Techniques Used by Assertive Community Treatment (ACT) Teams to Encourage Adherence: Patient and Staff Perceptions

Abstract

Assertive community treatment (ACT) has become a cornerstone of care for people with serious mental illnesses. But it has also been suggested that ACT is an inherently coercive approach, with a variety of techniques, including leverage, frequently employed to encourage treatment adherence. Staff and patients of 4 ACT teams participated in focus groups exploring their experiences with and opinions about the use of these techniques in ACT. Little evidence was found of significant use of leverage or perceptions of coercion. Instead both groups reported that supporting patients and building relationships were the preferred mechanisms for promoting treatment goals. This study suggests that ACT need not appear to either staff or patients as an intrinsically coercive model for the delivery of mental health services.

Perceptions of Coercion in the Community: A Qualitative Study of Patients in a Danish Assertive Community Treatment Team

“…This is worth mentioning since all patients had been heavy users of psychiatric services for an average of 12 years, while included in the AT team for only 1 year. This supports the few other studies on patients' experiences of ACT which correspondingly reveal that, contrary what critics claim, patients in ACT generally value the availability and active and persistent approach by case-managers [2,10,11,13].…”

“…However, critics question the ethics of this persistence of ACT to reluctant patients and accuse it of being paternalistic and coercive [2][3][4][5][6]. ''Is treatment that won't go away ethical?''…”

Characteristics of Community Mental Health Clinics Associated With Treatment Engagement

“…The survey comprised 16 questions assessing the types of services offered at the clinic, clinic office hours, location, and transportation questions. These questions were culled from past studies on clinic characteristics that were associated with treatment engagement (3)(4)(5). Data were either provided by each site's principal investigator or collected by a trained clinic staff research assistant over the phone.…”

“…For example, several authors have noted that certain clinic characteristics have a role in improving engagement of mental health clients. These characteristics include assertive outreach (4,5), case management (5), provider-client match in ethnic background and language spoken in the clinic visit (4), flexible hours (4), and transportation support (6). Most of this research has been largely theoretical, qualitative, or based on single clinic samples (4,6), with few studies examining the effects of these characteristics on treatment utilization across different community clinics.…”

Understanding the Role of Individual Consumer–Provider Relationships Within Assertive Community Treatment

“…Consumers have consistently identified the therapeutic or helping relationship with providers as being the most critical ingredient of case management and ACT (Appelbaum and Le Melle 2008;Mueser et al 1998;Redko et al 2004;Solomon et al 1995). Moreover, the working alliance has been positively correlated with an array of clinical outcomes (Howgego et al 2003).…”