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Assertive community treatment for people with severe mental disorders
1Department of Community Psychiatry, University of Manchester, Academic Unit, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, Lancashire, UK, PR2 4HT. Max.Marshall@man.ac.uk
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Assertive Community Treatment (ACT) improves patient contact with services and reduces hospital admissions compared to standard care. While not improving mental state, ACT enhances accommodation and employment outcomes for individuals with severe mental disorders.
Area of Science:
- Psychiatry and Mental Health Services Research
- Evidence-based practice in mental healthcare
Background:
- Assertive Community Treatment (ACT) emerged in the 1970s as a community-based alternative to psychiatric hospitalization.
- ACT employs a team-based model to maintain patient engagement with services, reduce hospital readmissions, and enhance quality of life and social functioning.
Purpose of the Study:
- To evaluate the effectiveness of Assertive Community Treatment (ACT) against standard community care, hospital-based rehabilitation, and case management.
- Key outcomes assessed include service contact, psychiatric hospitalization rates, clinical and social functioning, and cost-effectiveness.
Main Methods:
- Conducted comprehensive electronic database searches (CINAHL, Cochrane, EMBASE, MEDLINE, PsycLIT, SCISEARCH) from inception to 1997.
- Included randomized controlled trials comparing ACT with standard community care, hospital rehabilitation, or case management for severe mental disorders (ages 18-65).
- Analyzed categorical, count, and standardized scale data using appropriate statistical methods, including Odds Ratios and standardized mean differences.
Main Results:
- ACT significantly increased patient contact with services and reduced hospital admissions compared to standard community care.
- ACT demonstrated improvements in accommodation status and employment, and higher patient satisfaction, but no significant changes in mental state or social functioning.
- ACT reduced hospital care costs but showed no clear overall cost advantage when all costs were considered; it also reduced hospital admissions compared to hospital-based rehabilitation.
Conclusions:
- Assertive Community Treatment (ACT) is an effective intervention for improving service engagement and reducing hospitalizations in severe mental disorders.
- ACT positively impacts social outcomes like accommodation and employment, although it does not directly improve mental state or general social functioning.
- ACT presents a viable alternative to traditional care models, particularly in reducing inpatient bed use and associated costs.