The Evidence for ACT

Tip: When reviewing these articles, please note the design of the study, the population that received the services, and how the actual services were provided and documented. ACT works best and is most cost-effective when provided to the individuals for whom it was designed. Similar outcomes can only be expected if the services provided match the services that achieved the documented results. In general, studies have found that the closer the services match the evidence-based ACT model (aka higher fidelity to the evidence-based ACT model), the better the results.

Documented Outcomes of Assertive Community Treatment (ACT) Over Time

Twenty-five years of evidence that Assertive Community Treatment (ACT) improves people’s lives. 1 2 3 The following publications document the types of outcomes experienced by ACT program participants.

  1. Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Management and Health Outcomes, 9(3), 141-159. https://doi.org/10.2165/00115677-200109030-00003

  2. Dixon, L. (2000). Assertive community treatment: Twenty-five years of gold. Psychiatric Services, 51(6), 759-765. https://doi.org/10.1176/appi.ps.51.6.759

  3. Substance Abuse and Mental Health Services Administration. (2008). Assertive community treatment: Building your program (DHHS Publication No. SMA-08-4344). U.S. Department of Health and Human Services. https://library.samhsa.gov/sites/default/files/sma08-4344-buildingyourprogram.pdf

Documentation of ACT Outcomes by Outcome Type

Reduced Psychiatric Hospitalizations

ACT significantly reduces hospital admissions compared with traditional case management. 4 5 6 When implemented as designed for the appropriate population, the high cost of intensive ACT services has been offset by the reduction of hospitalizations, 7 8 and is more cost-efficient than standard case management by the third year of enrollment. 9

  1. Bond, G. R., McGrew, J. H., & Fekete, D. M. (1995). Assertive outreach for frequent users of psychiatric hospitals: A meta-analysis. The Journal of Mental Health Administration, 22(1), 4-16. https://doi.org/10.1007/BF02519193

  2. Dolber, T., Runnels, P., & Pronovost, P. J. (2025). Assertive community treatment for complex and costly patients. The American Journal of Managed Care, 31(7). https://doi.org/10.37765/ajmc.2025.89768

  3. Marshall, M., & Lockwood, A. (2000). Assertive community treatment for people with severe mental disorders. The Cochrane Database of Systematic Reviews, 2, CD001089. https://doi.org/10.1002/14651858.CD001089

  4. Essock, S. M., Frisman, L. K., & Kontos, N. J. (1998). Cost-effectiveness of assertive community treatment teams. The American Journal of Orthopsychiatry, 68(2), 179–190. https://doi.org/10.1037/h0080328

  5. Latimer E. A. (1999). Economic impacts of assertive community treatment: a review of the literature. Canadian Journal of Psychiatry, 44(5), 443–454. https://doi.org/10.1177/070674379904400504

  6. Clark, R. E., Teague, G. B., Ricketts, S. K., Bush, P. W., Xie, H., McGuire, T. G., Drake, R. E., McHugo, G. J., Keller, A. M., & Zubkoff, M. (1998). Cost-effectiveness of assertive community treatment versus standard case management for persons with co-occurring severe mental illness and substance use disorders. Health Services Research, 33(5 Pt 1), 1285–1308.

Reduced Homelessness and Increased Stable Housing

ACT programs reduce the number of days individuals experience lack of shelter. Individuals engaged with ACT services are more likely to be living in stable housing situations. 6 10 11 12 13 14 15 16 17 18

  1. Clarke, G. N., Herinckx, H. A., Kinney, R. F., Paulson, R. I., Cutler, D. L., Lewis, K., & Oxman, E. (2000). Psychiatric hospitalizations, arrests, emergency room visits, and homelessness of clients with serious and persistent mental illness: findings from a randomized trial of two ACT programs vs. usual care. Mental Health Services Research, 2(3), 155–164. https://doi.org/10.1023/a:1010141826867

  2. Korr, W. S., & Joseph, A. (1995). Housing the homeless mentally ill: Findings from Chicago. Journal of Social Service Research, 21(1), 53–68. https://doi.org/10.1300/J079v21n01_04

  3. Lehman, A. F., Dixon, L. B., Kernan, E., DeForge, B. R., & Postrado, L. T. (1997). A randomized trial of assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry, 54(11), 1038–1043. https://doi.org/10.1001/archpsyc.1997.01830230076011

  4. Meisler, N., Blankertz, L., Santos, A. B., & McKay, C. (1997). Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders. Community Mental Health Journal, 33(2), 113–122. https://doi.org/10.1023/a:1022419316396

  5. Morris, D. W., & Warnock, J. K. (2001). Effectiveness of a mobile outreach and crisis services unit in reducing psychiatric symptoms in a population of homeless persons with severe mental illness. The Journal of the Oklahoma State Medical Association, 94(8), 343–346.

  6. Morse, G. A., Calsyn, R. J., Klinkenberg, W. D., Trusty, M. L., Gerber, F., Smith, R., Tempelhoff, B., & Ahmad, L. (1997). An experimental comparison of three types of case management for homeless mentally ill persons. Psychiatric Services (Washington, D.C.), 48(4), 497–503. https://doi.org/10.1176/ps.48.4.497

  7. Shern, D. L., Tsemberis, S., Anthony, W., Lovell, A. M., Richmond, L., Felton, C. J., Winarski, J., & Cohen, M. (2000). Serving street-dwelling individuals with psychiatric disabilities: outcomes of a psychiatric rehabilitation clinical trial. American Journal of Public Health, 90(12), 1873–1878. https://doi.org/10.2105/ajph.90.12.1873

  8. Yuan, Y., & Manuel, J. (2025). Factors associated with housing stability among individuals with co-occurring serious mental illness and substance use disorders receiving assertive community treatment services. Community Mental Health Journal, 61(6), 1007–1016. https://doi.org/10.1007/s10597-024-01443-8

  9. Clausen, H., Ruud, T., Odden, S., Benth, J. S., Heiervang, K. S., Stuen, H. K., & Landheim, A. (2020). Improved rehabilitation outcomes for persons with and without problematic substance use after 2 years with assertive community treatment-A prospective study of patients with severe mental illness in 12 Norwegian ACT teams. Frontiers in Psychiatry, 11, 607071. https://doi.org/10.3389/fpsyt.2020.607071

Reduced Symptoms and Overall Improved Functioning

Clients engaged in ACT program services experience a reduction of negative mental health symptoms 18, improvement in functioning 19 and quality of life. 20 21 When paired with IPS, clients engaged in ACT services show equal 22 or improved 23 24 25 competitive employment and earned income compared with traditional employment or mental health programs.

  1. Kim, T.W., Jeong, J.H., Kim, Y.H. et al. (2015). Fifteen-month follow up of an assertive community treatment program for chronic patients with mental illness. BMC Health Services Research, 15, 388. https://doi.org/10.1186/s12913-015-1058-y

  2. Drake, R. E., McHugo, G. J., Clark, R. E., Teague, G. B., Xie, H., Miles, K., & Ackerson, T. H. (1998). Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: A clinical trial. American Journal of Orthopsychiatry, 68(2), 201-215. https://doi.org/10.1037/h0080330

  3. Vidal, S., Perroud, N., Correa, L. et al. (2020). Assertive community programs for patients with severe mental disorders: Are benefits sustained after discharge?. Community Mental Health Journal, 56(3), 559–567. https://doi.org/10.1007/s10597-019-00513-6

  4. Macias, C., Rodican, C. F., Hargreaves, W. A., Jones, D. R., Barreira, P. J., & Wang, Q. (2006). Supported employment outcomes of a randomized controlled trial of ACT and clubhouse models. Psychiatric Services (Washington, D.C.), 57(10), 1406–1415. https://doi.org/10.1176/ps.2006.57.10.1406

  5. Gold, P. B., Meisler, N., Santos, A. B., Carnemolla, M. A., Williams, O. H., & Keleher, J. (2006). Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness. Schizophrenia Bulletin, 32(2), 378–395. https://doi.org/10.1093/schbul/sbi056

  6. McFarlane, W. R., Dushay, R. A., Deakins, S. M., Stastny, P., Lukens, E. P., Toran, J., & Link, B. (2000). Employment outcomes in family-aided assertive community treatment. The American Journal of Orthopsychiatry, 70(2), 203–214. https://doi.org/10.1037/h0087819

  7. Pogue, J., Lipton, N., Chiang, I., Scannevin, G., Hameed, T., Thorning, H., Margolies, P. (2025). Recovery is working: Piloting individual placement and support with assertive community treatment teams. Psychiatric Services (Washington, D.C.), 76(7), 642-648. https://doi.org/10.1176/appi.ps.20240221

Greater Satisfaction with Services & Support

Research shows clients in ACT services show satisfaction with services and support 26 27 and overall higher rates of engagement. 28 29 30 31

  1. Graham, J., Denoual, I., & Cairns, D. (2005). Happy with your care?. Journal of Psychiatric and Mental Health Nursing, 12(2), 173–178. https://doi.org/10.1111/j.1365-2850.2004.00814.x

  2. Lofthus, A. M., Westerlund, H., Bjørgen, D., Lindstrøm, J. C., Lauveng, A., Clausen, H., Ruud, T., & Heiervang, K. S. (2016). Are users satisfied with assertive community treatment in spite of personal restrictions?. Community Mental Health Journal, 52(8), 891–897. https://doi.org/10.1007/s10597-016-9994-5

  3. Herinckx, H. A., Kinney, R. F., Clarke, G. N., & Paulson, R. I. (1997). Assertive community treatment versus usual care in engaging and retaining clients with severe mental illness. Psychiatric Services (Washington, D.C.), 48(10), 1297–1306. https://doi.org/10.1176/ps.48.10.1297

  4. Pettersen, H., Ruud, T., Ravndal, E., Havnes, I., & Landheim, A. (2014). Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use. International Journal of Mental Health Systems, 8(1), 40. https://doi.org/10.1186/1752-4458-8-40

  5. Priebe, S., Watts, J., Chase, M., & Matanov, A. (2005). Processes of disengagement and engagement in assertive outreach patients: qualitative study. British Journal of Psychiatry, 187(5), 438–443. https://doi.org/10.1192/bjp.187.5.438

  6. Wright, N., Callaghan, P., & Bartlett, P. (2011). Mental health service users' and practitioners' experiences of engagement in assertive outreach: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 18(9), 822–832. https://doi.org/10.1111/j.1365-2850.2011.01733.x