Assertive Community Treatment (ACT) is an evidence-based practice (EBP) proven to improve outcomes for people with severe mental illness. As one of the oldest and most widely researched EBPs 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 ACT, the Department of Behavioral Health and Development Services (DBHDS) assessed general financial figures including 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 ACT clients from these more expensive services. DBHDS used a cohort approach to analyze the impact of PACT overtime on PACT clients admitted in FY18. The assessment of data indicated ACT services resulted in lower hospitalization and incarceration rates for individuals being served with substantial associated cost reductions.

Some of the main findings in this report supporting the value of investment in ACT services across the Commonwealth include:

• The average cost per individual served by ACT teams across the Commonwealth in FY20 was $14,336, representing a reduction from last fiscal year.

• State hospitalization usage for all ACT served individuals admitted in FY18 was reduced by 43%, representing a cost avoidance of $9,162,378 related to this population.

• All new FY18 ACT served individuals accounted for 23,206 state hospital bed days in the two years prior to their ACT admission, and just 13,224 in the two years post their ACT admission.

• Across the FY16, FY17, and FY18 cohorts, the ACT program contributed to an overall cost avoidance of $29,286,086 in state hospital costs in the two years following initiation of ACT services.

• Local psychiatric hospitalization use for all ACT served individuals admitted in FY18 had a 47% reduction, which represents a cost avoidance of $4,033,564 related to this population.

• All new FY18 ACT served individuals accounted for 10,968 local hospital psychiatric bed days in the two years prior to ACT admission, and just 5,778 in the two years post ACT admission.

• Incarceration of all ACT served individuals admitted in FY18 was reduced by 64% and represents a cost avoidance of $938,278 related to this population.

• In the two years prior to admission to ACT, all new FY18 individuals served 15,847 days in confinement compared to only 5,645 days in the two years post entering ACT services.

• Across the FY16, FY17, and FY18 cohorts, the ACT program contributed to an overall cost avoidance of $2,518,151 in jail costs in the two years post initiation of ACT services.

To ensure that Virginia continues to achieve and improve upon the outcomes and cost reductions ACT has achieved to date, ongoing support and funding for not only the service itself, but also provider training, formal program fidelity evaluations, and expansion of staffing infrastructure at the state level will remain significant priorities.
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(*1) For a collection of relevant research, see: UNC Institute for Best Practices. (2019). ACT [Research]. Retrieved from http://www.institutebestpractices.org/act/research/