RD630 - Program of Assertive Community Treatment – Program Funding, Cost Effectiveness, and Impact – November 1, 2019

Executive Summary:

Assertive Community Treatment (ACT, or PACT as it is currently known in Virginia) is an evidence-based practice (EBP) that improves outcomes for people with severe mental illness. One of the oldest and most widely researched EBP’s in behavioral healthcare for people with severe mental illness, research shows that ACT reduces hospitalizations and incarceration, increases housing stability, and improves quality of life for people with the most severe symptoms of mental illness.(*1) To do so, ACT utilizes a multidisciplinary, community-based team of medical, behavioral health, and rehabilitation professionals who work together to meet the needs of the individuals that they serve.

In response to the General Assembly’s request to provide recent data on PACT, the Department of Behavioral Health and Development Services (DBHDS) assessed general financial figures – costs per team and costs per individual served, the program’s impact on state and local hospitalization and incarceration, and the associated cost implications from diverting PACT clients from these more expensive services. The assessment of data indicated that PACT services resulted in lower hospitalization and incarceration, and substantial associated cost reductions.

Some of the main findings in this report that support the value of investment in PACT services across the Commonwealth include:

• The average cost per client served by PACT teams across the Commonwealth is $15,754.

• State hospitalization use for all PACT clients admitted in FY16 had a 54% reduction, which represents a cost avoidance of $8,061,856 for that group.

• All new FY16 PACT clients accounted for 21,546 state hospital bed days in the two years before PACT admission, and just 11,642 in the two years after PACT admission.

• Seventy-eight percent or 1,704 of all 2,186 PACT clients in FY18 had zero local hospitalizations, 12% or 259 individuals had one hospitalization, and 10% or 223 individuals had multiple local hospitalizations.

• Incarceration of all PACT clients admitted in FY16 was reduced by 52.5% and represents a cost avoidance of $688,700 for that group.

• In the two years before admission to PACT, all new FY16 clients served 15,288 days in confinement compared to only 7,264 days in the two years after starting PACT services.
(*1) For a collection of relevant research, see: UNC Institute for Best Practices. (2019). ACT [Research]. Retrieved from http://www.institutebestpractices.org/act/research/