Reduction of Involuntary Admissions in Patients With Severe Psychotic Disorders Treated in the ACCESS Integrated Care Model Including Therapeutic Assertive Community Treatment

Abstract

Objective: The ACCESS treatment model offers assertive community treatment (ACT) embedded in an integrated care program to patients with severe psychotic disorders. Compared to standard care, it proved to be more effective in terms of service disengagement and other outcomes in patients with psychotic disorders over 12, 24, and 48 months. Many patients with severe mental disorders experience involuntary admissions which can be potentially traumatic. In this study, we assessed the effect of ACT on reducing involuntary admissions over an observation period of 4 years.Method: One hundred seventy-one patients treated in ACCESS were included in this study. The primary outcome was rate of involuntary admissions during 48 months. Secondary outcomes were differences between those with and without involuntary admissions in the 2 years prior to ACCESS regarding change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication non-adherence, and service-disengagement.Results: Of 171 patients, 58 patients (33.9%) were involuntarily admitted to hospital in the past 2 years before entry. During the 4 years of treatment, 16 patients (9.4%) were involuntarily admitted to hospital which was a significantly lower rate compared to the 2 years before inclusion in ACCESS (p < .001). Comparing the two groups, larger improvements in severity of illness (p = .004) and functional status (p = .043) were detected in the group with no history of involuntary admissions. At 4-year follow-up, of the remaining patients, 69.2% (n = 81) were full adherent (p < .001), compared to 18.9% (n = 31) at baseline with no differences between the two groups over the study period (p = .25). Over 4 years, only 13 patients (13.2%) were service-disengaged due to non-practical reasons.Conclusions: In this long-term study, we were able to demonstrate a reduction in involuntary admissions in four treatment years compared to the 2 years prior to admission to the ACCESS model in patients with severe and mostly multiphase schizophrenia spectrum disorders and affective disorders with psychotic features. This may help prevent patients from suffering from a potentially traumatic experience during treatment in the psychiatric system.Clinical Trial Registration:, identifier NCT01888627.

An Observational Study of Telemental Care Delivery and the Context for Involuntary Commitment for Mental Health Patients in a Group of Rural Emergency Departments

“…As a result of the prevalence of suicide risk for both youth and adults in this study, OP care was less likely to be recommended at ED discharge, and ED LOS was fairly long for those needing IP admission, similar to other studies, 39,40 especially in IC cases. 31,32 However, patients who presented in police custody experienced somewhat shorter ED wait times and ED LOS, potentially reflecting providers' perceptions of the need for emergent intervention. 31,41 More research is needed to determine the relative effectiveness regarding evidence-based MH treatment and preventive care activities through telemental health compared with nontelemental health among youth and adults in the region.…”

“…According to the authors, owing to the study's availability of ACT, the MH participants who had avoided or had never experienced the sometimes ''traumatic'' nature of IP IC demonstrated significantly improved severity of illness ( p = 0.004) and functional status ( p = 0.043) over time. 32 The majority (69.2%) of patients were also fully adherent to their OP treatment plan at 4-year follow-up ( p < 0.001). 32 Based on results of this study, implementation of a longitudinal study of adult and pediatric patients identified early in the rural communities as at risk for suicide could proactively serve to further inform participating rural stakeholder groups in the evaluation of targeted evidence-based structured MH OP treatment services.…”

“…32 The majority (69.2%) of patients were also fully adherent to their OP treatment plan at 4-year follow-up ( p < 0.001). 32 Based on results of this study, implementation of a longitudinal study of adult and pediatric patients identified early in the rural communities as at risk for suicide could proactively serve to further inform participating rural stakeholder groups in the evaluation of targeted evidence-based structured MH OP treatment services.…”

“…Mean wait time for IC patients brought to ED by law enforcement was shorter on average than for nonforensic patients, with time-toprovider averaging 11 min (95% CI [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]) compared with 20 min (95% CI ), respectively. Mean wait time for non-IC patients was 23 min (95% CI [19][20][21][22][23][24][25][26][27]), with a range of 17 min (95% CI [13][14][15][16][17][18][19][20][21]) for SA patients to 29 min (95% CI [20][21][22][23][24][25][26][27][28][29][30][31][32][33]…”

“…However, significantly improved MH outcomes have been observed with IC patients through a structured OP treatment program. 32 In a 4-year longitudinal randomized controlled trial Schöttle et al 32 reported a 25% reduction in IC for seriously mentally ill patients (N = 171) through utilization of a structured OP MH treatment program (assertive community treatment [ACT]). The piloted ACT program was an OP extension of the hospital setting.…”