby any combination of frequent hospitalizations, incarceration, homelessness,substance abuse, and treatment nonadherence.329