Preliminary outcome study on assertive community treatment in Japan

Abstract

Aims: The beneficial effects of assertive community treatment (ACT), which has been widely acclaimed as being successful in several foreign countries, must also be objectively evaluated with respect to the transition from inpatient to community‐based mental health treatment in Japan. This was the first study that examined effects of the ACT program in Japan using pre/post design data of the pilot trial of the ACT program in Japan project. Methods: The study included 41 subjects hospitalized at Kohnodai Hospital, National Center of Neurology and Psychiatry between May 2003 and April 2004 for severe mental illness and who met inclusion criteria for entry regarding age, diagnosis, residence, utilization of mental health services, social adjustment, and ability to function in daily activities. All subjects provided informed consent for study participation and were followed for 1 year after hospital discharge. Results: Comparison of the number of days and frequency of inpatient psychiatric hospitalization and frequency of emergency psychiatric visits between the 1‐year period before hospitalization and 1‐year period after hospital discharge showed a significant decrease in number of days and frequency of hospitalization. Comparison at 1 year after discharge with baseline showed no change in satisfaction with overall quality of life or Brief Psychiatric Rating Scale scores, but the Global Assessment of Functioning score significantly increased, and the antipsychotic dose (chlorpromazine equivalent) significantly decreased. Conclusion: Despite some limitations in methodology and conclusions, this study suggests that ACT enables persons with severe mental illness to live for longer periods in the community, without worsening of symptoms, decreased social function, or deterioration in quality of life.

The critical ingredients of assertive community treatment

“…Similarly, controlled trials in the U.S., particularly in good service areas, have not consistently found better outcomes for ACT in recent years, as the U.S. has continued to sharply reduce the rate of hospitalization admissions and length of hospital stays. Internationally, ACT continues to be an attractive service model option in some nations, such as Japan , with poorly developed community mental health services and routine use of long‐term hospitalizations.…”

The rise of assertive community interventions in South Africa: a randomized control trial assessing the impact of a modified assertive intervention on readmission rates; a three year follow-up

“…Single-site studies on the effectiveness of ACT tend to have small sample sizes (range 41 to 64) [6,7,11]. The reason for this may vary from country to country, but in a developing country such as RSA, limited human and financial resources are the main drivers behind this.…”

“…Though considered an expensive intervention, the costs were justified under the premise that inpatient costs were generally much higher. The approach has been well researched and tested over the last twenty years, with many countries reporting on a range of outcomes, such as readmission rates, patient satisfaction, degrees of symptomatology and social functioning [4,3,2,7]. Initial studies from particularly the US and Australia, reported positive outcomes in most of these areas, which prompted UK decision makers to launch 300 Assertive Outreach teams nationwide [1-3].…”

Japanese Outreach Model Project for patients who have difficulty maintaining contact with mental health services: Comparison of care between higher‐functioning and lower‐functioning groups

“…Japan had several ACT teams and research that showed some desirable outcomes. Nishio et al () found that individuals could live longer in the community without a worsening of symptoms or decreasing social function. Another study reported that an ACT group had a reduction of inpatient days and better client satisfaction than a non‐ACT group (Ito et al , ).…”