Assertive case management, originally developed in Wisconsin as Training in Community Living, and most commonly referred to now as Programs of Assertive Community Treatment or PACT, has proven in five studies using an experimental design and assessment of costs to be cost effective in reducing state psychiatric hospital care for persons meeting criteria of being severely mentally ill and at risk of hospitalization. Most community programs today however have very different state of the art community programs for the mentally ill than those in these earlier studies, including case management of a less intense nature and mobile emergency care. In order to properly assess the place of the PACT model in the mix of services that state programs make available,it is necessary to compare the PACT model to newer treatment programs with better assessment of total costs to the state, and to analyze the differential effectiveness of the PACT model and alternate models with chronically mentally ill of patients. The PACT model is very costly relative to other community treatment and effective alternatives for local programs are critical. This project proposes to,conduct such a cost effectiveness analysis. Patients eligible for acceptance into the PACT program will be randomly assigned to one of two experimental groups and a control group. The two experimental groups are identical programmatically but differ in sponsorship, non-profit vs. state. The control group will receive less intensive case management, and have access to a Mobile Crisis Program as well as a regular CMHC services. Measures of patient functioning, psychiatric symptomology, quality of life, contact with justice/correctional system, and family burden will be measured at baseline and at 6, 12 and 18 months. Costs will be measured in the area of health and mental health use, jail/correctional/courts contacts, family time and dollar costs, and maintenance costs (SSI, SSDI) etc.
