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individuals with serious mental illnesses has long been recognized. As early as 1964 Jack Ewalt, the director of the Joint Commission on Mental Illness and Health, noted:
At the Massachusetts Mental Health Center we have found that we can greatly reduce the relapse rate by providing continuity of care. . . . We do not allow patients to be transferred among wards or services—the only way he can lose his doctor is if the doctor dies or goes elsewhere.
    This principle was operationalized in the early 1970s by Leonard Stein and Mary Ann Test in Madison, Wisconsin, when they established the first Assertive Community Treatment(ACT) team for patients being discharged from the state hospital. ACT teams consist of 100 to 120 patients assigned to a team of approximately 10 mental health workers, usually including a psychiatrist, psychologist, psychiatric nurses, social workers, and others. The team takes total responsibility for the patients, visiting them in their board-and-care homes or wherever they are living, making sure they continue taking their medications, and responding to crises before they lead to rehospitalizations. If patients have to be hospitalized, then team members visit the hospital. If the patients end up in jail, then team members visit the jail. Team members have a regular night and weekend call schedule, so someone is always available 24 hours a day, 365 days a year, for the patients assigned to that team. The patients thus get to know their ACT team members just as the ACT team gets to know the patients and their families. The clinical, housing, vocational, and social needs of the patients are all coordinated by the ACT team. As Mary Ann Test described it:
The team members do not necessarily meet all the client’s needs themselves (they may involve other persons or agencies). However they never transfer this obligation to someone else. The buck stops with the team. . . . The team remains responsible for the client no matter what his or her behavior is. 23
ACT teams have been extensively studied over the years and have been reported to dramatically reduce rehospitalizations and the amount of time ACT patients spend in jail. They also increase the vocational success of the patients, and both patients and families have expressed great satisfaction with the ACT model. Much of the success of ACT teams comes from maintaining patients on their medication, and they do this, according to one summary, by using “access to resources such as housing and money as leverage to promote patients’ adherence to treatment recommendations.” 24
Because they have been proven to be highly effective, ACT teams have been adopted in 38 states as the best model for treating people with serious mental illnesses. One study estimated that 50% of individuals with serious mental illnesses would be helped by ACT teams, as such teams are useful for individuals who do not take their medications regularly or have trouble accessing the available treatment and rehabilitation services. Because NIMH estimates that approximately 12.3 million adults have schizophrenia, severe bipolar disorder, or severe depression in a given year, that means that 6.1 million of them would benefit by ACT teams. According to a 2011 estimate, “about 60,000 persons nationwide . . . were being served by ACT” teams; this is about 1% of those who need it. The reason ACT teams are not used more widely 40 years after being introduced is the system of funding mental health services, as described in the next section. ACT teams do not fit well with the traditional categories of funding created for Medicare reimbursement, and because they produce less federal Medicaid revenue for the states, they are markedly underutilized. 25
Most patients, therefore, continue to receive uncoordinated and disjointed mental illness services. They are randomly rehospitalized in whatever hospital happens to have a bed available despite the fact that the staff of that hospital may have little