Skip to main content Accessibility help
×
Home

A comparison of the implementation of Assertive Community Treatment in Melbourne, Australia and London, England

  • C. Harvey (a1), H. Killaspy (a2), S. Martino (a3), S. White (a4), S. Priebe (a5), C. Wright (a6) and S. Johnson (a2)...

Abstract

Aims.

The efficacy of Assertive Community Treatment (ACT) is well established in the USA, and to a lesser extent in Australia, whereas UK studies suggest little advantage for ACT over usual care. Implementation of ACT varies and these differences may explain variability in reported efficacy. We aimed to investigate differences in ACT implementation between Melbourne, Australia and London, UK.

Methods.

In a cross-sectional survey, we investigated team organisation, staff and client characteristics from four Melbourne ACT teams using almost identical methods to the Pan London Assertive Outreach studies of 24 ACT teams.

Results.

Client characteristics, staff satisfaction and burnout were very similar. Three of four Melbourne teams made over 70% of client contacts ‘in vivo’ compared to only one-third of comparable London teams, although all teams were rated as ‘ACT-like’. Melbourne teams scored more highly on team approach. Three quarters of clients were admitted in the preceding 2 years but Melbourne clients had shorter stays.

Conclusions.

Differences in the implementation of ‘active components’ of home treatment models that have been associated with better client outcomes (home visiting, team approach) may explain international differences in ACT efficacy. Existing fidelity measures may not adequately weight these important elements of the model.

Copyright

Corresponding author

*Address for correspondence: Dr Carol Harvey, Associate Professor in Psychiatry, Department of Psychiatry, University of Melbourne, Psychosocial Research Centre, 130 Bell St, Coburg, Victoria 3058, Australia. (Email: c.harvey@unimelb.edu.au)

References

Hide All
Ash, D, Brown, P, Burvill, P, Davies, J, Hughson, B, Meadows, G, Nagle, T, Rosen, A, Singh, B, Weir, W (2007). Mental health services in the Australian states and territories. In Mental Health in Australia. Collaborative Community Practice (ed. Meadows, G, Singh, B and Grigg, M), pp. 99131. Oxford University Press: Melbourne, Australia.
Australian Bureau of Statistics (2003). 2001 Census: Socio-Economic Indices for Areas. Australian Bureau of Statistics: Canberra.
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.
Bond, GR (1990). Intensive case management. Hospital and Community Psychiatry 41, 927928.
Burns, T (2008). Case management and assertive community treatment. What is the difference? Epidemiologia e Psichiatra Sociale 17, 99105.
Burns, T, Catty, J, Dash, M, Roberts, C, Lockwood, A, Marshall, M (2007). Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. British Medical Journal 335, 336342.
Burns, T, Catty, J, Watt, H, Wright, C, Knapp, M, Henderson, J (2002). International differences in home treatment for mental health problems: results of a systematic review. British Journal of Psychiatry 181, 375382.
Burns, T, Creed, F, Fahy, T, Thompson, S, Tryrer, P, White, I (1999). Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet 353, 21852189.
Catty, J, Burns, T, Knapp, M, Watt, H, Wright, C, Henderson, J, Healey, A (2002). Home treatment for mental health problems: a systematic review. Psychological Medicine 32, 383401.
Chinman, M, Allende, M, Bailey, P, Maust, J, Davidson, L (1999). Therapeutic agents of assertive community treatment. Psychiatric Quarterly 70, 137162.
Commission for Health Improvement (2003). Mental Health Trusts Overview. Available at http://www.chi.nhs.uk/Ratings/Trust/results/indicatorResults.asp?indicatorId=3566 (retrieved 25 May 2007).
Davidson, G, Campbell, J (2007). An examination of the use of coercion by assertive outreach and community mental health teams in Northern Ireland. British Journal of Social Work 37, 537555.
De Jong, A, van der Lubbe, PM, Wiersma, D (1996). Social dysfunction in rehabilitation: classification and assessment. In Handbook of Mental Health Economics and Health Policy. Volume I: Schizophrenia (ed. Moscarelli, M, Rupp, A and Sartorius, N), pp. 2738. John Wiley and Sons: Chichester.
Department of Health (1999). National Service Framework for Mental Health: Modern Standards and Service Models. Her Majesty's Stationery Office: London.
Department of Health (2001). The Mental Health Policy Implementation Guide. Her Majesty's Stationery Office: London.
Department of Health (2004). Hospital Activity Data. Available at http://www.performance.doh.gov.uk/hospitalactivity/index.htm (retrieved 25 May 2007).
Drake, RE, McHugo, GJ, Becker, DR, Anthony, WA, Clark, RE (1996). The New Hampshire study of supported employment for people with severe mental illness. Journal of Consulting and Clinical Psychology 64, 391399.
Fakhoury, W, White, I, Priebe, S, PLAO Study Group (2007). Be good to your patient: how the therapeutic relationship in the treatment of patients admitted to assertive outreach affects re-hospitalisation. Journal of Nervous and Mental Disease 195, 789791.
Fiander, M, Burns, T, McHugo, GJ, Drake, RE (2003). Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA. British Journal of Psychiatry 182, 248254.
Glover, GR, Robin, E, Emami, J, Arabscheibani, GR (1998). A needs index for mental health care. Social Psychiatry and Psychiatric Epidemiology 33, 8996.
Hackman, JR, Oldham, GR (1975). Development of the job diagnostic survey. Journal of Applied Psychology 60, 159170.
Hambridge, JA, 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.
Holloway, F, Carson, J (1998). Intensive case management for the severely mentally ill. Controlled Trial. British Journal of Psychiatry 172, 1922.
Hoult, J (1986). Community care of the acutely mentally ill. British Journal of Psychiatry 149, 137144.
Issakidis, C, Sanderson, K, Teeson, M, Johnson, S, Buhrich, N (1999). Intensive case management in Australia: a randomized controlled trial. Acta Psychiatrica Scandinavica 99, 360367.
Killaspy, H (2007). Assertive community treatment in psychiatry. British Medical Journal 335, 311312.
Killaspy, H, Bebbington, P, Blizard, R, Johnson, S, Nolan, F, Pilling, S, King, M (2006). The REACT study: randomised evaluation of assertive community treatment in north London. British Medical Journal 332, 815820.
Killaspy, H, Johnson, S, Pierce, B, Bebbington, P, Pilling, S, Nolan, F, King, M (2009). Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial. Social Psychiatry and Psychiatric Epidemiology 44, 532540.
Marshall, M (2008). What have we learnt from 40 years of research on intensive case management? Epidemiologia e Psichiatra Sociale 17, 106109.
Marshall, M, Lockwood, A (1998). Assertive Community Treatment for People with Severe Mental Disorders (Review). The Cochrane Library, Issue 2. John Wiley and Sons: Oxford.
Maslach, C, Jackson, SE, Leiter, MP (1996). The Maslach Burnout Inventory. Consulting Psychologists Press: Palo Alto, CA.
McHugo, GJ, Drake, RE, Whitley, R, Bond, GR, Campbell, K, Rapp, CA, Goldman, HH, Lutz, WJ, Finnerty, MT (2007). Fidelity outcomes in the national implementing evidence-based practices project. Psychiatric Services 58, 12791284.
Muirhead, D, Harvey, C, Ingram, G (2006). Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: clinical outcomes. Australian and New Zealand Journal of Psychiatry 40, 596605.
Phillips, SD, Burns, BJ, Edgar, ER, Mueser, KT, Linkins, KW, Rosenheck, RA, Drake, RE, McDonel Herr, EC (2001). Moving assertive community treatment into standard practice. Psychiatric Services 52, 771779.
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 characteristics and outcomes. Pan-London Assertive Outreach Study, part 3. British Journal of Psychiatry 183, 148154.
Priebe, S, Gruyters, T (1993). The role of the helping alliance in psychiatric community care: a prospective study. Journal of Nervous and Mental Disease 181, 552557.
Priebe, S, Watts, J, Chase, M, Matanov, A (2005). Processes of disengagement and engagement in assertive outreach patients: qualitative study. British Journal of Psychiatry 187, 438443.
Ruggeri, M, Tansella, M (2008). Editorials: case management or assertive community treatment: are they really alternative approaches? Epidemiologia e Psichiatra Sociale 17, 9398.
Salyers, MP, Bond, GR, Teague, GB, Cox, JF, Smith, ME, Hicks, ML, Koop, JI (2003). Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. Journal of Behavioral Health Services and Research 30, 304320.
SPSS (2006). SPSS for Windows, Version 14.0.2. SPSS Inc.: Chicago, IL.
Stata Corporation (2003). Stata Release 8.0. Stata Corporation: College Station, TX.
Stein, LI, Test, MA (1980). Alternatives to mental hospital treatment. Archives of General Psychiatry 37, 392397.
Sytema, S (1991). Social indicators and psychiatric admission rates: a case-register study in the Netherlands. Psychological Medicine 21, 177184.
Sytema, S, Wunderink, L, Bloemers, W, Roorda, L, Wiersma, D (2007). Assertive community treatment in the Netherlands: a randomized controlled trial. Acta Psychiatrica Scandinavica 116, 105112.
Teague, G, Bond, G, Drake, R (1998). Program fidelity in assertive community treatment: development and use of a measure. American Journal of Orthopsychiatry 68, 216232.
Thornicroft, G, Strathdee, G, Phelan, M, Holloway, F, Wykes, T, Dunn, G, McCrone, P, Leese, M, Johnson, S, Szmukler, G (1998 a). Rationale and design. PRiSM psychosis study 1. British Journal of Psychiatry 173, 363370.
Thornicroft, G, Wykes, T, Holloway, F, Johnson, S, Szmukler, G (1998 b). From efficacy to effectiveness in community mental health services. PRiSM Psychosis Study 10. British Journal of Psychiatry 173, 423427.
Tyrer, P (2000). Are small case-loads beautiful in severe mental illness? British Journal of Psychiatry 177, 386387.
UK 700 Group (1999). Comparison of intensive and standard case management for patients with psychosis: rationale of the trial. British Journal of Psychiatry 174, 7478.
Weaver, T, Tyrer, P, Ritchie, J, Renton, A (2003). Assessing the value of assertive outreach. Qualitative study of process and outcome generation in the UK700 trial. British Journal of Psychiatry 183, 437445.
Weiss, DJ, Dawis, RV, England, GW, Lofquist, LH (1967). Manual for the Minnesota Satisfaction Questionnaire. Minnesota Studies in Vocational Rehabilitation: XXII. Minneapolis, University of Minnesota, Industrial Relations Center Work Adjustment Project.
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.

Keywords

A comparison of the implementation of Assertive Community Treatment in Melbourne, Australia and London, England

  • C. Harvey (a1), H. Killaspy (a2), S. Martino (a3), S. White (a4), S. Priebe (a5), C. Wright (a6) and S. Johnson (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed