Assertive community therapy

Question 1

According to social explanations, what can mental disorders be triggered by

Answer 1

• factors in the environment

Question 2

Long term stays in psychiatric hospitals lead to institutionalisation - what is the negatives of this

Answer 2

• patients become used to everything being done for them
• not being able to make their own decisions
• making it hard to adjust to living outside

Question 3

what was done in the 70’s and 80’s to try and avoid institutionalisation

Answer 3

• move towards caring for patients with mental disorders in the community
• led to closure of psychiatric hospitals and wards
• based care programmes being set up

Question 4

Assertive community therapy - ACT

Answer 4

• multidisciplinary team approach to intensive case management
• in which team members share a caseload
• have high frequency patient contact
• low patient to staff ratios
• provide outreach to patients in the community

Question 5

what do ACT teams consist of

Answer 5

• psychiatrists
• other mental health clinicians

Question 6

what does the ACT team approach allow for

Answer 6

• integration of medicine management
• rehabilitation
• social services

Question 7

ACT treatment

Answer 7

• ongoing rather than time limited
• available 24 hrs a day
• highly individualised to a clients changing needs

Question 8

goals of ACT

Answer 8

• reduce hospitalisation rates
• help clients adapt to life in the community

Question 9

who is ACT most appropriate for

Answer 9

• individuals at high risk for repeated hospitalisations
• individuals who have difficulty remaining in traditional mental health treatment
• clients who have difficulties meeting personal goals
• clients who have trouble getting on with people
• people who struggle making and keeping friends
• people who struggle living independently

Question 10

which mental health illnesses does ACT help for

Answer 10

• schizophrenia
• patients who have frequent relapses

Question 11

which ideas do ACT link with

Answer 11

• deinstitutionalisation
• care in the community

Question 12

what other countries have adopted the ACT approach

Answer 12

• Australia
• Canada
• UK

Question 13

what other interventions is ACT used with

Answer 13

• social skills training
• family therapy

Question 14

Characteristics of ACT

Answer 14

• multidisciplinary treatment teams
• low client to case manager ratio
• hared caseloads among clinicians
• working with other professionals
• 24 hr coverage including emergencies
• close attention to illness management
• a focus on those who need the most help
• helping with independence, rehabilitation, recovery
• avoiding homelessness and re-hospitalisations
• treatment of patients in real life settings
• commitment to spend as much time with the person as necessary to rehabilitate them

Question 15

what other professionals do clinicians work with in ACT

Answer 15

• psychiatrists
• nurses
• social workers
• people with who the treatment has worked
• so whole team can focus on individual in quesiton

Question 16

how do ACT teams help treat patients in real life settings

Answer 16

• high frequency contact with clients
• assistance with practical problems with living
• helping and visiting them rather than offering therapies
• with enough staff to support
• so most services provided in community rather than clinic

Question 17

what kind of treatment does ACT offer

Answer 17

• holistic treatment
• which looks at all of the individuals needs

Question 18

effectiveness of ACT

Answer 18

• only 18% people working with ACT still spend a lot of time in hospital compared to 89% of people in other treatments
• those working with ACT who did go to hospital had shorter stays
• people had better functional outcomes, e.g independent living, employment
• less likely to be homeless
• less likely to stop treatment

Question 19

Vugt et al

Answer 19

• looked at impact of ACT on patients in Netherlands
• studied 20 different teams treating 530 patients
• researchers assessed outcomes on 3 different occassions
• also reviewed hospitalisations and homelessness over a 2 year follow up

Question 20

Vugt et al conclusions

Answer 20

• team structure was vital in successful outcomes
• sticking to original structure of ACT had the best patient outcomes

Question 21

Nishio et al

Answer 21

• reviewed if ACT helped patients transition from institutions to community
• 41 people who had been hospitalised for severe mental illness

Question 22

Nishio et al procedure

Answer 22

• number of days and frequency of hospitalisations as well as emergency visits 1 year before hospital discharge and 1 year after were reviewed

Question 23

Nishio et al results

Answer 23

• significant decrease in amount of hospitalisations
• decrease in antipsychotic medication
• increase in GAF score
• however no change in life satisfaction
• showing ACT allows people to live for longer in community
• without symptoms or quality of life deteriorating

Question 24

Issues with ACT in terms to location

Answer 24

• it is hard to replicate in less populated areas where people who require support are widely spread

Question 25

why is it hard to measure how useful ACT is

Answer 25

- it tends to be used alongside other interventions - e.g family therapy - making it hard to see how much of an impact it is having

Question 26

evaluate - Dixon

Answer 26

- Points out ACT has been seen as the model for mental health practice

Question 27

evaluate - Bond et al

Answer 27

- summarised 25 studies that looked at effectiveness of ACT = evidence based treatment - compared with standard community care ACT was highly effective - as it engaged clients - prevented re-hospitalisations - increased housing stability - improved clients quality of life - effective across most disorders - effective across different ages, gender, culture - only 11% clients in surveys say it is restricting

Question 28

ACT uses / applications

Answer 28

- severe mental health cases - more carefully implemented = the more effective - surveys show clients appreciate ACT - studies reporting effectiveness show no negative aspects of the programme - works with all age groups - works with both genders - works across all cultures

Question 29

Gomory - evaluate

Answer 29

- suggests ACT is coercive - client does not have choice in whether or not to undergo treatment - it is about social control - suggests 11% clients feel forced into treatment - seems case managers are more active in setting limits for clients who have more symptoms, more arrests, many hospitalisations and recent substance abuse - could be coercion in severe cases

Question 30

Bond - Gomory counterargument

Answer 30

- points out by preventing hospitalisation treatment increases a clients choice - helping them to live in the community - treatment increases freedom

Question 31

Strengths

Answer 31

- good for those who have many relapses - helps work on social interactions - Bond - beneficial characteristics - good for clients freedom - personalised - shared responsibility - reduced hospital admissions - emergency crisis intervention - holistic treatment - patient experience is very positive

Question 32

good for those who have many relapses -

Answer 32

- it could be problems with living outside the hospital that cause these issues - social skills training and family therapy can help someone improve their interactions

Question 33

focuses on improving social interactions

Answer 33

- treatments based on improving the individual to function in society - this is incorporated into ACT programmes - shows someone with SZ importance of social interactions

Question 34

how are characteristics of ACT beneficial

Answer 34

- multi disciplinary teams with a low client to staff ratio - by working alongside specialists e.g psychiatrists - allows patients to get treatment and support they need

Question 35

improves clients freedom

Answer 35

- ACT prevents re-hospitalisations - increases a clients choice - allows them to live in community - increasing freedom - therefore quality of life

Question 36

personalised care for all clients

Answer 36

- better suits their individual needs - results in better outcomes

Question 37

shared responsibility

Answer 37

- across different professionals - allows better care to be provided - quicker progress can be made

Question 38

reduced hospital admissions

Answer 38

- reduced length of stay in hospitals

Question 39

emergency crisis intervention

Answer 39

- reduces likelihood of a severe relapse and re-hospitalisations - staff available 24 hrs a day for service

Question 40

holistic treatment

Answer 40

- tailored to individual needs - e.g support to take medication - housing

Question 41

weaknesses

Answer 41

- do not have an effect on actual functioning - works best in heavily populated areas - Gomory (clients surrender responsibility and makes few decisions) - alternative explanations - demanding - time consuming - over reliance on staff - limited accessibility - doesn't treat symptoms of SZ - difficult to measure in terms of effectiveness - form of social control

Question 42

does not have an effect on actual functioning -

Answer 42

- doesn't help reduce positive and negative symptoms of sz - does not help with employment prospects - supportive employment programmes would need to be provided - as well as ways to reduce the effect of symptoms of SZ

Question 43

ACT works best in heavily populated areas -

Answer 43

- where there is a high incidence of SZ - due to effort and intensive focus that is needed during treatment - adequate staffing needed - ACT therefore works best in urban areas where there is more people with SZ and there can be a focus and teams are brought in as there are enough cases which warrant help - meaning ACT may not be provided in rural areas where there are fewer cases - due to cost implications - = not accessible to all

Question 44

alternative explanations

Answer 44

- if SZ is innate - suggests behaviour won't change regardless of environment

Question 45

demanding for staff

Answer 45

- high stress/pressure - making it difficult to meet different needs

Question 46

time consuming

Answer 46

- multiple interventions takes time - can be difficult to implement at once

Question 47

over reliance on staff

Answer 47

- reducing independence

Question 48

limited accessibility

Answer 48

- difficult to establish in rural areas - as they are widespread and it is costly

Question 49

difficult to measure ACT in terms of effectiveness

Answer 49

- due to combined approach with other treatments - we can't establish which treatment has the most impact

Question 50

form of social control

Answer 50

- some see ACT as coercive - may remove individuals choice - as individuals have to comply with programme rules or face re-hospitalisations - 11% clients feel forced into treatment