Schizophrenia: What Is Assertive Community Treatment (ACT)?

Medically Reviewed by Smitha Bhandari, MD on June 22, 2024
4 min read

Assertive community treatment (ACT) is a team-directed program that helps people with severe mental illness like schizophrenia. Its goal is to help you live as and where you wish and have stable housing in your chosen community instead of relying on the hospital. It also seeks to ease your family’s burden by making you more independent: ACT’s unified team approach comes to you, rather than the other way around.

The program isn’t the same as acceptance commitment theory, which uses mindfulness strategies to help people with schizophrenia after they leave the hospital.

Assertive community treatment is for people with schizophrenia in their late teens through older ages who have a hard time functioning in their own community. For example, you might have a hard time getting or sticking with a job, managing relationships, or using basic life skills. Also, people with schizophrenia tend to rely on hospitals and crisis services instead of taking part in community-based mental health services.

Other reasons you or a loved one might need an intervention treatment like ACT are:

  • You have co-occurring disorders – conditions that happen together. For example, substance misuse is common with schizophrenia.
  • You need help managing your medications or prescribed treatment.
  • You’ve had brushes with the law (arrested or charged with a crime, or spent time in prison).
  • You’re prone to stress.
  • You might have learning challenges or lack certain life skills.
  • You have a hard time making and getting to appointments on your own.
  • You’ve had bad experiences in the traditional case management system.
  • You don’t understand you need help.

If you’re being treated for schizophrenia, you may have one assigned case manager who refers you to services through a number of mental health, housing, or community rehab programs. But ACT developers believe their program improves on this traditional model in many ways, such as:

  • Various professionals work as a team instead of being outside consultants to each other. You don’t have to look any further than this team for all your needs, from physical and mental care to managing meds, finances, and benefits, to helping you handle community and family matters.
  • People with severe mental illnesses can have a hard time juggling and managing the many services they need on their own. ACT comes to you.
  • ACT doesn’t have to stick to the sometimes rigid rules of a traditional treatment program.
  • ACT doesn’t limit how long you can have services.

ACT services are there to help you every day, around the clock. They visit you several times a week and respond to crises when needed. You choose where visits will take place, such as in your own home, your family’s, or another location.

The ACT team includes mental health professionals with different specialties who treat, support, and provide rehab services. Each team includes a psychiatrist, a nurse, and at least two case managers. Social workers, peer specialists, substance abuse counselors, and people who can help you with employment and career planning may also help, too. You are part of the team and active in your own treatment.

ACT has several key approaches that makes it different, too:

  • Your care team is open-minded to new treatments. They tend to be more willing to try new or different medications, therapies, and crisis response than traditional programs.
  • They teach you new skills to help manage your time and daily lives.
  • They directly support your employment, including volunteer jobs, and help you keep up your education.
  • They offer family members, including your children, support and education.
  • They help you find resources for legal matters, transportation, and housing assistance.

Variations of ACT include forensic assertive community treatment (FACT). It’s geared for people with schizophrenia – or another severe mental illness – who are involved in the criminal justice system.

One study found that while some 89% of people in other treatment programs still spent a lot of time in the hospital, only 18% of people working with ACT did. Meanwhile, those working with ACT who did go to the hospital had much shorter stays.

In a large report that compared treatment methods, researchers found ACT improved outcomes over traditional treatments in several ways:

  • The people studied had better functional outcomes, such as living on their own and being employed.
  • They were less likely to be homeless.
  • They were less likely to stop treatment than people who used standard methods.

Even though ACT has proven successful, few people can access it right now. Only a handful of U.S. states have statewide versions of ACT; 19 states have at least one pilot program.