Assertive Community Treatment for Patients with Eating Disorders

Assertive Community Treatment, or ACT, is a model of care that provides patient-centered, community-based intervention for individuals with persistent mental illnesses. The goal of ACT is to help people stay out of the hospital and to develop skills so they can live comfortably in the community and so that their mental illness is not the main force in their lives. There are no arbitrary time limits on ACT services. Interventions are carried out as long as they are useful and nothing more beneficial is available.

ACT sometimes is confused with case management, which uses programs that broker services from other agencies. An ACT team usually consists of 10 to 12 staff members with experience in specialty areas such as psychiatry, social work, and substance abuse treatment. Services are tailored to the individual needs of the patient, and are available from a team of practitioners 24 hours a day, seven days a week.

Applying ACT to patients with chronic eating disorders

The ACT model has recently been adapted for patients with chronic eating disorders, for whom there are no evidence-based treatments. Dr. Allan Kaplan and colleagues at Toronto General Hospital and the University of Toronto, Canada, reported on their new ACT program for patients with eating disorders at the Eating Disorders Research Society meeting in Pittsburgh last October. The goals of this program are to improve the quality of life of psychosocially disabled and medically unstable eating disorders patients and to reduce their rates of rehospitalization.

Early results from the first group

The Toronto researchers reported on the outcome of the first cohort of patients in the ACT program. In the first two years of operation, approximately 70 persons have been referred to the program. Currently, 20 patients are in the program; all have or have had anorexia nervosa (AN); 50% have the restricting subtype of AN. The average age of the patients is 30.6 years; 87% of them are single; and they have a mean duration of illness of 15 years and a mean current body mass index (BMI) of 17.2 kg/m2.

At admission to the ACT program, patients had a mean Beck Depression Inventory score of 35.6, and a mean Beck Anxiety Inventory score of 30.8. At admission they reported having a poorer quality of life than hospitalized chronically ill psychotic patients. Forty percent met the Diagnostic and Statistical Manual for Mental Disorders (DSM-V) criteria for mood disorder, and 60 % met the DSM-IV criteria for anxiety disorder.

The study is ongoing, and long-term follow-up will determine if this model of treatment is effective for reducing illness and death in these patients.