Deinstitutionalization in the Netherlands and the effectiveness of act to maintain contact with the severe mentally ill

Abstract

Background and Aims

Deinstitutionalisation may put part of the severe mentally ill patients at risk to deteriorate in the community, mainly because they are difficult to engage with services. Assertive community treatment (ACT) is widely seen as an adequate answer for these difficult to engage patients. ACT is now rapidly implemented in many European mental health services, but recently the evidence base is questioned. Positive results of randomised trials in the US could not be replicated in the UK.

Method

In Groningen (The Netherlands) a psychiatric case register (PCR) is in operation since 1986, and now covers a catchment area of 1.6 million inhabitants. It is a perfect tool to study the transition from inpatient to community care.

We did a randomized controlled trial (RCT) to study the effectiveness of the first ACT team in our region, using the PCR to measure primary outcomes. It is the only RCT of ACT in the Netherlands. In total 118 patients were randomized to two conditions. The primary research questions were:

1. • Is ACT better than standard care in maintaining contact with patients?

2. • Is ACT better than standard care in reducing the use of inpatient care?

Results

ACT was superior in engaging patients to services, but no effect on the use of inpatient beds were found. Moreover, we did not find benefits in functioning, quality of life and unmet needs.

Conclusions

Too many patients are lost in standard care and therefore we highly value the sustained contact ability of ACT.