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Substance Abuse and Mental Health Services Administration
Assertive Community Treatment (ACT) for People Experiencing Homelessness
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People experiencing homelessness face daily challenges of survival and struggle to establish a sense of safety and security for themselves. This article explores the challenges of using the ACT model with people who experience both Severe Mental Illness (SMI) and homelessness. This article is the second in a series of three articles about ACT.

People experiencing homelessness face the challenges of basic survival on the streets or in a shelter setting. They are confronted with the daily struggle of finding food and shelter, and of establishing a sense of safety and security for themselves. Some among the homeless population struggle with substance abuse and medical issues at higher rates than the non-homeless population. They are among society’s most vulnerable members and live on the absolute margins.

Given these challenges, how can providers reach people with Severe Mental Illness (SMI) who are also experiencing homelessness? What are special considerations for adapting the ACT model to work with this population? In many ways, the services are similar. However, as seen above, providing these services to a homeless population presents unique challenges for providers.

Success of ACT in Homeless Populations

Despite these challenges, the ACT model has been successful with people experiencing homelessness. This is especially true in terms of improving symptoms of mental illness and reducing hospitalizations. It has also reduced homelessness overall and increased housing stability. One study compared patients experiencing homelessness, SMI, and substance abuse receiving either Integrated Assertive Community Treatment (IACT) or Assertive Community Treatment Only (ACTO). Those patients receiving the more integrated treatment reported more days in stable housing and higher satisfaction than those receiving the standard treatment. This suggests that the more integrated the approach to treatment, the better the outcomes for people experiencing homelessness.

Another study found that poor relationships between case workers and patients led to longer periods of homelessness. This might be explained by poor ACT implementation, and may not point to a flaw in the ACT design itself. But it does highlight that a strong therapeutic relationship is key in working with people experiencing homelessness and SMI.

Limitations of ACT

ACT is not a cure-all for people who experience homelessness and SMI. For example, it does not seem to improve social supports or social relationships. It also does not help prevent criminal behavior. And ACT works within existing political and economic realities, meaning that many external factors also affect success rates. These factors include availability of rental subsidies, the demographics of the individual (rural, suburban or urban), housing market conditions, and overall economic conditions.

Yet, people who are experiencing homelessness with SMI seem to value the supportive relationship with their ACT case workers. And while limitations do exist, the benefits of ACT are promising.

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HRC Resource
SAMHSA
2011
Rockville, MD
617-467-6014