A systematic review of Assertive Community Treatment for adults with complex mental illness; its effect on Emergency Department presentations and patient outcomes

A systematic review of Assertive Community Treatment for adults with complex mental illness; its effect on Emergency Department presentations and patient outcomes | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 17 September 2025 V1 Latest version Share on A systematic review of Assertive Community Treatment for adults with complex mental illness; its effect on Emergency Department presentations and patient outcomes Authors : Vanessa von Berg 0009-0009-0459-5041 [email protected] , Hazel Heng , and Md Shapin Ibne Sayeed Authors Info & Affiliations https://doi.org/10.22541/au.175812130.02181824/v1 171 views 112 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Emergency Department (ED) wait times have increased globally, resulting in treatment delays, heightened clinical risk, and system strain. Complex mental health consumers, particularly those with Serious and Persistent Mental Illness (SPMI), are a consistent sub-group of ED presenters. Assertive Community Treatment (ACT) has shown promise in reducing inpatient demand in clients with SPMI but has been criticised as cost intensive and limited patient rehabilitation outcomes. To respond to increasing demand on ED from complex mental health consumers this systematic review evaluated ACT’s effectiveness in reducing ED presentations and improving psychosocial outcomes. Nine databases were searched (31/12/2013–25/10/2023), yielding ten eligible studies with moderate Risk of Bias (ROB) scores. Studies spanned diverse geographic regions (Asia Pacific, Europe, North America) and included both urban and rural settings, with adult cohorts selected to enhance relevance for Australian Area Mental Health Services (AMHS). ACT was consistently associated with reductions in ED utilisation and costs. Seven studies reported statistically significant or observable decreases in ED attendance; via cost reductions and fewer or shorter visits. Improvements in psychosocial functioning were documented in five studies, although symptom reduction was limited. These findings were primarily based on clinician-reported Routine Outcome Measures (ROMs), with minimal inclusion of patient-reported outcomes, limiting interpretive reliability. The absence of comparisons between ED savings and ACT implementation costs restricts conclusions about sustainability. Future research should explore client perspectives, cost-benefit analyses, and community-based risk factors. Based on current evidence, ACT is provisionally recommended for high-needs SPMI clients underserved by less intensive case management models. Supplementary Material File (manuscript - act and ed - vonberg - wiley.docx) Download 222.54 KB Information & Authors Information Version history V1 Version 1 17 September 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords community mental health services complex mental illness emergency department methods psychosis Authors Affiliations Vanessa von Berg 0009-0009-0459-5041 [email protected] Northern Health View all articles by this author Hazel Heng La Trobe University View all articles by this author Md Shapin Ibne Sayeed Northern Health View all articles by this author Metrics & Citations Metrics Article Usage 171 views 112 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Vanessa von Berg, Hazel Heng, Md Shapin Ibne Sayeed. A systematic review of Assertive Community Treatment for adults with complex mental illness; its effect on Emergency Department presentations and patient outcomes. Authorea . 17 September 2025. DOI: https://doi.org/10.22541/au.175812130.02181824/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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