National Alliance on Mental Illness
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  ACT Start-Up Checklist

Checklist for Successful ACT Implementation


ACT is a comprehensive, service-delivery model for providing community-based treatment to people with severe and persistent mental illnesses. It has been the object of a number of controlled research studies that consistently show that the program decreases time spent in hospitals. ACT provides treatment, rehabilitation, and support services that enable consumers to spend significantly more time in independent living situations and more time employed. Consumers have fewer symptoms and increased satisfaction with life, and some studies have shown increased earnings from competitive employment.

The research points out that to achieve these kinds of successes, ACT's organizational, staff, and practice patterns have to be replicated, not just its philosophy.

You need:


  • At least $800,000 to $1 million in 2002, per team, per year, depending on staff salaries is needed for:

  • start-up funding of roughly two- to three-months expenses for hiring-or re-deploying-staff before claims reimbursement gradually sustains the new team program;

  • start-up funding of $25,000 to $50,000 for consultation on program design, training of team staff, and training of the mental health authority staff who will monitor the teams; and

  • on-going funding mechanisms with Medicaid, Medicare, state (and county) funds. (Page 109 in the manual lists sample costs for salaries, transportation, insurance, client service money, etc.)


  • You will need:

  • at least 16 hours a week of psychiatrist time for each 50 consumers;

  • team leader to direct the program who works side by side with consumers and staff;

  • at least three nurses;

  • mental health professionals who can provide specialized services (substance abuse treatment, peer support, vocational services); and

  • an overall 1:10 staff-to-consumer ratio.


  • The mental health authority should write standards that meet the model's organizational, staffing, and practice patterns described in Appendix 8 of The PACT Model of Community-Based Treatment for Persons with Severe and Persistent Mental Illnesses: A Manual for PACT Start-up to ensure PACT outcomes. Among other things, the standards:

  • ensure outreach-based, direct team provision of consumer-centered treatment, rehabilitation, and support;

  • include a daily organizational, multidisciplinary staff meeting; and

  • encourage family involvement.

Consultation and Training

  • Successful start-up takes consultation on planning and development and consultation on state/county mental health authority oversight of ACT initiatives.

  • On-going training and support is recommended for new teams during the first two years of operation. Continuing support should be available from the state/county monitoring staff, from consultants, and if available, from more experienced teams in your state.


  • Outcomes-evaluation information should be made available to the public. Outcomes measures should be both clinical-status and quality-of-life measures including housing situation, employment status, education, substance abuse, treatment side-effects, suicide rates, re-hospitalizations, premature death, and involvement with the criminal justice system.

State Monitoring

  • The state mental health authority (or county mental health authority in a county-based system) should monitor the teams to ensure that teams meet the state's assertive community treatment program standards.

  • State/county mental health authority staff should assess performance through outcomes data (see evaluation above), site visits, meetings with consumers and family members, and meetings with the ACT program advisory group.

  • The state should provide or arrange for additional training and consultation for teams to correct problems and enhance performance.

  • If the state has consumer satisfaction teams, their services should be made available to ACT programs. (Massachusetts, Ohio, Michigan, and Pennsylvania have or are developing them and Alabama, Georgia, Washington, and Wisconsin use them in some areas of their public mental health systems.)

  • Standards should include a provision for the mental health authority to adapt certain requirements to local conditions on a case-by-case basis when adjustments do not interfere with consumer outcomes.

Advisory Group

  • An advisory group made up of consumers, family members, professionals, and others supports and advocates for the project and encourages continuous quality improvement.