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Looking at vanishing treatment effect in Europe

Published online by Cambridge University Press:  02 January 2018

Stephen A. Ogunremi*
Affiliation:
Fraser Health Authority, Vancouver, Canada, email: Stephen.Ogunremi@fraserhealth.ca
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Abstract

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Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2014

The article by Rosen et al Reference Rosen, Killaspy and Harvey1 is a thought-provoking piece on the perception of the effectiveness of assertive community treatment in Europe. I write as a psychiatrist who has worked within assertive community teams (ACTs) on both sides of the Atlantic (the UK and Canada). Although the economic downturn and cutbacks are equally shared in both UK and Canadian health systems, the investment in specialist mental health programmes including ACT continues to gather pace in Canada due to the robust and demonstrable effectiveness of the teams. In Canada, there is a stronger fidelity to the original ACT model and a shift from the paternalistic to a more collaborative relationship with patients. There is greater emphasis on relationship building through varieties of psychosocial strategies, easier access to specialist and subsidised housing facilities and vocational opportunities.

The ACT service delivery in Canada is a true representation of the standard originally described in 1973 after 20 years of field testing in the USA. Reference Marx, Test and Stein2 It includes peer support workers who have life experience and can provide expertise that professional training cannot replicate. The peer support workers are fully integrated team members functioning in the team's generalist role. There is a 24-hour on-call service and treatment intervention is intensive with two or three face-to-face visits daily.

Undoubtedly, ACT is a clinically effective approach to managing the care of severely mentally ill people in the community. If aimed at the right patient population and when the model of care is fully adhered to, ACT can substantially reduce the costs of hospital care while improving the outcome and patient satisfaction. Reference Test and Stein3

References

1 Rosen, A, Killaspy, H, Harvey, C. Specialisation and marginalisation: how the assertive community treatment debate affects individuals with complex mental health needs. Psychiatrist 2013; 37: 345–8.Google Scholar
2 Marx, AJ, Test, MA, Stein, LI. Extrahospital management of severe mental illness: feasibility and effects of social functioning. Arch Gen Psychiatry 1973; 29: 505–11.Google Scholar
3 Test, MA, Stein, LI. Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry 1980; 37: 392–7.Google Scholar
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