The Limits of Evidence-Based Medicine and Its Application to Mental Health Evidence-Based Practice (Part Two): Assertive Community Treatment Assertively Reviewed

Abstract

This article is the second of two published in Ethical Psychology and Psychiatry; the first appeared in Volume 15, Number 1. The first article argued the very serious limitations of evidence-based medicine (EBM) and its very popular mental health offshoot evidence-based practice (EBP; Gomory, 2013). This article is meant to be a consolidation and update of a 1999 analysis of Assertive Community Treatment (ACT), the best “validated” mental health EBP according the National Institute of Mental Health (NIMH) and academic researchers. This analysis reconfirms the failure of ACT as a treatment modality and a platform for successfully reducing hospitalization; its touted consistent effect except when ACT can apply administrative coercion to keep its clients out of the hospital or quickly discharge them. When ACT fails to have such administrative coercive control, it does no better than other community mental health delivery systems. The use of ACT coercion begun over 40 years ago, the article further argues, set the table for conventionalizing psychiatric coercion as evidence-based best practice.