Experimental studies of the program of assertive community treatment (pact): A meta-analysis

Abstract

The effectiveness of the Program of Assertive Community Treatment (PACT) versus standard inpatient/outpatient treatment was investigated through a meta-analysis. The study included 19 peer-reviewed published articles describing controlled, randomized experiments comparing PACT to standard treatment of individuals with severe mental illness. Treatment was found to have a significant relationship with effectiveness on each of the following six indicators: number of hospital admissions, length of hospital stay, social functioning, symptomatology, patient satisfaction, and cost. The use of PACT was associated with fewer admissions, shorter length of stay, higher social functioning, lower symptomatology, greater patient satisfaction, and lower cost. These findings were challenged, however, by the confounding effect of attrition and the small amount of total variance explained in the effectiveness indicators by the PACT intervention. Future replication studies of PACT using larger sample sizes and standardized measures of benefits and costs appear necessary to justify major shifts in mental health and vocational rehabilitation services and funding policies.