Does Assertive Community Treatment Reduce the Use of Compulsory Admissions?

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

This study examines substance use disorder (SUD) treatment utilization patterns in response to a pandemic. Retrospective electronic medical record data were collected during three time periods (N = 390): "Pre-COVID-19" (12/02/2019-03/14/2020), "COVID-19" (03/15/2020-06/30/2020), and COVID-19 "Re-entry" (7/01/2020-10/01/2020). Number of visits in each time period, SUD diagnosis, treatment modality (video, telephone, none), demographic, and clinical variables were examined. One-way analyses of variance (ANOVA) and chi-square analyses tested the relationships between treatment modality, demographics, clinical variables, and psychiatric emergency room (PER) visits. Binary logistic regressions examined the effect of treatment modality on PER use during COVID-19 and Re-entry, controlling for alcohol, opioid, and cocaine use disorders, age, and past-year (pre-COVID-19) PER use. Treatment modality was associated with SUD (alcohol, cocaine, opioids), age, and PER visits. Veterans who primarily attended telephone appointments were more likely to require PER services compared to those attending video appointments. In the full model, alcohol use disorder (AUD), past-year PER visits, and treatment modality (telephone visits) continued to be significantly associated with COVID-19 PER use, while past-year PER visits correlated with Re-entry PER use. During COVID-19, veterans whose main treatment modality was telephone were more likely to require PER services than veterans who were seen by video, even after controlling for age, AUD, opioid use disorder, and past-year PER visits. This study is the first to have examined SUD treatment modality utilization patterns in response to COVID-19. Findings suggest that treatment modality during the initial phase of COVID-19 correlated with PER presentation.

This study describes an assertive community treatment (ACT) model in a rural Canadian location and examines characteristics of ACT service users, their degree of satisfaction with ACT, and whether their engagement with ACT resulted in reduced reliance on acute psychiatric services and hospital emergency room use. Chart audits were used to collect demographic and clinical participant data, including days of psychiatric admission and emergency room (ER) visits. Twenty-nine ACT clients agreed to participate. The majority of participants (82.8%) were male and had been diagnosed with schizophrenia or a schizoaffective disorder (65.5%). There was a high rate of concurrent substance abuse (75.9%). The average number of readmission days was reduced from 14 to 0 (p < 0.05) following engagement with ACT, and the average number of visits to ER s was reduced from 3 to 1 (p < 0.05). Participants reported overall high satisfaction with ACT services. Study implications for policy and practice are discussed along with future research recommendations.

Three types of case management were compared to determine their relative effectiveness in helping people with severe mental illness who were homeless or at risk of homelessness. Subjects recruited from a psychiatric emergency room and inpatient units were randomly assigned to one of the three treatment conditions: broker case management, in which the client's needs were assessed, services were purchased from multiple providers, and the client was monitored; assertive community treatment only, in which comprehensive services were provided for an unlimited period; and assertive community treatment augmented by support from community workers, who assisted with activities of daily living and were available for leisure activities. Of 165 subjects recruited, 135 were followed for 18 months. Compared with clients assigned to broker case management, clients assigned to assertive community treatment only and assertive community treatment with community workers had superior outcomes on several variables. They were number of contacts with the assigned treatment program, resource utilization (for example, use of entitlements), severity of thought disorder, activity level, and client satisfaction. Clients in the assertive community treatment only condition achieved more days in stable housing than those in the other two treatment conditions. No significant treatment group effects were found on income, self-esteem, or substance abuse. Assertive community treatment is superior to broker case management in assisting individuals with serious mental illness who are at risk of homelessness.

Adapting the assertive community treatment (ACT) for the needs of different communities: A comparative case study of KUINA ACT Japan and Mt. Sinai ACT Canada

Adapting the assertive community treatment (ACT) for the needs of different communities: A comparative case study of KUINA ACT Japan and Mt. Sinai ACT Canada

Predicting community tenure in patients with recurrent utilization of a psychiatric emergency service

The success of the Program for Assertive Community Treatment (PACT) has led to its replication with different client populations, especially those who are underserved by the traditional treatment system. This paper describes a program in Baltimore that has adapted the PACT model to serve homeless persons with severe mental illness. Although the essential ingredients and philosophy of the original model were maintained, the original team approach has been modified by the use of "miniteams." All staff share knowledge of all program clients through formal mechanisms such as daily meetings; however, each client is assigned to a miniteam composed of a clinical case manager, a psychiatrist, and a consumer advocate. Another deviation from the PACT model is that services can be time limited. The authors describe four phases of treatment and problems, including interventions characteristic of each phase.

Within the context of community care, assertive community treatment (ACT) targeting individuals with severe mental disorders is typically a prolonged endeavor. Despite its extended nature, evidence on the long-term effects of ACT remains limited. This study aimed to assess the long-term effects of ACT services in Japan over 7years by comparing readmission outcomes between the ACT and treatment-as-usual (TAU) groups. This study traced participants from a prior randomized controlled trial (RCT) examining the short-term effects of ACT program in Japan. We assessed their readmission experiences, including the frequency and length (days) of readmissions over 7years through medical record review. Multivariable analyses were conducted to examine outcomes by group. Of the 63 participants tracked for 7years of follow-up (ACT group = 34, TAU group = 29), there were no significant group differences in readmission rate (TAU = 79% vs. ACT = 53%; odds ratio = 0.41, 95% CI = 0.12 to 1.35, p = 0.144) or cumulative days of hospitalization (Β = -75.66, 95% CI = -184.41 to 33.09, p = 0.173). However, the ACT group had significantly fewer hospitalizations (Β = - 1.03, 95% CI = - 1.97 to - 0.10, p = 0.030) than the TAU group. In particular, readmissions in the ACT group substantially decreased at 2years after initial randomization. In the Japanese medical landscape, an ACT program for individuals with severe mental illness might help mitigate the frequency of readmission compared with TAU over the long term. In particular, the pronounced benefits of the ACT program appear to emerge approximately 2years after the start of ACT services. Future research in different countries is needed to confirm the findings of this study, particularly the timing at which the long-term effects of ACT services emerge for various outcomes. The trial was retrospectively registered on 5 August 2025 with the Japan Registry of Clinical Trials (Registration number: jRCT1030250281).

The purpose of this study was to evaluate the effect of two intensive community mental health programs on the suicidality of clients with serious mental illness. Eighty individuals with severe and persistent mental illness were enrolled in this randomized controlled study comparing two models of intensive community support: Assertive Community Treatment (ACT) and Intensive Case Management (ICM). Suicidal ideation and behaviours were measured using the Modified Scale for Suicide Ideation. Study clients underwent comprehensive interviews at baseline and were reinterviewed 9 and 18 months later. The Dartmouth Assertive Community Treatment Scale (DACTS) instrument was used to gain more insight into the specific ACT and ICM program structures and characteristics that provide crisis support and suicide intervention. A chart review of 2 randomly chosen months of service looked at the on-call after-hours pager use of ACT program clients. The ACT intervention was effective in reducing suicidal ideation over 18 months. In addition, the prevalence of suicidal ideation was significantly lower at 18 months in ACT clients versus ICM clients. This is the first study to suggest that ACT may confer some additional benefit in terms of reduced suicidality in clients with severe and persistent mental illness.

Assertive Community Treatment and the Physical Health Needs of Persons With Severe Mental Illness: Issues Around Integration of Mental Health and Physical Health

Gender, diagnosis and involuntary psychiatry admission in Ireland: A report from the Dublin Involuntary Admission Study (DIAS)

The relationship between quality of life and employment status for individuals with severe and persistent mental illness was investigated. Forty individuals in the Program for Assertive Community Treatment (PACT) participated in the study. PACT is a community-based program for persons with severe and persistent mental illness which emphasizes the importance of employment in rehabilitation. Participants were interviewed using Lehman's Quality of Life Interview. A large effect size for difference between individuals who were employed and those who were unemployed was found for assessment of global quality of life. Medium and small effect sizes were found for satisfaction with family, financial situation, health and social relations, safety, and daily activities. Minimal effect size was found for satisfaction with living situation.

This article discusses economic considerations associated with evidence-based practices for people with severe mental illness that involve grouping treatment and rehabilitation staff into a single team. The article includes a brief review of the evidence and arguments that both assertive community treatment and supported employment are effective in promoting recovery, as well as having other favourable outcomes. In terms of cost, assertive community treatment appears to allow flexible deployment of resources such that the number of days in hospital is reduced, which means that in many cases this form of treatment pays for itself. Evidence for a similar cost offset with supported employment is much more limited. Even when such practices increase overall costs, they appear to be more costeffective than the alternatives with which they have been compared. Consideration of these findings together suggests that improved synthesis and use of individual-level clinical information, which are more easily achieved by a team, are key to more cost-effective service delivery for people who need the expertise of different kinds of professionals.