Mental Health Nursing

100 Acute Mental Health Nursing
Table 5.3 Essential elements of assertive community
treatment (ACT)
Organisation and delivery of services
1. Core services team
(a) Fixed point of responsibility
(b) Primary provider of services
(c) Continuity of care and caregivers across time and functional areas
(d) Low client-to-staff ratios
2. Assertive outreach and in vivo treatment
3. Individualised treatment
4. Ongoing treatment and support
Treatments and services provided
1. Direct assistance with systems management
(a) Medications
(b) 24-hour crisis availability
(c) Brief hospitalisation
(d) Long-term one-to-one clinical relationship
2. Facilitation of an optimally supportive environment
(a) Assistance with meeting basic needs
(b) Assistance with a supportive social environment
(c) Assistance with a supportive family environment (psychoeducation)
3. Direct assistance with instrumental functioning (work, social relations, activities of daily
living)
(a) In vivo skills teaching
(b) In vivo support
(c) Environmental modification
Desired patient outcomes
1. Reduced symptomatology and relapse
2. Increased community tenure
3. Enhanced satisfaction with life
4. Less subjective distress
5. Improved instrumental functioning
(a) Employment
(b) Social relations
(c) Activities of daily living
Adapted from M.A. Test (1992) ‘Training in community living’, in R.P. Lieberman (ed.),
Handbook of Psychiatric Rehabilitation. New York: Macmillan.
member of the treatment team (Deci et al., 1995). ACT teams function
as continuous care teams who work with patients with serious mental
illness and their families over time to improve their quality of life.
In effect, these programmes function as a community-based ‘hospital