Hospitalisation of severely mentally ill patients with and without problematic substance use before and during Assertive Community Treatment: an observational cohort study

Abstract

BackgroundCo-occurring substance use increases the risk of hospitalisation in people with severe mental illness, whereas Assertive Community Treatment (ACT) generally reduces hospitalisation in patients with severe mental illness and high inpatient service use. Because the superiority of ACT over standard services amongst patients with problematic substance use is uncertain, the present study examined inpatient service use amongst patients with and without problematic substance use in the 2 years before and the 2 years after they enrolled into ACT teams.MethodsThis naturalistic observational study included 142 patients of 12 different ACT teams throughout Norway. The teams assessed the patients upon enrolment into ACT using clinician-rated and self-reported questionnaires. We obtained hospitalisation data from the Norwegian Patient Register for the 2 years before and the 2 years after enrolment into ACT. We used linear mixed models to assess changes in hospitalisation and to explore associations between problematic substance use and changes in hospitalisation, controlling for socio-demographic and clinical characteristics.ResultsA total of 84 (59 %) participants had problematic substance use upon enrolment into the ACT teams. In the 2 years after ACT enrolment both participants with and without problematic substance use experienced a reduction in total inpatient days. Those with problematic substance use also had fewer involuntary inpatient days. Exploratory analyses suggested that symptom severity and functioning level interacted with problematic substance use to influence change in total inpatient days.ConclusionThese findings may suggest that ACT teams successfully support people with complex mental health problems in the community, including those with problematic substance use, and thereby contribute to a reduction in inpatient service use.

Involuntary admission in Norwegian adult psychiatric hospitals: a systematic review

“…In another study [ 85 ], involuntary admission did not significantly influence outcomes in terms of BPRS scores. One study showed that including specific patient groups in ACT-teams reduced the number of involuntary inpatient days [ 86 , 87 ].…”

How clinicians make decisions about CTOs in ACT: a qualitative study

“…The Norwegian ACT evaluation did not show a reduction in the number of admissions, but there was a significant reduction in compulsory admissions and total inpatient days. Patients with co-occurring substance abuse had significantly fewer involuntary inpatient days, despite severe problematic substance use at 2 years follow-up [ 42 ]. Although the ACT model has been criticized for being paternalistic and coercive, studies show that patients are generally more engaged and satisfied with ACT than traditional community-based services [ 25 ].…”

The impact of substance use disorders on clinical outcomes in older‐adult psychiatric inpatients

“…This rate of SUD is higher than estimates for non‐hospitalized older adults both with and without a diagnosis of a mental health disorder, suggesting that SUD may be a factor leading to higher rates of hospitalization in older‐age adults with mental illness. This is established in the general adult population, where SUD can be an aggravating factor for psychopathology and can increase the burden of medical comorbidities . A recent survey of >100 000 electronic health records estimated that the occurrence of Type 2 diabetes in individuals age 51 to 64 with SUD was 19% vs 11% for those without SUD …”

“…This is established in the general adult population, where SUD can be an aggravating factor for psychopathology and can increase the burden of medical comorbidities. 17 A recent survey of >100 000 electronic health records estimated that the occurrence of Type 2 diabetes in individuals age 51 to 64 with SUD was 19% vs 11% for those without SUD. 18 In this dataset, cocaine was the most prevalent SUD and had the largest effect on inpatient LOS.…”