Bemoeizorg in de psychiatrie

Objective

To compare assertive community treatment (ACT), which encompasses intensive ambulant mental health care to care-avoiding psychiatric patients, with the standard care for these patients.

Design

Open randomised controlled trial.

Method

Patients receiving long-term mental health care were screened with the Health of the Nation Outcome Scales (HoNOS). Patients with a total score ≥15 were considered to be severely mentally ill, an indication criterion for ACT. By means of block randomisation these patients were assigned to ACT or to standard care. The primary outcome was preventing drop-out from care, and secondary outcomes were admission days per month, housing stability, psychopathology, social functioning, and quality of life. This study was registered as an International Standard Randomised Clinical Trial, number ISRCTN 11281756.

Results

A total of 118 patients were included in the study. They received ACT (n = 59) or standard care (n = 59). ACT was significantly better in sustaining contact with patients, but not in reducing admission days. No differences in the other secondary outcomes were found.

Conclusion

Many patients receiving standard care inadvertently drop out, which often results in further marginalisation. With assertive community treatment, drop-out is averted for most patients. We consider this to be an important positive result.