scholarly journals A visitor's view of Madison's Program for Assertive Community Treatment (PACT)

1989 ◽  
Vol 13 (7) ◽  
pp. 352-355 ◽  
Author(s):  
M. Muijen ◽  
G. McNamee

Before commencing work on the Daily Living Programme at the Maudsley Hospital, in London, to compare the benefits of community care with standard hospital admission for patients with serious mental illness, a visit to Madison was arranged, where some ten years ago a similar study had been carried out (Stein & Test, 1980). We had the impression from the substantial literature which has appeared on the mental health service in Madison (Stein & Test, 1985) that they have implemented in practice their positive research findings on community care. It was felt that their lengthy experience with such a service could be beneficial to the UK, where such services are now being developed. This visit included PACT (Program for Assertive Community Treatment); a research programme investigating the long-term prognosis of mainly schizophrenic patients, and the various units of the mental health services in Madison.

2007 ◽  
Vol 56 (3) ◽  
pp. 208-218 ◽  
Author(s):  
Louise de França Machado ◽  
Catarina Magalhães Dahl ◽  
Maria Cecília de Araújo Carvalho ◽  
Maria Tavares Cavalcanti

OBJETIVO: Realizar uma revisão de estudos sobre programa de tratamento assertivo na comunidade (PACT) e case management para verificar se os resultados demonstram desfechos mais favoráveis quando tais modelos são implementados na rede comunitária de assistência para portadores de doença mental grave e persistente. MÉTODOS: A coleta de artigos - publicados entre 1985 e 2005 - foi realizada em duas etapas: a primeira, na base de dados PubMed, com expressões-chave mental health, community care, services evaluation e seleção de artigos cuja temática era PACT e case management, e a segunda, no banco de dados da revista Psychiatric Services, com palavras-chave assertive community treatment, PACT e case management. Foram desconsiderados estudos que analisavam serviços exclusivos para crianças, idosos e pacientes com diagnóstico único de abuso de álcool/drogas; abordavam unicamente os custos da intervenção e se referiam exclusivamente a serviços hospitalares. RESULTADOS: A partir da leitura dos 73 estudos selecionados, os autores descreveram oito categorias nas quais os artigos foram agrupados, visto que um artigo poderia pertencer a mais de uma categoria. CONCLUSÕES: O PACT e o case management são estratégias importantes e reconhecidamente mais eficazes, quando comparados a outros modelos de cuidado, em trazer evoluções favoráveis para indivíduos com doença mental grave e persistente.


1999 ◽  
Vol 174 (4) ◽  
pp. 346-352 ◽  
Author(s):  
Anthony F. Lehman ◽  
Lisa Dixon ◽  
Jeffrey S. Hoch ◽  
Bruce Deforge ◽  
Eimer Kernan ◽  
...  

BackgroundHomelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed.AimsTo evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland.MethodsA total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed.ResultsCompared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0. 58 in favour of ACT. Patterns of care and costs varied according to race.ConclusionACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.


Psych ◽  
2021 ◽  
Vol 3 (4) ◽  
pp. 792-799
Author(s):  
Vaios Peritogiannis ◽  
Fotini Tsoli

The Assertive Community Treatment (ACT) model of care has been long considered to be effective in the management of patients with severe mental illness (SMI) in most Western countries. The implementation of the original ACT model may be particularly challenging in rural and remote communities with small and dispersed populations and lack of adequate mental health services. Rural programs may have to adapt the model and modify the ACT fidelity standards to accommodate these limitations, and this is the rationale for the introduction of more flexible, hybrid ACT models. In rural Greece, the so called Mobile Mental Health Units (MMHUs) are well-established community mental health services. For patients with SMI that have difficulties engaging with treatment services, the new hybrid ACT model has been recently launched. The objective of this manuscript is to present the recently launched hybrid ACT model in rural areas in Greece and to explore the challenges and limitations in its implementation from the experience of a team of mental health professionals with ACT experience. Referral criteria have not been strictly set, but the number of previous relapses and hospitalizations is taken under consideration, as well as the history of poor treatment adherence and disengagement from mental health services. The main limitation in the implementation of the hybrid ACT service is that it has been introduced in several areas in the absence of a pre-existing community mental health service. This may impact referrals and limit focus on the difficult cases of patients with SMI, thus making the evaluation of the model inapplicable.


Medical Law ◽  
2019 ◽  
pp. 351-419
Author(s):  
Emily Jackson

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter discusses mental health law in the UK. It begins with a brief history of mental health law and policy. This is followed by discussions of: admission to the mental health system; treatment of the mentally ill under the Mental Health Act 1983; Deprivation of Liberty Safeguards (DoLS) and Cheshire West, and Community Treatment Orders. It also looks at the implications of the Human Rights Act and the UN Convention on the Rights of Persons with Disabilities (UNCRPD) for mental health law. It also considers the conclusions of the Independent Review of the Mental Health Act 1983.


2019 ◽  
Vol 64 ◽  
pp. 230-237 ◽  
Author(s):  
Jim Campbell ◽  
Gavin Davidson ◽  
Pearse McCusker ◽  
Hannah Jobling ◽  
Tom Slater

2008 ◽  
Vol 17 (2) ◽  
pp. 110-114 ◽  
Author(s):  
Sonia Johnson

AbstractThe usefulness of Assertive Community Treatment (ACT) in European countries with well-developed community care systems has been disputed, despite considerable relevant literature. This paper aims to assess reasons for and against implementing ACT in such countries. ACT may not be useful where generic community mental health teams are not yet well-developed, where admission rates are already low, or where an alternative model based on close integration of a full range of types of care is in place. Good reasons for introducing ACT include listening to patients' preferences, being able to monitor a high risk group of patients more successfully, good staff satisfaction, and the potential for using ACT teams as a platform for delivering interventions for difficult to treat psychosis. The ACT model is more likely to thrive in future if a recovery orientation can be adopted.


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