Assertive community treatment and psychiatric pharmacy

Abstract

Assertive Community Treatment (ACT) is an intensive, community-based psychiatric service developed by a team of researchers at the Mendota State Hospital in Wisconsin. It was initiated during the movement of deinstitutionalization in the 1960s, allowing for an increase in hospital discharges from state operated institutions into community-based programs. The research team derived ACT from the inpatient psychiatric treatment team model and proposed ACT to be a “hospital without walls.” In addition, the research team hypothesized that providing 24-hour mental health services to newly discharged clients would reduce the amount of rehospitalizations and psychiatric symptom relapses. Since its implementation in the 1970s, it has proven to be an extremely effective evidence-based practice that has grown and flourished in the United States, Canada, Australia, and the United Kingdom. ACT teams are multidisciplinary and consist of a psychiatrist, nurses, social workers, peer specialists, vocational specialists, and substance abuse specialists. ACT services are considered more intensive than case management and the majority of services are provided to clients in the community and at their place of residence. One of the core features of this service model is to promote client recovery and independence in all aspects of their life. As seen in the sample daily ACT schedule below (Table 1), treatment is intended to be comprehensive and may include housing assistance, vocational or educational support, assistance with activities of daily living, substance abuse treatment, medication support, and mental and physical health treatment. Crisis intervention is always available and clients have access to an ACT staff member via telephone 24 hours a day.