Hospitalisation of severely mentally ill patients with and without problematic substance use before and during Assertive Community Treatment: an observational cohort study.

Hanne Clausen,Robert E Drake,Torleif Ruud,Helen Killaspy,Hanne Kilen Stuen,Kristin Sverdvik Heiervang,Sigrun Odden,Jūratė Šaltytė Benth,Anne Landheim

doi:10.1186/s12888-016-0826-5

Abstract

BackgroundCo-occurring substance use increases the risk of hospitalisation in people with severe mental illness, whereas Assertive Community Treatment (ACT) generally reduces hospitalisation in patients with severe mental illness and high inpatient service use. Because the superiority of ACT over standard services amongst patients with problematic substance use is uncertain, the present study examined inpatient service use amongst patients with and without problematic substance use in the 2 years before and the 2 years after they enrolled into ACT teams.MethodsThis naturalistic observational study included 142 patients of 12 different ACT teams throughout Norway. The teams assessed the patients upon enrolment into ACT using clinician-rated and self-reported questionnaires. We obtained hospitalisation data from the Norwegian Patient Register for the 2 years before and the 2 years after enrolment into ACT. We used linear mixed models to assess changes in hospitalisation and to explore associations between problematic substance use and changes in hospitalisation, controlling for socio-demographic and clinical characteristics.ResultsA total of 84 (59 %) participants had problematic substance use upon enrolment into the ACT teams. In the 2 years after ACT enrolment both participants with and without problematic substance use experienced a reduction in total inpatient days. Those with problematic substance use also had fewer involuntary inpatient days. Exploratory analyses suggested that symptom severity and functioning level interacted with problematic substance use to influence change in total inpatient days.ConclusionThese findings may suggest that ACT teams successfully support people with complex mental health problems in the community, including those with problematic substance use, and thereby contribute to a reduction in inpatient service use.

Highlights

Co-occurring substance use increases the risk of hospitalisation in people with severe mental illness, whereas Assertive Community Treatment (ACT) generally reduces hospitalisation in patients with severe mental illness and high inpatient service use
For participants who had not completed the Alcohol Use Disorder Identification Test (AUDIT) and Drug Use Disorder Identification Test (DUDIT) (n = 12, 8 %) or who had a score below cutoff (n = 58, 41 %), we added the clinician-rated Alcohol Use Scale (AUS) and Drug Use Scale (DUS)
For nine participants the clinicians gave a score of 3 or higher on the AUS and/or the DUS, and we classified these participants as having problematic substance use

Summary

Introduction

Co-occurring substance use increases the risk of hospitalisation in people with severe mental illness, whereas Assertive Community Treatment (ACT) generally reduces hospitalisation in patients with severe mental illness and high inpatient service use. Assertive Community Treatment (ACT) is an intensive, multidisciplinary, community-based mental health service model that reduces hospitalisation amongst people with severe mental illnesses, such as schizophrenia, that are high users of inpatient care [9]. Do not engage successfully with standard mental health services [10], and experience recurrent cycles of relapse, hospital readmissions [10, 11], and high use of inpatient services [9, 12, 13]. The prevalence of current substance abuse in ACT populations ranges from 49 to 72 % [15,16,17,18], higher than other mental health outpatient groups

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Conclusion