Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-20T13:27:21.154Z Has data issue: false hasContentIssue false
  • English
  • Français

A comparison of the implementation of Assertive Community Treatment in Melbourne, Australia and London, England

Published online by Cambridge University Press:  18 March 2011

C. Harvey ,
H. Killaspy ,
S. Martino ,
S. White ,
S. Priebe ,
C. Wright  and
S. Johnson
C. Harvey*
Affiliation:
Department of Psychiatry, The University of Melbourne and North Western Mental Health, Melbourne, Australia
H. Killaspy
Affiliation:
University College London and Camden and Islington NHS Foundation Trust, London, UK
S. Martino
Affiliation:
South West Area Mental Health Service, Melbourne, Australia
S. White
Affiliation:
Division of Mental Health, St George's University of London, London, UK
S. Priebe
Affiliation:
Barts and The London School of Medicine, London, UK
C. Wright
Affiliation:
Division of Mental Health, St George's University of London and South West London and St George's NHS Mental Health Trust, London, UK
S. Johnson
Affiliation:
University College London and Camden and Islington NHS Foundation Trust, London, UK
*
*Address for correspondence: Dr Carol Harvey, Associate Professor in Psychiatry, Department of Psychiatry, University of Melbourne, Psychosocial Research Centre, 130 Bell St, Coburg, Victoria 3058, Australia. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

The efficacy of Assertive Community Treatment (ACT) is well established in the USA, and to a lesser extent in Australia, whereas UK studies suggest little advantage for ACT over usual care. Implementation of ACT varies and these differences may explain variability in reported efficacy. We aimed to investigate differences in ACT implementation between Melbourne, Australia and London, UK.

Methods.

In a cross-sectional survey, we investigated team organisation, staff and client characteristics from four Melbourne ACT teams using almost identical methods to the Pan London Assertive Outreach studies of 24 ACT teams.

Results.

Client characteristics, staff satisfaction and burnout were very similar. Three of four Melbourne teams made over 70% of client contacts ‘in vivo’ compared to only one-third of comparable London teams, although all teams were rated as ‘ACT-like’. Melbourne teams scored more highly on team approach. Three quarters of clients were admitted in the preceding 2 years but Melbourne clients had shorter stays.

Conclusions.

Differences in the implementation of ‘active components’ of home treatment models that have been associated with better client outcomes (home visiting, team approach) may explain international differences in ACT efficacy. Existing fidelity measures may not adequately weight these important elements of the model.

Keywords

Case managementcommunity mental health servicespatient care teamschizophrenia
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 20 , Issue 2 , June 2011 , pp. 151 - 161
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ash, D, Brown, P, Burvill, P, Davies, J, Hughson, B, Meadows, G, Nagle, T, Rosen, A, Singh, B, Weir, W (2007). Mental health services in the Australian states and territories. In Mental Health in Australia. Collaborative Community Practice (ed. Meadows, G, Singh, B and Grigg, M), pp. 99–131. Oxford University Press: Melbourne, Australia.Google Scholar
Australian Bureau of Statistics (2003). 2001 Census: Socio-Economic Indices for Areas. Australian Bureau of Statistics: Canberra.Google Scholar
Billings, J, Johnson, S, Bebbington, P, Greaves, A, Priebe, S, Muijen, M, Ryrie, I, Watts, J, White, I, Wright, C (2003). Assertive outreach teams in London: staff experiences and perceptions. Pan-London assertive outreach study, part 2. British Journal of Psychiatry 183, 139–147.CrossRefGoogle ScholarPubMed
Bond, GR (1990). Intensive case management. Hospital and Community Psychiatry 41, 927–928.Google ScholarPubMed
Burns, T (2008). Case management and assertive community treatment. What is the difference? Epidemiologia e Psichiatra Sociale 17, 99–105.CrossRefGoogle ScholarPubMed
Burns, T, Catty, J, Dash, M, Roberts, C, Lockwood, A, Marshall, M (2007). Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. British Medical Journal 335, 336–342.CrossRefGoogle ScholarPubMed
Burns, T, Catty, J, Watt, H, Wright, C, Knapp, M, Henderson, J (2002). International differences in home treatment for mental health problems: results of a systematic review. British Journal of Psychiatry 181, 375–382.CrossRefGoogle ScholarPubMed
Burns, T, Creed, F, Fahy, T, Thompson, S, Tryrer, P, White, I (1999). Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet 353, 2185–2189.CrossRefGoogle ScholarPubMed
Catty, J, Burns, T, Knapp, M, Watt, H, Wright, C, Henderson, J, Healey, A (2002). Home treatment for mental health problems: a systematic review. Psychological Medicine 32, 383–401.CrossRefGoogle ScholarPubMed
Chinman, M, Allende, M, Bailey, P, Maust, J, Davidson, L (1999). Therapeutic agents of assertive community treatment. Psychiatric Quarterly 70, 137–162.CrossRefGoogle ScholarPubMed
Commission for Health Improvement (2003). Mental Health Trusts Overview. Available at http://www.chi.nhs.uk/Ratings/Trust/results/indicatorResults.asp?indicatorId=3566 (retrieved 25 May 2007).Google Scholar
Davidson, G, Campbell, J (2007). An examination of the use of coercion by assertive outreach and community mental health teams in Northern Ireland. British Journal of Social Work 37, 537–555.CrossRefGoogle Scholar
De Jong, A, van der Lubbe, PM, Wiersma, D (1996). Social dysfunction in rehabilitation: classification and assessment. In Handbook of Mental Health Economics and Health Policy. Volume I: Schizophrenia (ed. Moscarelli, M, Rupp, A and Sartorius, N), pp. 27–38. John Wiley and Sons: Chichester.Google Scholar
Department of Health (1999). National Service Framework for Mental Health: Modern Standards and Service Models. Her Majesty's Stationery Office: London.Google Scholar
Department of Health (2001). The Mental Health Policy Implementation Guide. Her Majesty's Stationery Office: London.Google Scholar
Department of Health (2004). Hospital Activity Data. Available at http://www.performance.doh.gov.uk/hospitalactivity/index.htm (retrieved 25 May 2007).Google Scholar
Drake, RE, McHugo, GJ, Becker, DR, Anthony, WA, Clark, RE (1996). The New Hampshire study of supported employment for people with severe mental illness. Journal of Consulting and Clinical Psychology 64, 391–399.CrossRefGoogle ScholarPubMed
Fakhoury, W, White, I, Priebe, S, PLAO Study Group (2007). Be good to your patient: how the therapeutic relationship in the treatment of patients admitted to assertive outreach affects re-hospitalisation. Journal of Nervous and Mental Disease 195, 789–791.CrossRefGoogle Scholar
Fiander, M, Burns, T, McHugo, GJ, Drake, RE (2003). Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA. British Journal of Psychiatry 182, 248–254.CrossRefGoogle ScholarPubMed
Glover, GR, Robin, E, Emami, J, Arabscheibani, GR (1998). A needs index for mental health care. Social Psychiatry and Psychiatric Epidemiology 33, 89–96.CrossRefGoogle ScholarPubMed
Hackman, JR, Oldham, GR (1975). Development of the job diagnostic survey. Journal of Applied Psychology 60, 159–170.CrossRefGoogle Scholar
Hambridge, JA, Rosen, A (1994). Assertive community treatment for the seriously mentally ill in suburban Sydney: a programme description and evaluation. Australian and New Zealand Journal of Psychiatry 28, 438–445.CrossRefGoogle Scholar
Holloway, F, Carson, J (1998). Intensive case management for the severely mentally ill. Controlled Trial. British Journal of Psychiatry 172, 19–22.CrossRefGoogle ScholarPubMed
Hoult, J (1986). Community care of the acutely mentally ill. British Journal of Psychiatry 149, 137–144.CrossRefGoogle ScholarPubMed
Issakidis, C, Sanderson, K, Teeson, M, Johnson, S, Buhrich, N (1999). Intensive case management in Australia: a randomized controlled trial. Acta Psychiatrica Scandinavica 99, 360–367.CrossRefGoogle ScholarPubMed
Killaspy, H (2007). Assertive community treatment in psychiatry. British Medical Journal 335, 311–312.CrossRefGoogle ScholarPubMed
Killaspy, H, Bebbington, P, Blizard, R, Johnson, S, Nolan, F, Pilling, S, King, M (2006). The REACT study: randomised evaluation of assertive community treatment in north London. British Medical Journal 332, 815–820.CrossRefGoogle ScholarPubMed
Killaspy, H, Johnson, S, Pierce, B, Bebbington, P, Pilling, S, Nolan, F, King, M (2009). Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial. Social Psychiatry and Psychiatric Epidemiology 44, 532–540.CrossRefGoogle ScholarPubMed
Marshall, M (2008). What have we learnt from 40 years of research on intensive case management? Epidemiologia e Psichiatra Sociale 17, 106–109.CrossRefGoogle ScholarPubMed
Marshall, M, Lockwood, A (1998). Assertive Community Treatment for People with Severe Mental Disorders (Review). The Cochrane Library, Issue 2. John Wiley and Sons: Oxford.Google Scholar
Maslach, C, Jackson, SE, Leiter, MP (1996). The Maslach Burnout Inventory. Consulting Psychologists Press: Palo Alto, CA.Google Scholar
McHugo, GJ, Drake, RE, Whitley, R, Bond, GR, Campbell, K, Rapp, CA, Goldman, HH, Lutz, WJ, Finnerty, MT (2007). Fidelity outcomes in the national implementing evidence-based practices project. Psychiatric Services 58, 1279–1284.CrossRefGoogle ScholarPubMed
Muirhead, D, Harvey, C, Ingram, G (2006). Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: clinical outcomes. Australian and New Zealand Journal of Psychiatry 40, 596–605.CrossRefGoogle ScholarPubMed
Phillips, SD, Burns, BJ, Edgar, ER, Mueser, KT, Linkins, KW, Rosenheck, RA, Drake, RE, McDonel Herr, EC (2001). Moving assertive community treatment into standard practice. Psychiatric Services 52, 771–779.CrossRefGoogle ScholarPubMed
Priebe, S, Fakhoury, W, Watts, J, Bebbington, P, Burns, T, Johnson, S, Muijen, M, Ryrie, I, White, I, Wright, C (2003). Assertive outreach teams in London: patient characteristics and outcomes. Pan-London Assertive Outreach Study, part 3. British Journal of Psychiatry 183, 148–154.CrossRefGoogle ScholarPubMed
Priebe, S, Gruyters, T (1993). The role of the helping alliance in psychiatric community care: a prospective study. Journal of Nervous and Mental Disease 181, 552–557.CrossRefGoogle ScholarPubMed
Priebe, S, Watts, J, Chase, M, Matanov, A (2005). Processes of disengagement and engagement in assertive outreach patients: qualitative study. British Journal of Psychiatry 187, 438–443.CrossRefGoogle ScholarPubMed
Ruggeri, M, Tansella, M (2008). Editorials: case management or assertive community treatment: are they really alternative approaches? Epidemiologia e Psichiatra Sociale 17, 93–98.CrossRefGoogle ScholarPubMed
Salyers, MP, Bond, GR, Teague, GB, Cox, JF, Smith, ME, Hicks, ML, Koop, JI (2003). Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. Journal of Behavioral Health Services and Research 30, 304–320.CrossRefGoogle ScholarPubMed
SPSS (2006). SPSS for Windows, Version 14.0.2. SPSS Inc.: Chicago, IL.Google Scholar
Stata Corporation (2003). Stata Release 8.0. Stata Corporation: College Station, TX.Google Scholar
Stein, LI, Test, MA (1980). Alternatives to mental hospital treatment. Archives of General Psychiatry 37, 392–397.CrossRefGoogle ScholarPubMed
Sytema, S (1991). Social indicators and psychiatric admission rates: a case-register study in the Netherlands. Psychological Medicine 21, 177–184.CrossRefGoogle Scholar
Sytema, S, Wunderink, L, Bloemers, W, Roorda, L, Wiersma, D (2007). Assertive community treatment in the Netherlands: a randomized controlled trial. Acta Psychiatrica Scandinavica 116, 105–112.CrossRefGoogle ScholarPubMed
Teague, G, Bond, G, Drake, R (1998). Program fidelity in assertive community treatment: development and use of a measure. American Journal of Orthopsychiatry 68, 216–232.CrossRefGoogle ScholarPubMed
Thornicroft, G, Strathdee, G, Phelan, M, Holloway, F, Wykes, T, Dunn, G, McCrone, P, Leese, M, Johnson, S, Szmukler, G (1998 a). Rationale and design. PRiSM psychosis study 1. British Journal of Psychiatry 173, 363–370.CrossRefGoogle Scholar
Thornicroft, G, Wykes, T, Holloway, F, Johnson, S, Szmukler, G (1998 b). From efficacy to effectiveness in community mental health services. PRiSM Psychosis Study 10. British Journal of Psychiatry 173, 423–427.CrossRefGoogle ScholarPubMed
Tyrer, P (2000). Are small case-loads beautiful in severe mental illness? British Journal of Psychiatry 177, 386–387.CrossRefGoogle ScholarPubMed
UK 700 Group (1999). Comparison of intensive and standard case management for patients with psychosis: rationale of the trial. British Journal of Psychiatry 174, 74–78.CrossRefGoogle Scholar
Weaver, T, Tyrer, P, Ritchie, J, Renton, A (2003). Assessing the value of assertive outreach. Qualitative study of process and outcome generation in the UK700 trial. British Journal of Psychiatry 183, 437–445.CrossRefGoogle ScholarPubMed
Weiss, DJ, Dawis, RV, England, GW, Lofquist, LH (1967). Manual for the Minnesota Satisfaction Questionnaire. Minnesota Studies in Vocational Rehabilitation: XXII. Minneapolis, University of Minnesota, Industrial Relations Center Work Adjustment Project.Google Scholar
Wright, C, Burns, T, James, P, Billings, J, Johnson, S, Muijen, M, Priebe, S, Ryrie, I, Watts, J, White, I (2003). Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, part 1. British Journal of Psychiatry 183, 132–138.CrossRefGoogle ScholarPubMed