Is assertive community treatment coercive?

Background Assertive community treatment (ACT) has become one of the cornerstones of care for people with serious mental illnesses. ACT is usually conceptualized as incorporating a multidisciplinary team approach, active and persistent attempts to engage clients, direct provision of comprehensive health and social care, and in-vivo and out-of-hours working. In addition, the service is ongoing, not time-limited, and has a low practitioner-to-client ratio (usually 1:10). However, ACT is not without its critics, many of them focused on the use of "coercive" techniques with ACT patients [1,2]. At one end of the spectrum are those opponents of ACT who contend, "ACT is largely a euphemistic label for coercion." Despite substantial interest in the coercive aspects of ACT, no studies have focused specifically on understanding the phenomenology of the use and experience of leverage in ACT.