What is the recommended staffing makeup for assertive community treatment (ACT) teams? Are there enough clinicians to provide ACT services?

Assertive Community Treatment (ACT) is an evidence-based psychiatric rehabilitation practice that provides a comprehensive approach to service delivery to consumers with severe mental illness (SMI). ACT teams typically include a psychiatrist or advance practice nurse; supervisor (psychologist, counselor, or social worker); care managers; peer support specialists; and nurses, with an approximately 10:1 staff/patient ratio. However, only 13% of mental health facilities nationwide have ACT teams, and only 20% of these with ACT teams offer all core ACT services.

One reason for the lack of access to ACT programs may be a lack of adequate workforce to staff the teams. A recent SAMHSA report estimated the number of clinicians that would be needed to provide ACT services to the population of individuals with schizophrenia across the United States, and found major shortfalls across all of the different provider groups. This report provides useful information on recommended staffing levels for ACT teams as well as a range of other evidence-based treatments for serious mental illness.


  1. SAMHSA Behavioral Workforce Report. 2020.
  2. Spivak, S et al (2019). Distribution and correlates of Assertive Community Treatment (ACT) and ACT-like programs: results from the 2015 N-MHSS. Psychiatric services, 70(4), 271-278.
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