Legal Approach to Revolutionizing Mental Health Care: The Power of Assisted Community Treatment (ACT) and Street-Medicine Orders


In a world that continually strives for progress and innovation, the field of mental health care is no exception. One of the most groundbreaking approaches in recent years is Assisted Community Treatment (ACT) (also referred to as Assertive Community Treatment or Assertive Outpatient Treatment), combined with the concept of street-medicine Court issued orders. These strategies have ushered in a new era of care for chronically and/or seriously mentally ill individuals, offering them a lifeline to a more stable, fulfilling life.  Combined in recent advances in psychotropic medication(s), ACT is being used in many States (including Hawai’i) to treat the most vulnerable population in our community.

Hawai’i’s ACT law is housed in Hawai’i Revised Statutes Chapter 334, beginning at Section 334-121.

Understanding the Need for ACT and Street-Medicine Orders

Chronic and serious mental illnesses, such as schizophrenia, bipolar disorder, and severe depression, can significantly disrupt an individual’s life, making it challenging for them to engage in treatment, maintain housing, or even meet their basic needs.   These disorders can also cause dangerous behavior.  Traditional models of mental health care often fall short in providing comprehensive support for these individuals.

This is where Assisted Community Treatment comes into play. ACT is a holistic approach to mental health care that emphasizes community-based, multidisciplinary support for individuals with severe mental illnesses. It promotes continuous care, outside of a hospitalized setting, helping individuals maintain their health, housing, and overall quality of life.

To further augment the effectiveness of ACT, street-medicine orders have emerged. These orders empower healthcare providers to bring mental health care and medication directly to the streets, addressing the needs of those who may not be able to access conventional services. The combination of ACT and street-medicine orders creates a powerful synergy, promoting long-term recovery and stability among the chronically mentally ill.

The Key Components of Assisted Community Treatment

  1. Multidisciplinary Teams: ACT teams consist of attorneys, paralegals, Guardian Ad Litems, psychiatrists, nurses, social workers, and other professionals working together to provide comprehensive care. This collaborative approach ensures that individuals receive a range of services tailored to their unique needs.
  2. Community-Based Services: Rather than relying on office or hospital visits, ACT takes services directly to the community. Team members visit individuals at their homes, in shelters, on the streets, or wherever they are most comfortable.
  3. Continuous Care: ACT teams offer ongoing support, irrespective of the ups and downs of mental illness. This consistency is crucial in preventing relapses and promoting recovery.
  4. Crisis Intervention: ACT teams are equipped to handle crises effectively, preventing hospitalizations and emergency room visits whenever possible.
  5. Housing Support: Stable housing is a critical component of mental health recovery. ACT teams work to secure and maintain appropriate housing for their clients.
  6. Medication Management: Medication adherence is a common challenge for people with severe mental illness. ACT teams help clients manage their medications, ensuring that they are effective and properly administered. In the State of Hawaii, certain ACT Court Orders allow for mandatory medication.

The Power of Street-Medicine Orders

Street-medicine orders take ACT to a new level, reaching individuals who might be homeless, isolated, or otherwise difficult to engage. Healthcare providers and attorneys, often in collaboration with law enforcement, can seek and obtain medication orders, granting teams the authority to approach and assist individuals in public spaces.

These orders are particularly vital for individuals who are a danger to themselves or others, as they allow for intervention even when individuals may refuse help. This compassionate approach balances individual autonomy with the need for immediate care.

The Impact of ACT and Street-Medicine Orders

The combined approach of ACT and street-medicine orders has yielded promising results:

  1. Reduced Hospitalizations: By providing ongoing support, ACT teams have significantly reduced the need for psychiatric hospitalization, easing the burden on healthcare systems.
  2. Improved Quality of Life: Many individuals have found stable housing and are more engaged in their communities, leading to an improved overall quality of life.
  3. Reduced Criminal Justice Involvement: Street-medicine orders have helped divert individuals from the criminal justice system into appropriate mental health care, addressing the issue of overcriminalization of mental illness.
  4. Promotion of Recovery: These approaches prioritize the recovery model, helping individuals regain independence, self-sufficiency, and self-esteem.

 Assisted Community Treatment combined with medication orders represents a powerful paradigm shift in the field of mental health care. It offers hope to those who are often marginalized, ensuring they receive the care they need in a compassionate and comprehensive manner. As society continues to evolve, it’s crucial that we embrace innovative approaches like ACT and street-medicine orders to ensure that all individuals, regardless of their mental health, can thrive in our communities.