Community Mental Health Journal

, Volume 48, Issue 5, pp 652–661

Implementation of Assertive Community Treatment in Australia: Model Fidelity, Patient Characteristics and Staff Experiences

  • Carol Harvey
  • Helen Killaspy
  • Salvatore Martino
  • Sonia Johnson
Original Paper

DOI: 10.1007/s10597-011-9466-x

Cite this article as:
Harvey, C., Killaspy, H., Martino, S. et al. Community Ment Health J (2012) 48: 652. doi:10.1007/s10597-011-9466-x


The impact of variable implementation of the Assertive Community Treatment (ACT) model on patient outcomes is increasingly recognised. We conducted the first study of four established Australian ACT teams, examining team composition, processes and model fidelity, using previously validated questionnaires. Demographic and clinical details of patients and their own experiences of ACT were gathered from staff. Associations between burnout and work experiences were examined. All teams were ACT-like (mean DACTS score = 3.7, SD = 0.3) with few significant patient differences between teams, except diagnosis (schizophrenia 61–93%, co-morbid substance abuse 16–33%) and proportion living alone (23–72%). Clinicians were fairly satisfied, but inter-team differences in staffing profile and experience emerged and one team scored highly on emotional exhaustion. Increased burnout was associated with greater stress due to taking a team approach. Inter-team differences suggested that attention to effective team working and leadership, as well as model fidelity, may be warranted.


Assertive community treatment Community mental health services Severe mental illness Schizophrenia Staff burnout Team working 

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Carol Harvey
    • 1
  • Helen Killaspy
    • 2
  • Salvatore Martino
    • 3
    • 4
  • Sonia Johnson
    • 5
  1. 1.Department of PsychiatryThe University of Melbourne & North Western Mental Health, Psychosocial Research CentreCoburgAustralia
  2. 2.Department of Mental Health SciencesUniversity College London and Camden and Islington NHS Foundation Trust, Royal Free HospitalLondonUK
  3. 3.South West Area Mental Health ServiceMelbourneAustralia
  4. 4.Glen IrisAustralia
  5. 5.Research Department of Mental Health SciencesUniversity College London and Camden and Islington NHS Foundation Trust, Charles Bell HouseLondonUK