Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia

Zavradashvili, Nana; Donisi, Valeria; Grigoletti, Laura; Pertile, Riccardo; Gelashvili, Ketevan; Eliashvili, M.; Amaddeo, Francesco

doi:10.1007/s00127-009-0125-2

Cited by 11 publications

(7 citation statements)

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“…Yet, in Lausanne, Switzerland, a retrospective study 6 has shown a positive impact of an ACT program on hospitalization rate and clinical and social outcomes. Also, the establishment of ACT in low‐income countries may be beneficial 7 . These apparently contradictory findings may be related to the characteristics of patients included, and/or to the comparative ambulatory treatments offered, which may in some places be better than the ‘older care’ which was offered as a control treatment in the older trials 5 …”

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confidence: 99%

Effects of an assertive community program in patients with severe mental disorders and impact on their families

Huguelet

Koellner

Boulguy

et al. 2012

Psychiatry Clin Neurosci

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Aims: Assertive community treatment (ACT) is known to have a positive impact on the number and length of inpatient stays. However, recent studies have shown little or no effect of such programs in European settings. This paper aims to describe the impact of a newly implemented ACT program on patients and their families' burden. Predictive factors have also been examined. Method: Fifty‐five patients characterized by heavy use of psychiatric care, numerous hospitalizations, or failure to link with outpatient psychiatric care and their relatives were followed. Data were gathered on patients before and after follow up as well as on relatives' burden and costs. The number and domains of clinician interventions have been detailed. Results: The ACT program had a positive effect on symptoms, psychosocial adaptation and quality of life. Age was the most significant predictor of changes. Older patients, most of them suffering from delusional disorders, showed no improvement or even some impairment. Finally, the program appeared to have a marked effect on easing families' burden in domains such as assistance in daily life activities and costs. Conclusions: ACT appears to be recommended for patients with poor outcome when treated in other settings. Early intervention seems to be justified as highlighted by younger age being the best predictor of positive changes. Families can be helped considerably, particularly those confronted with patients with persistent disturbing symptoms which do not, however, warrant hospitalization. Finally, the fact that patients with delusional disorder do not seem to improve warrants further research.

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confidence: 99%

Effects of an assertive community program in patients with severe mental disorders and impact on their families

Huguelet

Koellner

Boulguy

et al. 2012

Psychiatry Clin Neurosci

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“…Auch in den letzten Jahren liegt der Schwerpunkt gesundheitsökonomischer Analysen überwiegend in der Bewertung spezifischer gemeindepsychiatrischer Behandlungsformen, insbesondere auf der Basis des ACT-Ansatzes [5,24,39,40], aber auch zur Krisenintervention [9,23] und zur Frühintervention bei Psychoseerkrankungen [22,25]. Aktuelle Studien zur Kosteneffektivität von ACT-Programmen in Großbritannien [4,23,24], Polen [39], Georgien [40] und den USA [5] zeigen, dass diese im Vergleich zur Routinebehandlung in der Regel zu einer Erhöhung der ambulanten psychiatrischen Versorgungskosten führen und dass diese höheren ambulanten Kosten nur dann durch eine gleichzeitige Reduzierung stationärer Behandlungskosten ausgeglichen werden ("cost offset"), wenn es sich bei der Untersuchungspopulation um Patienten mit einem besonders hohen Hospitalisierungsrisiko handelt, wie z.…”

Section: Aktuelle Entwicklungenunclassified

“…Aktuelle Studien zur Kosteneffektivität von ACT-Programmen in Großbritannien [4,23,24], Polen [39], Georgien [40] und den USA [5] zeigen, dass diese im Vergleich zur Routinebehandlung in der Regel zu einer Erhöhung der ambulanten psychiatrischen Versorgungskosten führen und dass diese höheren ambulanten Kosten nur dann durch eine gleichzeitige Reduzierung stationärer Behandlungskosten ausgeglichen werden ("cost offset"), wenn es sich bei der Untersuchungspopulation um Patienten mit einem besonders hohen Hospitalisierungsrisiko handelt, wie z. B. im Fall der von Cusack et al [5] untersuchten psychisch kranken Straftäter.…”

Section: Aktuelle Entwicklungenunclassified

“…B. im Fall der von Cusack et al [5] untersuchten psychisch kranken Straftäter. Demgegenüber zeigen die Untersuchungen, bei denen neben den Kosten auch die Ergebnisse der ACT-Programme einbezogen werden, dass diese entweder mit einer Erhöhung der Behandlungszufriedenheit [24] oder mit einer Verbesserung klinischer Merkmale [4,40] verbunden sind.…”

Section: Aktuelle Entwicklungenunclassified

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Health economic evaluation of community-based psychiatric interventions

Kilian

2012

Nervenarzt

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The health economic evaluation of community mental health interventions can contribute to an optimization of the allocation of mental health care resources. Existing studies on the health economic evaluation of community mental health interventions include a wide range of treatment options from the deinstitutionalization of long-term inpatients into community-based services to specialized services for specific patient groups. The results of these studies indicate that community-based mental health care is not generally less costly in comparison to more institutionalized forms of care. Programs that are based on the ACT approach have been found to be more efficient than inpatient care. Compared to the current standard of mental health care in most western European countries, an intensification of community mental health interventions could increase the efficiency of psychiatric treatment especially for heavy users and first episode patients. However, methodological flaws and a lack of national studies limit the validity of current health economic investigations, particularly for Germany.

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“…The results demonstrated that such a programme could potentially reduce rates of hospitalization, homelessness and imprisonment and increase employment. Another single group pre‐post study of 24 MHC investigated the outcomes of an ICMHS programme in Georgia (Zavradashvili et al, 2010). The results showed that a high‐quality ICMHS was feasible and could cost less than the usual treatment and inpatient care, while apparently improving clinical and social outcomes.…”

Section: Introductionmentioning

confidence: 99%

Walking with the illness and life: Experience of the community life of people previously under the services of an integrated community mental health service

Chiang

Chien

Wan³

et al. 2020

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? There have been some studies on the experience and community life of mental health clients receiving integrated community mental health service (ICMHS). Evaluation of ICMHS suggests that the service could have positive clinical and social outcomes, but the results are inconclusive. What does the paper add to existing knowledge? Research studies have focused on clients and/or staff of the ICMHS, while in this study, the experiences and perspectives of family members are also explored. More comprehensive knowledge about the work for, and community life of, people previously under the services of ICMHS is added to the existing knowledge. This study found that with “timely support” and “family presence,” people who had received the services of ICMHS continued to engage in more social activities (“expanding social networks”), had “better family relationships,” were “letting go” of thinking too much and more able to relax, and had “better self‐efficacy and self‐caring” in the community. Professional contact after ICMHS through continuous conversations (e.g. home visits and follow‐up calls) and social activities are essential for both clients and their families to carry on living with the illness. Timely support, family presence, support to family members in the community and better social networks are key experiences of ICMHS clients. What are the implications for practice? Although the ICMHS’ resources are limited, better promotion is urgently needed for the public to realize the services and to support mental health clients. Mental health professionals may develop practice models through exploratory and confirmatory factors analyses of the themes identified from this study as the outcome measures. The cost‐effectiveness of services and relapse rates over time should also be evaluated for future practice development. Further studies for practice on the difference that family support can make to the community life of former ICMHS clients are warranted. This may be achieved through research designs that compare people with, and without, family members. Abstract IntroductionMore comprehensive understanding, from the experiences and multiple perspectives of the clients, families and staff, about the community life of former clients of the integrated community mental health service (ICMHS) is scarce. AimTo explore the community life experiences of people after their discharge from the ICMHS. MethodA qualitative approach with an interpretative phenomenological analysis was utilized for this study. Data were collected through individual semi‐structured interviews of 37 participants, including people discharged from an Integrated Community Centre of Mental Wellness, their family members and staff members. ResultsSix themes emerged from the analysis: “timely support,” “family presence,” “better family relationships,” “expanding social networks,” “letting go” and “better self‐efficacy and self‐care,” under the main theme of “walking with the illness and life.” Discuss...

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Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia

Abstract: High-quality community care costs less than usual treatment and inpatient care and seems to be effective to improve clinical and social outcomes; for these reasons, policymakers should consider, in their future mental health reforms, allocating more resources to community-based care.

Cited by 11 publications

References 8 publications

Effects of an assertive community program in patients with severe mental disorders and impact on their families

Effects of an assertive community program in patients with severe mental disorders and impact on their families

Health economic evaluation of community-based psychiatric interventions

Walking with the illness and life: Experience of the community life of people previously under the services of an integrated community mental health service

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