Assertive community treatment

Domain V · Systemic, relational, group & community · Mary Ann Test, Arnold Marx, Leonard Stein · 1972 · Madison, Wisconsin

What it is

Assertive community treatment (ACT) is a service delivery model, not a single psychotherapy. A transdisciplinary team of about 10–12 staff takes on around 100 adults with severe and persistent mental illness and the greatest functional difficulties. It acts as their fixed point of responsibility,…

Format

• ACT has no session count. The "dose" is set at team level. The TMACT standard is an average of at least 3 face-to-face contacts and at least 2 hours of face-to-face contact per client per week, with at least 75% of contacts in the community. Each client should see at least 3 different staff members…
• Team format (prerequisites for every phase)

Who practises it, and how they are trained or regulated

• Core team: a full-time team leader who also practises; a psychiatric care provider (at least 0.8 FTE per 100 clients); at least 2.85 FTE registered nurses per 100 clients; and a full-time program assistant.
• Assertive community treatment (ACT) is a service delivery model, not a single psychotherapy. A transdisciplinary team of about 10–12 staff takes on around 100 adults with severe and persistent mental illness and the greatest functional difficulties. It acts as their fixed point of responsibility, delivering nearly all treatment, rehabilitation and practical support itself, mostly in the person's home and community,…
• This guide is written for a clinician joining or working with an ACT team, such as a team psychologist or therapist, team leader, nurse or specialist, or a referring therapist. The model is not proprietary and no single licence is required. In the US, however, state mental health authorities and payers usually certify ACT teams and require periodic fidelity review (DACTS or TMACT) before services can be billed as…

Evidence status, as the guide reports it

• Version followed: the US ACT model as now specified by the Tool for Measurement of ACT (TMACT, Version 1.0, Revision 3, 2018; Monroe-DeVita, Moser & Teague) for team structure and fidelity standards, with day-to-day team procedures taken from the SAMHSA/CMHS Implementing Evidence-Based Practices…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Curriculum content belongs to IMR and WRAP; see their own manuals.
• Advocacy that speaks for the person when they could speak for themselves.
• "Supportive chats" counted as therapy. TMACT's protocol defines what counts.
• Housing that is conditional on treatment compliance, which does not meet EP8.
• A drift back to office or clinic appointments, which is a common fidelity slide.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.