Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use

BACKGROUND Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use. METHODS Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses. RESULTS The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients' own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment. CONCLUSIONS The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients' contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client's quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment.