What is ACT?
The evidence based Assertive Community Treatment (ACT) model provides comprehensive, individualized 24/7 assistance to people with severe and persistent mental illness. ACT services are intended to assist an individual in his or her journey toward recovery by helping each participant achieve his/her potential and lead a meaningful life in a community of his/her choosing. King County has two ACT programs:
Individuals are identified at psychiatric hospitals and/or jails by the nature and severity of their illnesses, and are directed into one of these two programs. Carefully crafted eligibility criteria identify the most frequent users of jail and hospitals. Community outreach efforts locate and engage these individuals in services and housing, as needed.
Why do we need ACT services in King County?
In King County, individuals who are mentally ill and homeless are four times more likely to be jailed and three times more likely to be hospitalized than individuals who are mentally ill and have homes. Homelessness is common among people in county jails. Fifty percent of all inmates using King County Jail Health reported they were homeless. Incarceration often results in loss of housing and benefits, separation from treatment, and disqualification for future housing. If legal competence is questioned, the inmate faces prolonged jail stays and hospitalization to resolve this issue. These prolonged stays often result in individuals with mental illnesses staying in jail ten times longer than comparably-charged individuals without a mental illness.
The PACT and FACT models represent a partnership between philanthropy, housing authorities, and public funders. This partnership provides cross-system policy-making, funding, and a collaborative approach to services. Key players from criminal justice, behavioral and medical health, and housing collaborate to help those most likely to cycle through homelessness and institutional confinement. First, they identify and engage these individuals, then provide the intensive services and housing stability needed to prevent further arrests or hospitalizations.
King County has contracts with community-based providers to offer ACT, an evidence-based practice, to up to 230 individuals who are among the most frequent users of psychiatric hospitals and jails. The goal of PACT and FACT is to transform an ineffective and expensive system into one that creates stability for frequent users of the system. PACT and FACT aim to break the "revolving door" cycle of individuals who often end up in the jails or psychiatric hospitals due to their psychiatric conditions and circumstances. PACT and FACT offer psychiatric and mental health services, as well as placing an emphasis on creating housing stability. The ultimate goal of both PACT and FACT is to keep people out of expensive systems of confinement and into services that enable them to stay safely in the community with stable housing and supports.
What are the ingredients of ACT?
Transdisciplinary team approach
Fixed point of responsibility - rather than sending consumers to a variety of providers for assistance, the team provides most, if not all, of the services each participant needs.
Time unlimited - services are provided as long as they are needed.
Flexible services - services are based upon the individual needs/goals of each participant and change as the needs change.
24/7 crisis services
What makes ACT special?
More than 25 research studies demonstrate that ACT reduces hospital stays and improves housing stability while being more satisfactory to consumers and their families than standard care. ACT is one of the six practices endorsed by the "Evidence Based Practice Project" sponsored by the Robert Wood Johnson Foundation, Substance Abuse and Mental Health Services Administration (SAMHSA), National Alliance on Mental Illness (NAMI) and several state and local agencies.
How does ACT help participants?
ACT services are individualized for each participant based upon his/her needs and goals. ACT teams assist participants with housing, employment, sobriety, staying out of the hospital and living more independently. Through a team approach and small caseloads, ACT teams are able to give individual attention to each participant and her/his needs. But the ACT teams do not provide services "to" or "for" the participant. Rather, they work "with" the individual. Each participant is expected to be involved, to the extent they are able, in the plans and efforts to achieve the goals decided upon.
Involvement with ACT is voluntary. Though many individuals with severe and persistent mental illness could benefit from ACT services, ACT is intended to help those who are most disabled by their mental illness or co-occurring disorders and have been hospitalized or incarcerated many times or for long periods of time.