Mental Health Gets Its A.C.T. Together

At the Mendota Heights Mental Health Institute (Madision, Wisonsin) in the 1970s, mental health professionals observed that persons discharged to the community, following treatment in a hospital, returned multiple times to the hospital over the years. This phenomena was called, “the revolving door.”

At the Mendota Heights Mental Health Institute, Len Stein, Mary Ann Test, Arnold J. Marx, William H. Knoedler and Deborah J. Allness devised a model of care to disrupt “the revolving door”: the model was called Assertive Community Treatment. Assertive Community Treat or A.C.T., in essence, brings treatment to where the person is living: an apartment, supported-living environment, homeless shelters. They found that treatment interventions needed to be extended into the community in order to strengthen gains made in the hospital.

The Assertive Community Treatment team generally consists of a psychiatrist, team leader, nurses, rehabilitation specialists or generalists, vocational rehabilitation specialist, and a chemical dependency counselor. The idea is to integrate the strengths of the team with a level and frequency that fits the person’s needs at the time.

For example, a person with schizophrenia may need help with medicine adherence. As a result, the A.C.T., team can either bring medicines to the person a number of times a week and do “eyes on meds.” This intervention will reduce the risk of stopping medicines and subsequent risk of symptoms returning. The number of visits each week can be adjusted based on the benefits and outcome.

Another advantage of A.C.T., services is that the team is much more responsive and efficient than traditional services in mitigating a crisis. Since the A.C.T., team is in contact with clients on a routine basis, the team is more sensitive to changes in behaviors. And as a result, the A.C.T., team can adjust their schedule of visits to meet the person’s needs during those critical periods. This may include an unscheduled contact with the team’s psychiatrist.

A.C.T. has another advantage: the team can continue to work with the person for an extended period of time, thereby strengthening gains the person has made in their recovery. This ability to maintain a long-term relationship results in a strong working-knowledge by the team of the person and a sense of confidence by the person that things aren’t going to fall apart again.

A.C.T. teams cover both metro and rural areas. Some of the teams are linked to local mental health centers. In 2005, I was a member of the Great River A.C.T., team in Monticello, MN., which was connected to Central MN. Mental Health Center from St. Cloud, MN. In Willmar, Woodland Centers maintains an A.C.T., team that serves the surrounding area, helping persons with severe mental illness live in their communities.

The model of care designed by the pioneers at Mendota Heights Mental Health Institute in the 1970s has solved the “revolving door” problem. And today, A.C.T., is recognized  as an “evidenced-based” practice. The benefits to persons with mental illness have been shown, under scientific scrutiny, to work.

You can learn more about accessing an A.C.T., service in your area by contacting your county social services or local mental health center. For more information about A.C.T. check out this link:

And until next time, treat yourself and others with kindness, it’s good for the brain.

4 Responses to “Mental Health Gets Its A.C.T. Together”

  1. D.J.Benwa says:

    Act has been a tremendous blessing to our clients in the community as it is very important that they not feel abandoned once they are discharged from an inpatient setting.
    Making a connection and offering consistent support has greatly reduced the amount of re-hospitalizations, thereby reducing disruptions to employment, housing, etc….etc.
    Our psychiatrist makes house calls to many of our clients and that to has made a very positive impact on their self-worth.
    The whole concept of ACT is currently playing a very vital role in our clients ability to stay independent in the community, as well as preventing them from relapses in their symptoms.

  2. Randall Wehler says:

    Mr. Thibault, your informative and well-written article on the A.C.T. programs underscores a reality in mental illness — that recovery is an on-going process and successful as long as well-matched supports are there to meet unique needs. Please continue to inform our community what else is “out there” to help people.

  3. Patrick Thibault says:

    Hi Mr. Wehler,

    Thanks for emphasizing that “recovery” is an ongoing process and relies on a number of factors, especially matching the right help at the right time. I plan to introduce more about the variety of services available in future posts, such as psychologists, counselors, vocational rehabilitation specialists. Thank you!

  4. Patrick Thibault says:

    Thanks for your informative response. The service really has impacted persons with mental illness. Your comment that breaking the cycle of hospitalization allows the person to achieve some level of stability as defined by employment, housing underscores A.C.T.’s effectiveness and importance to the mental health system.

    Continued success in your work and look forward to any additional comments you might have about mental health services or other relevant topics.