harm reduction/housing first version of the model, as implemented in the late 2010s. some clinicians and dual diagnosis specialists have voiced concerns that the model creates a safe environment for increased drug use, resulting in more instances of overdose and even death; they are awaiting an empirical study to confirm these suspicions. tomi gomory at florida state university has also been critical of pact. he has written: "advocates of programs of assertive community treatment (pact) make numerous claims for this intensive intervention program, including reduced hospitalization, overall cost, and clinical symptomatology, and increased client satisfaction, and vocational and social functioning. however, a reanalysis of the controlled experimental research finds no empirical support for any of these claims." gomory has asserted that the chief characteristics of pact are "intensity, assertiveness, or aggressiveness, which may better be identified as coercion. for example, reduced hospitalization in act is simply accomplished by having an administrative decision rule not to admit act patients into the hospital regardless of symptomatic behavior (the patients are kept and treated in the community) while patients in routine treatment are hospitalized regularly. when this rule is not present the research shows no reduced hospitalization by act compared to routine treatment." madison psychiatrist ronald j. diamond has provided support for that position: "the development of programs for assertive community treatment (pact), assertive community treatment (act) teams and a variety of similar mobile, continuous treatment programs has made it possible to coerce a wide range of behaviors in the community." gomory has also argued that professional enthusiasm for the medical model is the main driver of pact expansion, rather than any clear benefit to clients who receive the service. in the professional journal psychiatric services, test and stein have replied to gomory's assertions that pact is inherently coercive and that the research claiming to support it is scientifically invalid, and gomory, in turn, has answered their reply. moser and bond address coercion and the broader concept of "agency control" (practices in which the treatment team maintains supervisory responsibility over consumers) in a discussion of data from 23 act programs. their review shows that "agency control" varies greatly among different programs; it may be particularly high with patients diagnosed in the schizophrenia spectrum who also have active substance use issues. a widely distributed book co-authored by gomory has called the public's attention to various treatment failures allegedly caused by therapies described in the book as "coercive," including pact. future the cost-effectiveness of act was relatively easy to demonstrate in the early days, when psychiatric hospital beds were more heavily used than they are now. in the years to come, program planners will have to justify the comparatively high cost of act through the continued use of careful admission criteria and rigorous program evaluation. to ensure the best possible service quality on a routine basis, public regulators and payers would also benefit from having fidelity and outcome monitoring tools more easily administered than those currently available. the defining characteristics of the act approach will remain an attractive framework for services to meet the needs of special populations, such as individuals whose psychiatric symptoms get them into trouble with the criminal justice system, refugees from foreign countries who struggle with the added burden of mental illness, and children and adolescents with serious emotional disturbances. one major piece of unfinished business in the mental health field is the discovery that people with serious mental illnesses die an average of 25 years earlier than the general public, often from disorders that are inherently preventable or treatable; this public health disaster is a critical issue for act providers and the people they serve. another important area for future program design and evaluation is the use of act in combination with other established interventions, such as integrated dual disorder treatment for people with co-occurring mental health and substance use diagnoses, supported employment programs, education for concerned family members, and dialectical behavior therapy for individuals diagnosed with borderline personality disorder. ironically, the dissemination of separate evidence-based practices, not all of which are easily integrated with each other, has once again made service coordination a pivotal issue in community mental health — as it was during the latter decades of the 20th century, when act was created as an antidote to the "nonsystem" of care.