We are unaware of publications that have presented basic information on the proportions of patients who discontinue ACT treatment either early in treatment or after more extensive involvement or on clinical correlates of early or late termination. Despite the continuing evolution of community practices for people with severe mental illnesses, there have been no recent studies supporting time-unlimited service delivery, and a small number suggest that safe transitions are possible ( 3, 4, 5 ). However, the assumption that such services should be time unlimited may limit access to ACT, because staff resources may remain committed to clients who can successfully transition to other services. The principle of "continuous long-term service" originated with research findings that even after 14 months of treatment, participants who terminated experienced subsequent clinical deterioration and increased hospitalization ( 2 ). The Dartmouth ACT fidelity scale lists long-term service delivery as a fidelity indicator, such that the highest score on this item is for programs that provide services indefinitely ( 1 ). A long-standing operating principle of assertive community treatment (ACT) is that services should be time unlimited.
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