Experience from the first ACT programme in Denmark. I. Baseline evaluation 1981-2000

In 1999, a Danish expert report strongly recommended the Assertive Community Treatment (ACT) model to be implemented in Denmark. On 1 May 2001 we started in the Tønder region (45,000 inhabitants), Sønderjylland (SJ) county (254,000 inhabitants), aiming an evaluation of the ACT model. Before starting the clinical study, an epidemiological baseline evaluation of trends in psychiatric service was performed. Data included all admissions to mental hospitals/wards from 1981 to 2000 from the intervention/control region (Tønder/Aabenraa) and from all Denmark together with outpatient data from the period 1995-2000. The bed rate in the SJ county (76/100,000 31 December 2000) was halved during the period. The staff increased by more than 50%. The increase in admission rate and decrease in bed days per admission showed homogeneous pattern between intervention and control region. The hospital incidence of schizophrenia and the first-time admission rate were at the same level in the intervention/control region and all Denmark, but the country had a higher use of beds. The point prevalence and referral rates of outpatients increased to around 6/1000 and 7/1000/year, respectively in both regions. In conclusion, the regions of intervention and control had, prior to the start of ACT, the same pattern of use of psychiatric services, enabling an unbiased register-based evaluation of effects.