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WITHDRAWN: Assertive community treatment for people with severe mental disorders
Max Marshall1, Austin Lockwood
1University of Manchester, The Lantern Centre, Vicarage Lane, Of Watling Street Road, Fulwood, Preston., Lancashire, UK.
The Cochrane Database of Systematic Reviews
|April 15, 2011
Summary
Assertive Community Treatment (ACT) improves patient outcomes and reduces hospital admissions for severe mental illness. This evidence-based approach enhances social functioning and quality of life, making it a valuable community care model.
Area of Science:
- Psychiatry and Mental Health Services Research
- Evidence-Based Practice in Healthcare
- Community Mental Health Interventions
Background:
- Assertive Community Treatment (ACT) emerged in the 1970s as a community-based alternative to psychiatric hospitalization.
- ACT is a team-based model designed to maintain patient engagement with services, decrease hospital readmissions, and improve overall quality of life and social functioning.
Purpose of the Study:
- To evaluate the effectiveness of Assertive Community Treatment (ACT) compared to standard community care, hospital-based rehabilitation, and case management.
- Key outcome measures included service contact, psychiatric hospital admission rates, clinical and social outcomes, and cost-effectiveness.
Main Methods:
- Systematic review of randomized controlled trials identified through comprehensive electronic database searches (CINAHL, Cochrane, EMBASE, MEDLINE, PsycLIT, SCISEARCH).
- Inclusion criteria focused on RCTs comparing ACT with standard community care, hospital rehabilitation, or case management for adults with severe mental disorders.
- Data analysis involved calculating odds ratios, number needed to treat (NNT), and standardized mean differences for various outcome measures, with quality assessment of included studies.
Main Results:
- ACT significantly increased patient contact with services and reduced hospital admissions compared to standard community care.
- ACT demonstrated reduced hospital admissions and increased independent living compared to hospital-based rehabilitation.
- While ACT reduced hospital care costs, overall cost-effectiveness varied when compared to standard care and case management.
Conclusions:
- Assertive Community Treatment (ACT) is a clinically effective strategy for managing individuals with severe mental illness in community settings.
- Targeted ACT implementation, particularly for high-need patients, can significantly lower hospital care costs while enhancing patient outcomes and satisfaction.
- Recommendations support the establishment and utilization of ACT teams by policymakers, clinicians, and service users.
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