Assertive Community Treatment (ACT) was developed in
Madison, Wisconsin in the early 70's.  The program is
for those who require careful monitoring and complex
management to prevent relapse (p 101) and to provide
"continuous care."  Long-lasting medications are
administered by staff in the client's home and friends,
family, neighbors are continually informed (p 102)
about the client's course.  A hospital setting is
transposed from the inpatient setting to a community-
based 'hospital without walls' (p 103.)  NAMI has
underwritten the cost of establishing Programs of
Assertive Community Treatment, Incorporated.  (Area
code is Columbia, South Carolina.)  NAMI, NIMH and CMHS
sponsored an ACT standards meeting in 1996.  ACT
development is a major initiative of NAMI's Campaign to
End Discrimination (p 102).  (These remarks from
Santos, MD, South Carolina, who writes as an ardent
advocate for and researcher of ACT.)

PACT candidates "were seen as aggressively dependent on
family or institutions and engaged in behaviors
designed to have others provide protection." 
Hospitalization is seen as a reward for maladaptive
behavior. (Mowbray, p 108).  ACT has a "non-discharge"
policy.  Step-down teams address "commitments" to
continued consumer growth (Mowbray, p 129). ACT is an
ongoing program ( Meisler, p 142).  Multiple daily home
visits may be necessary to deliver each dose of
medication ( Meisler, p 146).  Shared caseloads were
predictors of success (McGrew, p 187) and reduced
burnout.

I saw not one word about choice or force in the whole
volume.  Nor any words about graduating from the
program, about recovering.  The tone of the volume is
about maintaining control and some life quality.

Administration and policy in mental health, 25:2,
November 1997.  This is a special issue, ten articles
about Assertive Community Treatment.  To save typing, I
have, incorrectly, only cited by page number and first
author, not the full formal citations.