Coercion Justified?

This dissertation examines the research and theory offered for Programs of Assertive Community Treatment, the model that is supported by Institutional Psychiatry as the most well validated and best model of intervention applicable to the psychiatric population labeled the Severely and Persistently Mentally Ill. Although this program has been researched for over 25 yrs. and the extensive literature on this model claims to have established it's efficacy on both the systems and patient level, the findings of my critical review dispute these claims based on the examination of the empirical evidence of all available randomized controlled trials of this intervention as well as through a close conceptual analysis of the theoretical framework and a situational analysis of the individuals who invented this model. I explicate the faulty view of science (Justification) which drives the findings, by applying a view I argue is more correct ( K. Popper's Fallibilism). My analysis demonstrates that no superior efficacy can be associated with PACT methodology when compared to no treatment or standard treatment control groups. Further, any statistically significant impact putatively favoring PACT is either a tautological outcome based on administrative rules differentially applied to PACT and CONTROL groups, or are misattributions of worker activity as client outcome, or are based only on data supporting various outcomes and the ignoring or minimizing of negative results which contradict such claims, or are based on manipulation of data to indicate significance for variables which are not supported by the data (by for example collapsing various outcome variables some of which are statistically significant, but are tautological, like number of 3 hospital stays, and some which are not statistically significant but empirically important like less homelessness, or less time spent incarcerated, and suggesting that the significance found (derived from the tautological components) indicates treatment effectiveness for the non tautological components). Finally, the conceptual analysis of this model demonstrates that this model is coercive and may lead to harm(excessive suicide among its treatment population for example).