International Overview
Fewer hospitalizations
Improved housing stability
Better retention in mental health services
High satisfaction (patients and families)
Cost effective
These findings have been replicated in more than 25 RCT studies.
The first study to evaluate an ACT approach to services was conducted in Madison, Wisconsin in the 1970’s. The study found that this approach resulted in less time spent in psychiatric hospitals, better independent–living skills, improved symptomatology, enhanced work and social functioning, and higher consumer satisfaction. (Stein & Test, 1980)
Studies in other communities have also shown ACT is effective in reducing the number of days spent in hospitals. Such studies occurred Kent County, Michigan (Mulder, 1985), Sydney, Australia (Hoult, Renolds, Charbeonneau – Powis, Weeks & Briggs, 1983), Chicago (Bond, 1990) and Indiana (Bond, Miller, Krumweid & Ward, 1998). In addition, some of these studies found that clients in ACT programs had fewer symptoms than their counterparts (Hoult, 1983; Stein & Test, 1980).
Additional studies supported the first round of research. Many involved an expanded range of clients, including veterans (Rosenheck, Neal, Leaf, Milsteind & Frisman, 1995), clients in Great Britain (Marks, 1991), and homeless people with severe mental illness (Morse, Calsyn, Allen, Temelhoff, & Smith, 1992). After a review of these studies, Burns & Santos (1995) found strong evidence that ACT reduces the number of psychiatric hospital days.
Ontario Overview
Ontario ACT data outcomes related to effectiveness have been consistent with the research literature and have supported the investment for the new teams introduced in the mid 2000’s. For example, in 2005–2006, 2412 out of 4048 ACT clients had zero hospital admissions. Clients enjoyed a 62% reduction in hospital admissions after receiving services from ACT for one year as compared to their utilization prior to ACT admission. This improvement increased to an 83% reduction after six years in ACT.
Further, most studies on the cost effectiveness of ACT have either shown cost savings (Weisbred, 1980), Bond et al., 1988; Nelson et al., 1995; Quinevan, 1995) or no cost difference (Jerrel and Hull, 1989). ACT has also been shown to be most cost effective when it is provided to clients with a previous history or high use of mental health services (Rosenbeck, 1994). Ontario ACT teams have proven to be cost effective based on the Common Data Set findings that the average ACT client used 71 hospital bed days in each of the 2 years pre–ACT.
