Assertive community treatment (ACT)

Assertive community treatment (ACT) is an intensive, team-based model of community mental health care designed to provide comprehensive treatment for individuals with severe and persistent mental illness. ACT depends on a multidisciplinary team of social workers, a psychiatric prescriber, nurses, mental health professionals, peer specialists, and case managers who work together. ACT and similar treatment programs aim to give patients access to many types of care at any time—twenty-four hours per day, seven days per week. This model of care is meant to reduce the number of hospitalizations patients need and the amount of care that other people, such as family members, have to provide for patients with severe mental illnesses. The ACT method of care is undertaken by a team of professionals with various backgrounds who work together to provide comprehensive care beyond the medical care most patients receive under other models.

Background

ACT was developed in the 1960s in Wisconsin. A group of doctors—including Arnold Marx, Leonard Stein, and Mary Ann Test—noticed that patients who received inpatient mental health services often responded very well to treatment. However, many patients experienced relapse or deterioration in functioning following hospital discharge due to a lack of continuity in care. Their mental health diminished when they had only outpatient mental health services. The doctors noticed that many patients, especially those with the most serious mental health conditions, would be hospitalized many times for the same issue. The doctors believed they could develop a new mental health service model, allowing more patients to stay well while still living in the community. They believed patients did better in a hospital setting because care and social support were available twenty-four hours per day. These doctors created an ACT model of care to help patients who required more access and many interventions in daily life.

Before ACT and other psychosocial treatments were common, many medical professionals used a case management model of care. In this model, patients who require mental health services visit various medical professionals for each symptom or condition that needs treatment. Often, however, the care individuals receive in this model is not integrated, meaning providers do not work together to understand all the different medical interventions a person is receiving. Although some patients benefit from the case management model, psychiatrists have found that some patients, especially those with the most serious conditions, benefit more from integrated care provided by various professionals with different backgrounds and specialties.

Overview

ACT programs are sometimes called Programs of Assertive Community Treatment (PACT), assertive outreach, or continuous treatment teams. ACT programs are generally implemented by ACT teams, who work together to provide integrated care for patients. Since an ACT team needs to fill many needs for many types of patients, an ideal ACT team has professionals from different fields and various backgrounds. Most ACT teams have a psychiatrist. Other professionals on such teams usually include an employment specialist, a substance use specialist, a psychiatric nurse, and other mental health professionals. The team communicates every day about the status of the patients they care for. Usually, ACT teams care for fewer patients than the same number of professionals using a case management model would care for. With fewer patients, however, an ACT team can focus more fully on the patients under its care. Studies have shown that even though ACT models of care have a higher up-front cost, it can offset some of those costs because they reduce hospitalization and incarceration, which are common among people who have severe mental health conditions.

Another important aspect of ACT programs is that most medical care is provided by the core team so that the patient does not have to be referred to an outside provider. In the case management model of care, one worker might refer their patients to many other professionals. In the ACT model, the team members provide most mental health medical care so they can coordinate with one another. This is effective because all the medical care is integrated rather than carried out by many professionals who do not communicate with one another. Developments show that ACT models are increasingly being integrated with broader healthcare systems, including patient-centered medical home approaches, to improve care coordination.

Medical professionals involved in an ACT program often are very involved in their patients’ lives. Team members may assist with daily living skills, care coordination, medication adherence, and accessing community resources. These team members also do many tasks that ensure patients have necessities of everyday life, such as housing and healthcare. The team members take on these tasks because they realize that improving mental health often depends, at least in part, on a patient having a stable place to live and having other basic needs met.

Studies have examined the effectiveness of ACT models of care, and many have shown that patients have better outcomes in several areas, including maintaining stable housing, finding employment, and attending healthcare appointments. Other research indicates that ACT programs can help reduce hospital readmissions and improve an individual’s quality of life. Longer-term treatment may yield the best benefit. Although ACT models of care can be very effective, they are resource-intensive and best reserved for individuals with high service needs who do not respond well to traditional outpatient treatment. Patients who actively seek out mental healthcare, take medications, and attend medical appointments regularly generally do not benefit from the comprehensive care of an ACT team. ACT models of care are most effective for patients who have the most severe mental health conditions and for whom everyday tasks, such as maintaining a job and taking medication, might be difficult. For example, patients with mental health conditions such as schizophrenia and mood disorders with psychotic features may benefit from an ACT model of care because they may not realize that they have health conditions and, therefore, might not seek or accept treatment. Research suggests that ACT models are increasingly being adapted for medically complex, high-cost patients with multiple health and social needs, not only for severe mental illness.

Bibliography

“Assertive Community Treatment (ACT): Process, Technique, Usages, Efficacy and Limitation.” Bright Path, 26 Jun. 2025, www.brightpathbh.com/mental-health/assertive-community-treatment. Accessed 24 Mar. 2026.

“Assertive Community Treatment.” CARF International, www.carf.org/Programs/ProgramDescriptions/BH-Assertive-Community-Treatment. Accessed 24 Mar. 2026.

“Assertive Community Treatment.” Center for Evidence-Based Practices, Case Western Reserve University, case.edu/socialwork/centerforebp/practices/assertive-community-treatment. Accessed 24 Mar. 2026.

“Assertive Community Treatment.” Cleveland Clinic, 15 Apr. 2024, my.clevelandclinic.org/health/treatments/assertive-community-treatment-act. Accessed 24 Mar. 2026.

“Assertive Community Treatment Program.” Health and Human Services, Office of Inspector General, oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000228.asp. Accessed 20 Mar. 2025.

Bond, Gary R., and Robert E Drake. “The Critical Ingredients of Assertive Community Treatment.” World Psychiatry, vol. 14, no. 2, 2015, pp. 240–42.

Cuncic, Arlin. “The Basics of Assertive Community Treatment.” VeryWell Mind, 8 May 2024, www.verywellmind.com/assertive-community-treatment-4587610. Accessed 24 Mar. 2026.

Dolber, Trygve, et al. “Assertive Community Treatment for Complex and Costly Patients.” The American Journal of Managed Care, vol. 31, no. 7, 1 July 2025, pp. e173–75, doi:10.37765/ajmc.2025.89768. Accessed 24 Mar. 2026.

Drake, R. E. “Brief History, Current Status, and Future Place of Assertive Community Treatment.” American Journal of Orthopsychiatry, vol. 68, no. 2, 1998, pp. 172–75.

Lesser, Ben. “What Is Assertive Community Treatment?” DualDiagnosis, 3 Mar. 2024, dualdiagnosis.org/co-occurring-disorders-treatment/assertive-community-treatment. Accessed 24 Mar. 2026.

“Psychosocial Treatments.” National Alliance on Mental Illness, www.nami.org/learn-more/treatment/psychosocial-treatments. Accessed 24 Mar. 2026.

“Research.” UNC Institute for Best Practices, University of North Carolina School of Medicine, 14 Oct. 2025, www.med.unc.edu/psych/cecmh/unc-institute-for-best-practices/assertive-community-treatment-act/research/. Accessed 24 Mar. 2026.

Ruud, Torleif, et al. “Clinical Outcomes and Outcome Predictors of Two-Year Assertive Community Treatment in Norway: An Explorative Prospective Pre–Post Study.” BMC Psychiatry, vol. 24, 2024, doi:10.1186/s12888-024-06181-5. Accessed 24 Mar. 2026.