Is Assertive Community Treatment Ethical Care?
AbstractETHICS Editor: Edward M. Hundert, MD Is Assertive Community Treatment Ethical Care? Jeffrey Stovall, MD Assertive Community Treatment (ACT) has emerged as the leading community-based treatment for individuals with severe and persistent mental illness. In recent years, initiatives from advocacy groups,1 public agencies,1 and insurers2 have pushed community-based providers to develop treatment teams based on the ACT model of care. Research3,4 has shown the effectiveness of ACT in decreasing hospital admission rates, reducing hospital lengths of stay, and increasing community tenure for individuals with chronic mental illnesses. ACT may well be the best-investigated nonpharmacological treatment for this population. However, only limited research and discussion have focused on the unique ethical issues arising in the practice of ACT. This article brieï¬y reviews ACT and presents the generally accepted ethical standards that apply to all medical care. It employs clinical vignettes to highlight points of potential collision between ACT and current ethical standards and attempts to provide resolution of these conï¬icts. WHAT IS ASSERTIVE COMMUNITY TREATMENT? As originally developed and implemented in Madison, Wisconsin, ACT is characterized by community-based in vivo interventions, the ability to provide rapid and intensive responses, and the assumption of continuous, long-term, and full clinical responsibility