IN DEPTH: Assertive Community Treatment History
A group of mental health professionals at the Mendota Mental Health Institute in Wisconsin started Assertive Community Treatment (ACT). They recognized the high rate of readmission for people who were discharged from inpatient care in stable condition, only to return to the hospital soon afterward. This group reviewed how the mental health system worked in order to determine strategies they could use to help people remain in their communities.
One issue that was observed by the group of mental health professionals was that when people left the hospital, the intensity of services available immediately decreased. Even when hospital staff spent concentrated time teaching people skills they needed to live in the community, people were often unable to apply these skills once they were living in the community. Additionally, the stress associated with adjusting to a community setting often left people with serious psychiatric symptoms particularly vulnerable to relapse. Services and supports needed to prevent relapse were difficult to access and were only available for a limited time. Sometimes the services people needed did not exist, nor was anyone responsible for making sure that people received the help they needed to stay out of the hospital.
The group of mental health professionals moved inpatient staff into the community to work with people where they lived and worked. Multidisciplinary teams were created to give people the support needed to continue living in the community. The types of services available and how long these services were provided depended on each person’s unique needs. Experience and knowledge of team members were pooled to ensure that people received the help they needed in an effective manner. ACT team members met daily to discuss how each person was doing, and services were adjusted when necessary. Services were provided 24 hours per day, 7 days per week. As people’s symptoms improved, ACT team members decreased services and supports, but remained available when needed. Since the late 1970s, the principles of this model have remained the same.