Harvard Mental Health Letter

Assertive community treatment

In the mid-1970s, as the exodus of patients from state mental hospitals accelerated, mental health professionals in Madison, Wisconsin, developed a new approach to helping the mentally ill cope with life on the outside. More popular than ever, this method is receiving systematic attention from researchers, while variations on the basic model are explored. This form of intensive case management is called assertive community treatment (ACT).

A team of professionals, including a psychiatrist, nurse, social worker, drug abuse and employment counselors, and others, work with severely mentally ill patients. Ten to 12 staff members are responsible for 100 to 120 patients, coordinating their care and providing services for most aspects of their lives.

The ACT team may plan and monitor treatment, accompany patients to medical and dental appointments, represent them in hearings, and help them budget, pay bills, and apply for entitlements. Patients also receive help with housekeeping, shopping, cooking, the use of transportation, finding and keeping jobs, and housing. Team members educate the patients about mental illness, provide drug abuse counseling, and help patients cope with psychotic episodes and other psychiatric crises. They may order, deliver, and supervise the use of medications. A patient who is depressed and suicidal after a psychotic episode might be persuaded to accept medication and supportive psychotherapy. An isolated patient who will not let a stranger touch him might let the team nurse change a dressing on a wound.

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