Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-28T15:02:07.241Z Has data issue: false hasContentIssue false

The Gloucester assertive community treatment team: A description and comparison with other services

Published online by Cambridge University Press:  13 June 2014

Nathan Gregory
Affiliation:
Gloucester Assertive Community Treatment Team, Gloucestershire Partnership NHS Trust, Burleigh House, Nettleton Road, Gloucester GL1 0JH
Rob Macpherson
Affiliation:
Specialist Services, Gloucestershire Partnership NHS Trust, Gloucester GL1 0JH, England

Abstract

Assertive Community Treatment (ACT) has developed globally as a model of community care for the severely mentally ill. However, in the United Kingdom there is mixed evidence regarding improvements in outcome and concerns about ACT teams having poor fidelity to the original ACT model.

Objective: This study presents the fidelity characteristics of an established ACT team serving Gloucester City. It describes service user demographic and illness data and compares these findings to other important studies in the United Kingdom.

Method: The Dartmouth Assertive Community Treatment Scale was applied to rate the Gloucester ACT team's fidelity characteristics. The Gloucester Caseload Project Demographic Pro-Forma was collected from all of the team's 79 service users.

Results: The population of severely mentally ill ACT service users in Gloucester City were an older and more “disabled” group compared to the classic ACT studies. Furthermore, although findings indicate a high level of fidelity to the original ACT model, the team it is still associated with high levels of inpatient treatment.

Conclusion: High fidelity ACT services appear to be associated with high admission rates. Therefore teams should not be viewed as alternatives to hospital admission but have goals of improving engagement and social functioning. Furthermore, findings have allowed the team to benchmark its service and target areas for further service development. More consistent reporting of fidelity data on ACT research would facilitate comparison across different services.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gold, P., Meisler, N., & Santos, A. (2003). The Program of Assertive Community Treatment: Implementation and Dissemination of an Evidence-Based Model of Community-Based Care for Persons with Severe and Persistent Mental Illness. Cognitiveand Behavioural Practice, 10, 290303.CrossRefGoogle Scholar
2.Stein, L., & Test, M. (1980). An alternative to mental health treatment I: conceptual model, treatment programand clinical evaluation. Achieves of General Psychiatry, 37, 392397.CrossRefGoogle Scholar
3.Hoult, J., Reynolds, I., & Chaarbonneau-Powis, M. (1983). Hospital versus community treatment: the results of a randomised controlled trial. Australian and New Zealand Journal of Psychiatry, 17, 160167.CrossRefGoogle Scholar
4.Hambridge, J., & Rosen, A. (1994). Assertive community treatment for the seriously mentally ill in suburban Sydney: A programme description and evaluation. Australian and New Zealand Journal of Psychiatry, 28, 438445.CrossRefGoogle Scholar
5.Sanderson, K., Issakidis, C., Johnston, S., Teeson, M., Salkeld, G., & Buhrich, N. (1996). Cost effectiveness of intensive case management for people with serious mental illness. New South Wales: CRUFAD.Google Scholar
6.Bond, G., Drake, R., & Mueser, K. (2001). Assertive community treatment for people with severe mental illness: critical ingredients and impact on patients. Disease Management and Health Outcomes, 9, 141159.CrossRefGoogle Scholar
7.McHugo, G., Drake, R., Teague, G., & Xie, H. (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services, 50, 818824.CrossRefGoogle ScholarPubMed
8.Drake, R. (1998). Brief history, current status and future place of assertive community treatment. Journal of Orthopsychiatry, 68, 2, 172175.CrossRefGoogle ScholarPubMed
9.Teague, G., Bond, G., & Drake, R. (1998). Programme fidelity in assertive community treatment: development and use of a measure. American Journal of Orthopsychiatry, 68, 216232.CrossRefGoogle ScholarPubMed
10.Marshall, M., & Lockwood, A. (1999). Assertive Community Treatment for People with Severe Mental Disorders. The Cochrane Library: Issue 3, Oxford: Update Software.Google Scholar
11.Mueser, K., Bond, G., & Drake, R. (1998). Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin, 24, 1, 3774.CrossRefGoogle ScholarPubMed
12.Ziguras, J., & Stuart, G. (2000). A meta analysis of the effectiveness of mental health case management over 20 years. Psychiatric Services, 51, 11, 14101421.CrossRefGoogle ScholarPubMed
13.Marshall, M., & Lockwood, A. (2004). Assertive Community Treatment for People with Severe Mental Disorders. The Cochrane Library, Issue 2, Chichester: John Wiley and Sons Ltd.Google Scholar
14.Department of Health. (1999). National Service Framework for Mental Health: Modern Standards and Service Models. London: Department of Health.Google Scholar
15.Department of Health. (2001a). The National Health Service Plan. A plan for investment, a plan for reform. London: Department of Health.Google Scholar
16.Sainsbury Centre for Mental Health. (1998). Keys to Engagement. Review of care for people with severe mental illness who are hard to engage with services. London: Sainsbury Centre for Mental Health.Google Scholar
17.Holloway, F., & Carson, J. (1998). Intensive case management for the severely mentally ill. Controlled trial. British Journal of Psychiatry, 172, 1922.CrossRefGoogle ScholarPubMed
18.Thornicroft, G., Strathdee, G., Phelan, M., Holloway, F., Wykes, T., Dunn, G., McCrone, P., Leese, M., Johnson, S., & Szmulker, G. (1998). Rationale and design. PRiSM Psychosis Study 1. British Journal of Psychiatry, 173, 363370.CrossRefGoogle Scholar
19.Burns, T., Creed, F., & Fahy, T. (1999). Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet, 353, 21852189.CrossRefGoogle ScholarPubMed
20.Jones, A. (2002). Assertive community treatment: development of the team, selection of clients, and impact on lengthof hospital stay. Journal of Psychiatric and Mental Health Nursing, 9, 261270.CrossRefGoogle Scholar
21.Ford, R., Barnes, A., Davies, R., Chalmers, C., Hardy, P., & Muijen, M. (2001). Maintaining contact with people with severe mental illness: five-year follow-up of assertive outreach. Social Psychiatry Psychiatrica Epidemiologica, 36, 444447.CrossRefGoogle Scholar
22.Priebe, S., Fakhoury, W., Watts, J., Bebbington, P., Burns, T., Johnson, S., Muijen, M., Ryrie, I., White, I., & Wright, C. (2003). Assertive outreach teams in London: patient characteristicsand outcomes. Pan-London Assertive Outreach Study, Part 3. British Journal of Psychiatry, 183, 148154.CrossRefGoogle Scholar
23.Burns, T., Fioritti, A., & Holloway, F. (2001). Case Management and Assertive Outreach Treatmentin Europe. Psychiatric Services, 52, 5, 631636.CrossRefGoogle Scholar
24.Sashidharan, S, Smyth, M, Owen, A. Thro a glass darkly: a distorted appraisal of community care. Br J Psych 1999: 175; 504507.CrossRefGoogle Scholar
25.Gournay, K., & Thornicroft, G. (2000). Comments on the UK700 case management trial. British Journal of Psychiatry, 370, 370372.Google Scholar
26.Fiander, M., Burns, T., & McHugo, G. (2003). Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA. British Journal of Psychiatry, 182, 248254.CrossRefGoogle ScholarPubMed
27.Burns, T., & Firn, M. (2002). Assertive Outreach in Mental Health: a manual for practitioners. Oxford: Oxford University Press.CrossRefGoogle Scholar
28.Ryan, P., & Morgan, S. (2004). Assertive Outreach. A Strengths Approach to Policy and Practice. London: Churchill Livingstone.Google Scholar
29.Holloway, F. (2002). Outcome measurement in mental health-welcome to the revolution. British Journal of Psychiatry, 181, 12.CrossRefGoogle Scholar
30.Department of Health. (2001b). Mental Health Information Strategy. London: Department of Health.Google Scholar
31.Phelan, M., Slade, M., & Thornicroft, G. (1995). The Camberwell Assessment of Need (CAN): the validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry, 167, 589595.CrossRefGoogle ScholarPubMed
32.Hall, M., Meaden, A., Smith, J., & Jones, C. (2001). Brief Report: The development and psychometric properties of an observer rated measure of engagement with mental health services. The Journal of Mental Health, 10, 4, 457465.CrossRefGoogle Scholar
33.Macpherson, R., Gregory, N., Slade, M., & Foy, C. (2005). Factors associated with changing patient needs in an Assertive Community Treatment Team. In press.Google Scholar
34.DETR. (2000). Indices of multiple deprivation 2000. London: DETR.Google Scholar
35.Director of Public Health. (2003). Health Improvement: A Shared Responsibility. Annual Report of the Director of Public Health. England: Gloucestershire Health Authority.Google Scholar
36.DETR. Annual report on rough sleeping. London: DETR, 1999.Google Scholar
37.World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: World Health Organisation.Google Scholar
38.Macpherson, R., Haynes, R., Summerfield, L., Foy, C., & Slade, M. (2003a). From research to practice. A lead mental health services needs assessment. Social Psychiatry and Psychiatric Epidemiology, 38, 276281.CrossRefGoogle Scholar
39.Department of Health. Mental Policy Implementation Guide. London: Department of Health.Google Scholar
40.Wright, C., Burns, T., James, P., Billings, J., Johnson, S., Muijen, M., Priebe, S., Ryrie, I., Watts, J., & White, I. (2003). Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, Part 1. British Journal of Psychiatry, 183, 132138.CrossRefGoogle ScholarPubMed
41.Thornicroft, G., Becker, T., Holloway, F., Johnson, S., Leese, M., McCrone, P., Szmukler, G., Taylor, R., & Wykes, T. (1999). Community mental health teams: evidence or belief? British Journal of Psychiatry, 175, 508513.CrossRefGoogle ScholarPubMed
42.Billings, J., Johnson, S., Bebbington, P., Greaves, A., Priebe, S., Muijen, M., Ryrie, I., Watts, J., White, I., & Wright, C. (2003). Assertive outreach teams in London: staff experiences and perceptions. Pan-London Assertive Outreach Study, Part 2. British Journal of Psychiatry, 183, 139147.CrossRefGoogle ScholarPubMed
43.McGrew, J., Pescosolido, P., & Wright, E. (2003). Case manager's perspectives on critical ingredients of assertive community treatment and on its implementation. Psychiatric Services, 54, 3, 370376.CrossRefGoogle ScholarPubMed
44.Chisholm, A., & Ford, R. (2004). Transforming Mental Health Care. Assertive outreach and crisis resolution in practice. London: The Sainsbury Centre for Mental Health.Google Scholar
45.Kent, A & Burns, T (2005). Assertive community treatment in UK practice. Advances in Psychiatric Treatment, 11, 388397.CrossRefGoogle Scholar
46.Schneider, J., BT., Wooff, D.et al (2006) Assertive outreach: policy and reality. Psychiatric Bulletin, 30, 8994.CrossRefGoogle Scholar