Assertive Community Treatment (ACT) is an evidence-based practice (EBP) proven to improve 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 ACT, 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 ACT clients from these more expensive services. The assessment of data indicated ACT services resulted in lower hospitalization and incarceration rates for individuals being served, and 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 FY21 was $14,458, representing a consistent trend with the previous fiscal year.

• State hospitalization usage for all ACT served individuals admitted in FY19 was reduced by 51 percent, representing a cost avoidance of $14,294,084 related to this population.

• All new FY19 ACT served individuals accounted for 29,669 state hospital bed days in the two years prior to their ACT admission, and just 14,499 in the two years post their ACT admission.

• Across the FY16, FY17, FY18, and FY19 cohorts, the ACT program contributed to an overall cost avoidance of $43,580,170 in state hospital costs in the two years following initiation of ACT services.

• Local psychiatric hospitalization use for all ACT served individuals admitted in FY19 had a 51 percent reduction, which represents a cost avoidance of $3,945,553 related to this population.

• All new FY19 ACT served individuals accounted for 9,904 local hospital psychiatric bed days in the two years prior to ACT admission, and just 4,886 in the two years post ACT admission.

• Incarceration of all ACT served individuals admitted in FY19 was reduced by 52 percent and represents a cost avoidance of $411,212 related to this population.

• In the two years prior to admission to ACT, all new FY 2019 individuals served 7,829 days in confinement compared to only 3,730 days in the two years post entering ACT services.

• Across the FY 2016, FY 2017, FY 2018, and FY 2019 cohorts, the ACT program contributed to an overall cost avoidance of $2,929,363 in jail costs in the two years post initiation of ACT services.
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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/