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Assertive community treatment: keeping what works

Published online by Cambridge University Press:  02 January 2018

Loopinder Sood  and
Andy Owen
Loopinder Sood
Affiliation:
Community psychiatry and Warwickshire NHS Partnership Trust, St Michael's Hospital, Warwick, UK, email: [email protected]
Andy Owen
Affiliation:
Community psychiatry, Coventry and Warwickshire NHS Partnership Trust, St Michael's Hospital, Warwick, UK
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Abstract

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The Psychiatric Bulletin , Volume 38 , Issue 1 , February 2014 , pp. 46
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2014

The excellent editorial by Rosen et al Reference Rosen, Killaspy and Harvey1 highlights the dilution of assertive community treatment (ACT) research in European settings, leading to a failure to demonstrate reductions in bed use in efficacy studies. Effectiveness studies in the UK have shown that ACT leads to reductions in bed use. Reference Mortimer, Shepherd, Fadahunsi, Jones, Kumar and Gangaram2,Reference Rana and Commander3 Furthermore, our experience of 93 patients followed up for a mean of 6.5 years after starting ACTshowed a reduction from a mean of 72 days per year prior to ACT to 44 days per year during ACT (P=0.002). Repeated measures using the Dartmouth Assertive Outreach Fidelity Scale Reference Teague, Bond and Drake4 demonstrated the team had high fidelity to the assertive outreach model.

The evidence supports the importance of trying to incorporate the effective components of ACT into new services. Despite these benefits, ACT teams continue to be dismantled.

References

1 Rosen, A, Killaspy, H, Harvey, C. Specialisation and marginalisation: how the assertive community treatment debate affects individuals with complex mental health needs. Psychiatrist 2013; 37: 345–8.Google Scholar
2 Mortimer, AM, Shepherd, CJ, Fadahunsi, A, Jones, A, Kumar, P, Gangaram, P. Assertive outreach: mirror-image study with contemporaneous controls. Psychiatrist 2012; 36: 245–8.CrossRefGoogle Scholar
3 Rana, T, Commander, M. Long-term follow-up of individuals on assertive outreach teams. Psychiatrist 2010; 34: 88–91.Google Scholar
4 Teague, GB, Bond, GR, Drake, RE. Program fidelity in assertive community treatment: development and use of a measure. Am J Orthopsychiatry 1998; 68: 216–32.Google Scholar
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