Is ACT worth it?
There’s no argument – ACT is expensive! But so is most health care.
In a 1999 paper Economic Impacts of Assertive Community Treatment: A Review of the Literature Dr. E Latimer analyzed the available info and concluded that “an ACT program must enroll people with prior hospital use of about 50 days yearly, on average, to break even.”
ACT teams should undoubtedly be accepting individuals with the highest use of hospital resources. But there are other indicators to consider – use of jail or emergency services, co-occurring addictions, functional deficits (which Latimer notes). But what about family burden? I’ve seen situations where an individual has lived in the community for decades without hospitalization only because family – almost always a mother – has been there to support them. What should be done in those situations?
As always I don’t have clear answers. I think Latimer’s 50 day mark is valuable and should be kept in mind. One of the strongest arguments for ACT is that, from its origins, it has been researched and thus been accountable. It should continue to be. But I suggest there also be openness to exceptions; should an individual with an average of 47 days of hospitalization per year over the preceding 5 years be declined by ACT?
In a 2005 paper Economic considerations associated with assertive community treatment and supported employment for people with severe mental illness Latimer points out that “One way of understanding why ACT teams can increase the efficiency of a mental health system is to contrast the relatively inflexible manner in which hospital resources are deployed when a patient is admitted to hospital with the much more adjustable deployment of the resources of an ACT team.”
In one of his papers Dr. Kim Mueser noted that “it may also be that the right community-based services are inherently cheaper … because they allow a much more flexible and targeted allocation of care resources to clients.”
I worked on inpatient units for for than a decade; flexible allocation of resources ain’t what hospitals specialize in. It’s good to be flexible!
What are your thoughts? Should hospital use be the most important determinant for acceptance for ACT?