Consumer perceptions of assertive community treatment interventions

The issue of coercion in community-based mental health programs is frequently linked to the development of the Assertive Community Treatment (ACT) model. Sixty-five adults diagnosed with severe and persistent mental illness, participating in an ACT model program, completed measures that assessed elements of coercion and the perceived frequency of use of ACT staff therapeutic limit setting activities, as well as the relationships between coercion, empowerment, quality of life, and the working alliance. On average, participants did not perceive high degrees of coercion or negative pressures and did not feel excluded from the process of making decisions. On the continuum of restrictiveness of therapeutic limit setting activities, participants perceived staff to be using less restrictive therapeutic limit setting activities more frequently. Elements of perceived coercion and specific activities were negatively related to quality of life, sense of empowerment, and the working alliance.