Assertive Community Treatment Level Services for Older Adults with Severe Mental Illness: Exploration of Practitioners’ Perspectives

Assertive community treatment (ACT) is a model of community care shown to improve outcomes for clients with severe mental illness (SMI). Yet there is limited research about using ACT for older adults with SMI, a growing population. This study explores ACT team members’ perspectives on caring for older adults. We obtained the number of older adults on each ACT team roster. ACT team staff members participated in semi-structured interviews regarding their experiences caring for older clients. Interview transcripts were analyzed by both authors using thematic analysis conducted with an inductive, semantic approach, generating several overarching themes. One third of ACT clients were over the age of 55 and 8.4% over 65. Some teams had upper age limits for eligibility. Themes emerging from our data included physical health, supports and services, geriatric “expertise,” and the tension between team versality and strain. Participants varied in whether they felt empowered and mandated to care for older clients, versus burdened by staffing shortages, finite resources, and lack of expertise. ACT teams were challenged by the complexity of their older clients, who comprise a significant minority of team rosters. Potential models to address this might include dedicated psychogeriatric ACT teams, integration of psychogeriatric specialists into teams, or improved access to geriatric consultation.