Assertive Community Treatment Teams Research Articles

Feasibility and Usefulness of Training Assertive Community Treatment Team in Cognitive Behavioral Therapy

Individuals with Serious mental illness require psychosocial treatments as adjunct to pharmacotherapy to promote recovery. An ACT team was trained in CBT interventions and charts were reviewed to identify sessions where CBT was utilized. Subjects who received at least 3 sessions of CBT went from 10% before training to 44% after training and 54% in the follow up period. All team members including bachelor's level staff provided CBT interventions. Results show that ACT Team members including those at bachelor's level can be trained in CBT and they utilize these interventions after training is completed.

Perceptions of Coercion in the Community: A Qualitative Study of Patients in a Danish Assertive Community Treatment Team

Assertive community treatment (ACT) has been claimed to be paternalistic and coercive, yet little is known about how patients experience the assertive aspects of ACT. To explore views on--and perceptions of--coercion of patients in Danish assertive community teams. In-depth interviews were conducted with six purposefully selected patients and analysed using thematic analysis. Patients reported lack of influence on treatment process and a poor alliance with case-mangers, not being recognised as an autonomous person, and experiences of staff crossing the line and intruding privacy, as most central to perceptions of coercion. A collaborative and mutually trusting relationship, commitment, persistence and availability of staff, and recognition of the need for social support and help with everyday activities, were most important for counteracting such experiences. Perceptions of coercion were not emphasised in patients' account of their engagement with ACT, and generally only related to patients' initial contact with ACT staff. The study suggests that developing mental health practices that enhance the formation of a therapeutic relationship with patients will minimize circumstances that induce perceptions of coercion. ACT, with its engaged and committed staff with sufficient time, focusing on social and practical issues, is successful in facilitating such a contact, as experienced by patients.

Use of Integrated Dual Disorder Treatment Via Assertive Community Treatment Versus Clinical Case Management for Persons With Co-Occurring Disorders and Antisocial Personality Disorder

We conducted secondary analyses of data from a randomized trial testing the effectiveness of Assertive Community Treatment (ACT) in delivery of integrated dual disorder treatment (IDDT) to explore the impact of IDDT delivered through ACT teams compared with standard clinical case management for dually-disordered persons with and without antisocial personality disorder (ASPD). This analysis included 36 individuals with ASPD and 88 individuals without ASPD. Participants with ASPD assigned to ACT showed a significantly greater reduction in alcohol use and were less likely to go to jail than those in standard clinical case management, whereas participants without ASPD did not differ between the 2 case management approaches. There were no significant differences for other substance use or criminal justice outcomes. This study provides preliminary evidence that persons with co-occurring serious mental illness, substance use disorders, and ASPD may benefit from delivery of IDDT through ACT teams.

New Models of Collaboration Between Criminal Justice and Mental Health Systems

New Models of Collaboration Between Criminal Justice and Mental Health Systems

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterA. George Awad M.D., Ph.D.Lakshmi N. P. Voruganti M.D., Ph.D.A. George Awad M.D., Ph.D.Search for more papers by this authorLakshmi N. P. Voruganti M.D., Ph.D.Search for more papers by this authorPublished Online:1 Nov 2009https://doi.org/10.1176/ps.2009.60.11.1558AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Satisfaction as an Outcome MeasureTo the Editor: We would like to take issue with Dr. Norquist's ( 1 ) July Taking Issue commentary, "Contented but Not Better: Problems With Satisfaction." His comments about the study by McCrone and colleagues ( 2 ), which used satisfaction as a primary outcome measure in a cost analysis of assertive community treatment teams in London, raised two important issues: the precision of satisfaction as a concept and its utility for policy decisions. His comments ignore an extensive literature that has refined the concept of satisfaction and has demonstrated the role of satisfaction as an indicator of health care quality ( 3 ). Recently, satisfaction has been successfully used as a primary outcome in clinical antipsychotic trials (Canuso C, Grinspan A, Merriman C, et al., unpublished manuscript, 2009). Satisfaction as a multidimensional construct captures the essence of what patients, clinicians, policy makers, and taxpayers hope to achieve ( 4 ). Thus we disagree with the thrust of Dr. Norquist's comments, which for some readers will raise doubts about such subjective constructs. We do agree that it would have been more informative if McCrone and colleagues had taken a multidimensional approach in addition to using a global measure of satisfaction. Several studies in the oncology field, as well as our studies of quality of life, have demonstrated the reliability of global measures. Although global measures capture patients' preferences, we agree that they do not provide information about factors that contribute to the genesis of the construct of satisfaction. Measures assessing satisfaction must be specifically focused. We have demonstrated that most psychiatric patients are able to focus on questions about satisfaction with the care they receive and are reliably and consistently able to express their inner feelings and their level of satisfaction ( 4 ). Uncritical acceptance of the notion that psychiatric patients are unreliable in expressing their inner feelings can set the field back 30 years. The paradox is that when psychiatric patients report their hallucinations and delusional experiences, which are subjective in nature, they are believed and their reports are taken to be valid in making a diagnosis. When we submitted our first paper in the mid-1970s, which presented data about negative subjective responses to antipsychotics, the editor returned the manuscript with a polite comment that the reviewers considered the subject as "soft science." It took several years for the concept of measuring subjective responses to antipsychotics to become well-established, mainstream clinical practice, and the practice has been further supported by dopamine neuroimaging studies. We agree that satisfaction as a construct requires continued refinement and more understanding of its components. However, administrators and policy makers who pay no attention to patients' dissatisfaction with therapeutic interventions should not be surprised when these interventions fail. We are afraid that Dr. Norquist's comments could discourage research and once more relegate subjective experiences such as satisfaction to the realm of "soft science." We do not doubt that many of our patients will never be contented unless they feel better.

The Role of Patient Activation in Psychiatric Visits

The Role of Patient Activation in Psychiatric Visits

Treatment Outcome in Patients Receiving Assertive Community Treatment

In an observational study of severely mentally ill patients treated in assertive community treatment (ACT) teams, we investigated how treatment outcome was associated with demographic factors, clinical factors, and motivation for treatment. To determine psychosocial outcome, patients were routinely assessed using the Health of the Nation Outcome Scales (HoNOS). Trends over time were analyzed using a mixed model with repeated measures. The HoNOS total score was modeled as a function of treatment duration and patient-dependent covariates. Data comprised 637 assessments of 139 patients; mean duration of follow-up was 27.4 months (SD = 5.4). Substance abuse, higher age, problems with motivation, and lower educational level were associated with higher HoNOS total scores (i.e., worse outcome). To improve treatment outcome, we recommend better implementation of ACT, and also the implementation of additional programs targeting subgroups which seem to benefit less from ACT.

Clinical Pharmacist Interventions on an Assertive Community Treatment Team

Assertive Community Treatment (ACT) is a community-based treatment approach intended to help in the recovery and rehabilitation of clients with severe and persistent mental illnesses. A clinical pharmacist is not routinely a member of an ACT team. The purpose of this study is to demonstrate the role of a pharmacist by reviewing recommendations and interventions made by a clinical pharmacist on an ACT team. Information was gathered through a chart review of clients at Community Alternatives in St. Louis, Missouri. All recommendations and interventions performed by the clinical pharmacist between February 1, 2008 and July 31, 2008 were recorded. A total of 341 interventions and recommendations for 29 clients were completed by the pharmacist. Medication management, medication adjustment recommendations, and mental health assessments were the most frequent interventions. This study suggests a clinical pharmacist can be beneficial to an ACT team and provide diverse services to both clients and other team members.

Schizophrenia: 1979-2009

Background: As more becomes known about the complex causation of schizophrenia, the variability of treatment response, and the effectiveness of preventive measures, treatments are likely to change. Methods: A standard regimen from a review article written in 1979 is examined and compared to currently recommended practice, thirty years later. Results: Over this period, there have been many small changes and some very significant improvements: attitudes toward families of patients have altered; patient autonomy has increased; early intervention, assertive community treatment teams, psychoeducation, and cognitive behavioral therapy have all been introduced in the last thirty years. Recovery (defined variously, but with a focus on counteracting disability and enhancing self-determination in the face of stigma), rather than symptom reduction, has become the main aim of treatment. Conclusions: Despite many changes, the overall health of patients with schizophrenia is poor and mortality rates are excessive. Impr...

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterErik Roskes M.D.Erik Roskes M.D.Search for more papers by this authorPublished Online:1 Sep 2009https://doi.org/10.1176/ps.2009.60.9.1273AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleThe Role of Coercion in Public Mental Health PracticeTo the Editor: In the July issue Moser and Bond ( 1 ) raise the important question of coercion in public mental health practice. Unfortunately, their article misses several important points. First, the word "forensic" does not appear in the article. Most states are dealing with expanding populations of justice-involved consumers in inpatient and outpatient services. For example, at the hospital where I work, the forensic population has increased from 28% in 2003 to 65% currently. Assertive community treatment teams, the article's focus, are often used as a promising approach to complex, justice-involved patients ( 2 ). It would be helpful to know the percentage of consumers in the programs studied who had court involvement, because the criminal justice system is inherently coercive. Clinical teams wishing to avoid coercive interventions often are avoiding collaboration with the justice system, exacerbating the problem of criminalization. Second, coercion is a continuous variable, is relative, and is an important, if unstated, aspect of every relationship. Usually, the choice is not between X or not X (where X is the undesired intervention) but rather between X and Y (where both X and Y are undesired interventions).For example, the authors erroneously state that "[d]epot injections of antipsychotic medication, often used with resistant and nonadherent consumers, virtually eliminate choice for two to four weeks." Injections may in fact be required by providers or a court as a condition of outpatient treatment. The consumer can accept the injections or refuse them and remain hospitalized.Furthermore, even assuming for argument's sake that injection removes choice, it removes only one choice—that of taking medication. The consumer retains many other options, such as where to live and what sort of food to eat. The consumer also has the option to refuse the injection, albeit with possible adverse consequences. This is no different from an employee's refusal to comply with an undesired directive, albeit on pain of losing his or her job.In addition, many coercive interventions require assessment of decision-making capacity (such as the ability to manage funds effectively in assignment of a representative payee) or of dangerousness (in civil commitment). The authors ignore this issue. Third, the authors found that the strongest predictors of a team's use of coercive interventions were the percentage of consumers with schizophrenia spectrum disorders and with active substance use. Both groups of disorders are associated with poor insight and denial of illness ( 3 , 4 ). Such individuals are prime candidates for involuntary interventions, and it is not surprising that these two factors predict use of coercive interventions. Finally, the authors do not comment on outcomes of treatment provided with and without coercion for similar groups of patients. This is the most important area for future study: are coercive interventions useful in changing a person's life course? If they are, they will continue to be used, regardless of how uncomfortable the idea of coercion makes us. The authors are correct when they conclude that "excessive use of control should be cause for concern," but they leave us in the dark about the line between appropriate and excessive use of coercive interventions.Dr. Roskes is director of forensic treatment at Springfield Hospital Center, Sykesville, Maryland.

Can a Nurse Practitioner Serve in the Prescriber Role on an Assertive Community Treatment Team?

Background: In the assertive community treatment (ACT) model, the psychiatrist's role on the team has been considered a critical one. Recently, some observers have suggested that the psychiatrist role as medication prescriber could be filled with a nurse-practitioner. Methods: Using surveys, interviews, and assessments of program fidelity, we examined the relative effectiveness of nurse-practitioner as prescriber, comparing two ACT teams, one employing a psychiatrist and the other a nurse-practitioner. Findings: At the organizational level, the ACT team with a nurse-practitioner (ACT-NP) had substantially better fidelity to evidence-based medication management standards than did the ACT team with a psychiatrist (ACT-MD) whereas both teams had low fidelity to medication management standards at the level of the individual prescriber (although similar to average fidelity in a national sample of mental health–center psychiatrists). Prescriber interviews revealed that the psychiatrist and nurse-practitioner ha...

Initiative to Build a Community-Based Mental Health System Including Assertive Community Treatment for People With Severe Mental Illness in Japan

In Japan, although the locus of care is still predominantly in psychiatric hospitals, a growing number of mental health service providers have become engaged in promoting community integration of people with severe mental illness. This paper describes an ongoing initiative to build a mental health and social services system, which is viewed as a model for other Japanese communities in creating support for people with severe mental illness. This initiative consists of two projects: development and evaluation of an assertive community treatment (ACT) team located in a suburb of Tokyo and a broader community support project in this same community. A pilot evaluation of consumer outcomes for the ACT team demonstrated that ACT is feasible and effective in the Japanese social and cultural context. The community support project was successful in start-up demonstration programs of case management, residential, and supported employment services. Challenges to the expansion of ACT and other community-based services...

A Pilot to Enhance the Recovery Orientation of Assertive Community Treatment Through Peer-Provided Illness Management and Recovery

Assertive community treatment (ACT) is widely regarded as an evidence-based practice (Bond, Drake, Mueser, & Latimer, 2001); however, observers have questioned the recovery orientation of the model. As an organizational model of service delivery, the recovery orientation of ACT can be improved through the integration of other, more clinically defined evidence-based practices. We present findings from an uncontrolled, 9-month pilot study in which a peer specialist was trained to provide illness management and recovery (IMR) on a well-established ACT team. This pilot included both quantitative measures of knowledge and recovery beliefs, and a qualitative interview with consumers (N = 14) and providers (N = 16). Consumer perceptions of recovery significantly improved, and there was a trend toward increased knowledge. In interviews, consumers and staff reported many benefits of IMR, including an increase in consumers' trying new things, being involved in more meaningful activities, and greater hope (for consu...

Scope of Agency Control: Assertive Community Treatment Teams' Supervision of Consumers

Assertive community treatment teams have been criticized as being inherently coercive; however, base rates of control practices used by teams have not been well documented. The purpose of this study was to assess the rates at which different forms of agency control, such as involuntary outpatient commitment, representative payeeship, intensive medication monitoring, and agency-supervised housing, were used by assertive community treatment teams. Also examined were program, practitioner, and consumer correlates of agency control practices. A statewide survey was conducted of 23 assertive community treatment teams serving consumers with severe mental illness. Data were collected on both team attributes and practitioner attributes. Extent of agency control was highly variable across sites. Intensive medication monitoring and representative payeeship were the most frequently used agency control practices. The strongest predictor of agency control was having a higher percentage of consumers on the caseload who were diagnosed as having a schizophrenia-spectrum disorder. Fidelity to the assertive community treatment model was not associated with agency control. However, lower quality of basic clinical services (for example, assessment and treatment planning) was associated with greater use of agency-supervised housing. Pessimistic practitioner attitudes were not significantly associated with agency control, but practitioner education was negatively associated with both representative payeeship and intensive medication monitoring. Assertive community treatment teams differed widely in their scope of agency control, and this variation was not associated with fidelity to the model. Consumer characteristics, such as a schizophrenia spectrum disorder and active substance use, were most closely associated with agency control.

Scope of Agency Control: Assertive Community Treatment Teams' Supervision of Consumers

Scope of Agency Control: Assertive Community Treatment Teams' Supervision of Consumers

Contented but Not Better: Problems With Satisfaction

Back to table of contents Next article Taking IssueFull AccessContented but Not Better: Problems With SatisfactionGrayson S. Norquist M.D., M.S.P.H.,Grayson S. Norquist M.D., M.S.P.H.Search for more papers by this author,Published Online:1 Jul 2009https://doi.org/10.1176/ps.2009.60.7.867AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In this issue McCrone and colleagues present the results of a cost analysis of assertive community treatment (ACT) teams in London. Cost data were linked to a primary outcome of client satisfaction. The authors used satisfaction because it was the only measure on which ACT teams differed from standard community treatment teams in the authors' original study. Use of satisfaction as a primary outcome measure raises two important issues: the precision of satisfaction as a concept and its utility for policy decisions.Satisfaction is a measure of a person's reaction to care. Such a reaction combines the individual's comparison to some standard and an emotional component. The problem is that people may not use the same standard for comparison, and emotional reactions differ based on life experiences. Thus it is difficult to develop precise measures that are replicable across populations. Use of a global assessment of satisfaction, although attractive in its simplicity, is fraught with problems. It is not clear whether the score represents satisfaction with overall care or with a particular aspect of it. Measuring specific components of care is critical to obtaining a more accurate picture of what is contributing to a person's satisfaction. One doesn't want to win a popularity contest at the expense of quality of care and improvement in clinical and functional status.A measure of satisfaction is essential to understanding clients' preferences and providing feedback to professionals and managers. However, as a single measure for policy purposes it has significant limitations. It is often unclear which components of satisfaction are critical and which can be affected by changes in the system or in providers' behavior. Multidimensional measures of satisfaction should be used, and specific components that are most important for policy decisions should receive the highest weights. However, policy makers should not rely solely on satisfaction as an indicator of the utility of a given intervention. Information about other factors, such as clinical and functional status, quality of life, and adherence to treatment regimens, is necessary to understand the utility of an intervention, and these other factors may deserve more emphasis.It doesn't seem prudent to use limited health care funds to improve general satisfaction when it is not clear what one is paying to improve and whether improved satisfaction results in a better life for those who receive the care. What if people are satisfied because they have more contact with staff? This implies that one should shift funding to lower-cost health care providers who will meet more frequently with clients. However, clinical and functional status may worsen as a result, and such a decision may lead to far greater costs over the long term.Department of Psychiatry and Human Behavior, University of Mississippi Medical Center FiguresReferencesCited byDetailsCited ByDeterminants of Satisfaction with Services, and Trust in the Information Received in Community Pharmacies: A Comparative Analysis to Foster Pharmaceutical Care Adoption11 May 2021 | Healthcare, Vol. 9, No. 5Visuomenės sveikata, Vol. 28, No. 7LetterPatrick W. Corrigan, Psy.D.Jonathon E. Larson, Ed.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterRobert E. Drake, M.D., Ph.D.Patricia E. Deegan, Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterAndrea Raballo, M.D.Frank Larøi, Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterHarriet P. Lefley, Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterIgnacio David Acevedo-Polakovich, Ph.D.Linda M. Callejas, M.A.Mario Hernandez, Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterA. George Awad, M.D., Ph.D.Lakshmi N. P. Voruganti, M.D., Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterGrayson S. Norquist, M.D., M.S.P.H.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterShannon Gulliver, M.D., M.Phil.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterAnna C. Muriel, M.D., M.P.H.William Pirl, M.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11 Volume 60Issue 7 July, 2009Pages 867-867PSYCHIATRIC SERVICES July 2009 Volume 60 Number 7 Metrics PDF download History Published online 1 July 2009 Published in print 1 July 2009

Contented but Not Better: Problems With Satisfaction

Back to table of contents Next article Taking IssueFull AccessContented but Not Better: Problems With SatisfactionGrayson S. Norquist M.D., M.S.P.H.,Grayson S. Norquist M.D., M.S.P.H.Search for more papers by this author,Published Online:1 Jul 2009https://doi.org/10.1176/ps.2009.60.7.867AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In this issue McCrone and colleagues present the results of a cost analysis of assertive community treatment (ACT) teams in London. Cost data were linked to a primary outcome of client satisfaction. The authors used satisfaction because it was the only measure on which ACT teams differed from standard community treatment teams in the authors' original study. Use of satisfaction as a primary outcome measure raises two important issues: the precision of satisfaction as a concept and its utility for policy decisions.Satisfaction is a measure of a person's reaction to care. Such a reaction combines the individual's comparison to some standard and an emotional component. The problem is that people may not use the same standard for comparison, and emotional reactions differ based on life experiences. Thus it is difficult to develop precise measures that are replicable across populations. Use of a global assessment of satisfaction, although attractive in its simplicity, is fraught with problems. It is not clear whether the score represents satisfaction with overall care or with a particular aspect of it. Measuring specific components of care is critical to obtaining a more accurate picture of what is contributing to a person's satisfaction. One doesn't want to win a popularity contest at the expense of quality of care and improvement in clinical and functional status.A measure of satisfaction is essential to understanding clients' preferences and providing feedback to professionals and managers. However, as a single measure for policy purposes it has significant limitations. It is often unclear which components of satisfaction are critical and which can be affected by changes in the system or in providers' behavior. Multidimensional measures of satisfaction should be used, and specific components that are most important for policy decisions should receive the highest weights. However, policy makers should not rely solely on satisfaction as an indicator of the utility of a given intervention. Information about other factors, such as clinical and functional status, quality of life, and adherence to treatment regimens, is necessary to understand the utility of an intervention, and these other factors may deserve more emphasis.It doesn't seem prudent to use limited health care funds to improve general satisfaction when it is not clear what one is paying to improve and whether improved satisfaction results in a better life for those who receive the care. What if people are satisfied because they have more contact with staff? This implies that one should shift funding to lower-cost health care providers who will meet more frequently with clients. However, clinical and functional status may worsen as a result, and such a decision may lead to far greater costs over the long term.Department of Psychiatry and Human Behavior, University of Mississippi Medical Center FiguresReferencesCited byDetailsCited byDeterminants of Satisfaction with Services, and Trust in the Information Received in Community Pharmacies: A Comparative Analysis to Foster Pharmaceutical Care Adoption11 May 2021 | Healthcare, Vol. 9, No. 5Visuomenės sveikata, Vol. 28, No. 7LetterPatrick W. Corrigan, Psy.D.Jonathon E. Larson, Ed.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterRobert E. Drake, M.D., Ph.D.Patricia E. Deegan, Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterAndrea Raballo, M.D.Frank Larøi, Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterHarriet P. Lefley, Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterIgnacio David Acevedo-Polakovich, Ph.D.Linda M. Callejas, M.A.Mario Hernandez, Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterA. George Awad, M.D., Ph.D.Lakshmi N. P. Voruganti, M.D., Ph.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterGrayson S. Norquist, M.D., M.S.P.H.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterShannon Gulliver, M.D., M.Phil.1 November 2009 | Psychiatric Services, Vol. 60, No. 11LetterAnna C. Muriel, M.D., M.P.H.William Pirl, M.D.1 November 2009 | Psychiatric Services, Vol. 60, No. 11 Volume 60Issue 7 July, 2009Pages 867-867PSYCHIATRIC SERVICES July 2009 Volume 60 Number 7 Metrics PDF download History Published online 1 July 2009 Published in print 1 July 2009

Alternatives to admission for children and adolescents: providing intensive mental healthcare services at home and in communities: what works?

To review the evidence on alternatives to inpatient mental healthcare for children and adolescents requiring intensive treatment for severe and complex mental health problems. Systematic reviews of intensive case management in adult mental healthcare conclude that intensive treatment models such as assertive community treatment and crisis resolution teams improve patient satisfaction and reduce hospital use in some circumstances. The relatively few studies on children suggest that intensive community-based services can be as effective as inpatient care for certain groups. However, the mental health needs of the young people involved in the studies, their social and family circumstances and the context of local mental health provision varied greatly. There is little high-quality research into the effectiveness of alternatives to inpatient care for young people requiring intensive treatment for complex, severe mental health problems. Studies support the use of alternatives to inpatient admission for particular groups of young people and suggest a need for a combination of complementary models of specialist intensive provision. There is insufficient evidence on which to base decisions on which model is best for which group of young people and randomized control studies are urgently needed.

ACT Tailored for Ethnocultural Communities of Metropolitan Toronto

ACT Tailored for Ethnocultural Communities of Metropolitan Toronto

Involuntary admission may support treatment outcome and motivation in patients receiving assertive community treatment

Patients with severe mental illness who are treated in assertive community treatment (ACT) teams are sometimes involuntarily admitted when they are dangerous to themselves or others, and are not motivated for treatment. However, the consequences of involuntary admission in terms of psychosocial outcome and treatment motivation are largely unknown. We hypothesized that involuntary admission would improve psychosocial outcome and not adversely affect their treatment motivation. In the context of routine 6-monthly outcome monitoring in the period January 2003-March 2008, we used the Health of the Nation Outcome Scales (HoNOS) and a motivation-for-treatment scale to assess 260 severely mentally ill patients at risk for involuntary admission. Mixed models with repeated measures were used for data analyses. During the observation period, 77 patients (30%) were involuntarily admitted. Relative to patients who were not involuntarily admitted, these patients improved significantly in HoNOS total scores (F = 17,815, df = 1, p < 0.001) and in motivation for treatment (F = 28.139, df = 1, p < 0.001). Patients who were not involuntarily admitted had better HoNOS and motivation scores at baseline, but did not improve. Involuntary admission in the context of ACT was associated with improvements in psychosocial outcome and motivation for treatment. There are no indications that involuntary admission leads to deterioration in psychosocial outcome or worsening of motivation for treatment.