Professor Emerita Dr. Mary Ann Test, whose work helped create what became known as Program of Assertive Community (PACT), passed away on January 31, 2025. This biography was written by Professor Emeritus, Jan Greenberg.
Dr. Mary Ann Test received her PhD in clinical psychology from Northwestern University in 1969. She moved to Madison to take a position at the Mendota Mental Health Institute (at the time known as Mendota State Hospital) as the Associate Director of the Schizophrenic Research Unit. In 1972, she became the co-Director of the Program of Assertive Community treatment (known at the time as the Training in Living Program). From 1975 to 1978 she served as the Director of Research and Psychology and joined the social work faculty in 1978, retiring from her full-time tenure position in 2001.
Following the national deinstitutionalization movement in 1960’s, thousands of persons with severe mental illness were returned to the community. However, communities were unprepared to deal with the significant challenges of meeting the needs of this most vulnerable group. At the time, no systematic, well-researched program existed to guide the reintegration of persons with severe and persistent mental illness back into the community. Consequently, many persons discharged from the hospital to the community often found themselves back in the hospital within a few months, known as “the revolving door” phenomenon.
Lisa Dixon (2000) describes the beginnings of the PACT program in an article celebrating its 25th anniversary.
Dr. Arnold Ludwig, the newly appointed director of research and education [at Mendota State Hospital], created a special treatment unit that evaluated various psychosocial techniques for people with chronic schizophrenia and hired Drs. Mary Ann Test and Arnold Marx. The initial focus of this talented trio was on developing techniques to be used in the inpatient setting.
After Dr. Leonard Stein replaced Dr. Ludwig, the new threesome of Marx, Stein, and Test realized that if they were going to address the revolving-door hospitalization phenomenon effectively, they had to move away from the hospital and into the community (p. 759).
It was during these years at Mendota that Dr. Test and her colleagues, Drs. Stein and Marx, developed and performed the first pilot evaluations of the Program of Assertive Community (PACT). Driven by the belief that people with serious mental illnesses could live fulfilling, productive lives as valuable members of their communities, these pioneers sought to provide comprehensive, individualized, and flexible community-based treatment to persons with schizophrenia who otherwise would have been hospitalized. Early evaluations demonstrated that the PACT program was successful in treating persons with schizophrenia in the community. There have been many replications of the PACT model supporting these early findings. Over the years, Mary Ann, along with her collaborators, Dr. William Knoedler, Deborah Allness, Suzanne Senn Burke, and Dr. Jana Frey, elaborated on and refined the PACT model to improve its efficacy and to facilitate the dissemination of the model.
The creation of the PACT model and its dissemination revolutionized the approach to delivering services in our public mental health system. Its impact has been far reaching as many of its key features were incorporated in the National Institute of Mental Health’s Community Support Program model and extended to serve persons with co-occurring substance abuse and mental illness, homelessness, jail diversion programs, and children with serious emotional disorders. The PACT model has been adopted world-wide including in Russia, the UK, Sweden, the Netherlands, Japan and Canada. As a consequence, countless people with serious mental illness and their families have benefitted worldwide.
Over the course of her career, Dr. Test published over 30 articles in highly prestigious journals in psychiatry and mental health. In addition, she authored two books or monographs, and countless book chapters. More importantly, her publications have been widely cited and made seminal contributions to the mental health field. The publication with L. Stein in 1980 on the PACT conceptual model has been cited approximately 3000 times (according to Google Scholar), and the series of articles published in the Archives of General Psychiatry in 1980 on the PACT model are considered classics.
Dr. Test received numerous prestigious awards including the Myrdal Award for Evaluation Practice from the American Evaluation Association, The Carl A Taube Award from the Mental Health Section of the American Public Health Association, the Service Award from the National Alliance for the Mentally Ill, and the Flynn Prize for “Scholarly Creative Activity that Demonstrably Advances Social Well-Being” from the Dworak- Peck School of Social Work, University of Southern California.
In her role as an educator, Dr. Test was instrumental in training the next generation of social workers, psychiatrists, and other mental health professionals. While working at Mendota and during her tenure at the UW-Madison, Mary Ann was involved in the training programs for psychiatric residents in preparing them to provide effective community-based treatment for persons with severe and persistent mental illness. .
Prior to the time that Dr. Test joined the social work faculty in 1978, there was virtually no social work training in community-based approaches to working with persons with severe and persistent mental illness. She developed the first course ever in the school to focus solely on persons with severe and persistent mental illnesses. Her colleague, Emerita Professor Mona Wasow, developed the first field unit devoted to training social work students to work with persons with serious mental illness and their families. When Deborah Allness joined the school in the mid-80s, a second field unit in serious mental illness was added. Through the efforts of Test, Wasow, and Allness, the school became the premier place in social work education in providing clinical training in working with persons with serious mental illness and their families, and in conducting rigorous evidence-based research on this population. In recognition of the efforts of these three pioneers, the school was awarded the Excellence in Training Award from the National Alliance of the Mentally Ill in 1988.
Though Mary Ann was highly selective in mentoring PhD students, her former trainees have had an enormous impact on social work education and research. Among her former PhD students are Beth Angell, the Dean at the School of Social Work University of Michigan; John Brekke, who served from 2004 to 2011 as the Associate Research Dean at the Dworak-Peck School of Social Work, USC; Alice Lieberman, who served two terms as Chair of the BSW program at the School of Social Work at the University of Kansas; Don Mowry, who served as the Chair of the Department of Social Work at the University of Wisconsin-Eau Claire; and Ok Kyung Yang, Professor and former Dean at The Graduate School of Social Welfare, Ewha Womans University, Seoul.
As a newly hired junior faculty member just out of my PhD program in the mid-1980s struggling with the transition from being a PhD student to a faculty member, from day one Mary Ann was supportive, encouraging, and so generous with her time. No matter how busy (back then she was travelling around the world giving talks on the PACT model) she always made time to read drafts of my manuscripts and grant applications, and provide extensive (I mean pages) of written feedback. As a group of 5-6 junior faculty, she always made us feel welcomed and valued. She was a strong advocate for junior faculty having a voice in major departmental committees and decisions.
Throughout her illustrative research career, Dr. Test remained a close partner with consumers and family members. She was the sole professional member on the committee back in 1979 that formed the National Alliance for the Mentally Ill (NAMI) and continued until the end of her life to be a close friend of NAMI and vocal advocate for improving community-based services. Mary Ann’s thinking about the role of consumers with mental illness in their treatment evolved over time. With the rise of the consumer and recovery movements, Mary Ann sought out (and consumers with mental illness sought her out) opportunities at the local and national level to meet with consumers of mental health services. From these conversations, she became a strong advocate for ensuring that consumers be partners in their treatment. .
Mary Ann was very close to her brother, Dick, and her niece, Tanya, whom Mary Ann adored. Mary Ann was a great lover of sports and animals. She played basketball as an undergraduate at Gettysburg College and was an avid fan of Wisconsin football and the Green Bay Packers. She loved going to the Milwaukee Brewers games and played on a summer women’s softball city league with her colleagues from social work, pharmacy and other units on campus. She most enjoyed her yearly skiing trips to Colorado with her colleagues and closest and lifelong friends, Sharon Berlin and Bonnie Svarstad. Her cat, Asha, was her constant companion for 22 years. Mary Ann was well-known throughout her neighborhood as she would often visit with neighbors during her daily walks with Asha. When Mary Ann’s dementia progressed and she was no longer able to get out, Asha would jump up onto Mary Ann’s lap so Mary Ann could gently stroke her.
Mary Ann was aware from an early age that she was at high risk for Alzheimer’s disease as her mother struggled with this disease. Her greatest wish was to remain at home. She was allowed to fulfill this wish because of loving, compassionate and dedicated support from Susan Rutter, her care manager for 8 years, and her two caregivers, Casey and Naffie, who work for Senior Helpers. They provided care that was so loving, compassionate, and respectful of Mary Ann’s wish to remain in control of her life. They most enjoyed drawing out Mary Ann’s sense of humor. During the last few months of Mary Ann’s life, Agrace Hospice provided professional and compassionate nursing care, support, and guidance. Without the love and support from Susan, Casey and Naffie, and Agrace Hospice, Mary Ann’s wish to live the last years of her life in her own home with Asha would not have been possible.
Citation:
Dixon, L. (2000). Assertive community treatment: Twenty-five years of gold. Psychiatric Services, 51(6), 759–765. https://doi.org/10.1176/appi.ps.51.6.759