scholarly journals Programa de tratamento assertivo na comunidade (PACT) e gerenciamento de casos (case management): revisão de 20 anos da literatura

2007 ◽  
Vol 56 (3) ◽  
pp. 208-218 ◽  
Author(s):  
Louise de França Machado ◽  
Catarina Magalhães Dahl ◽  
Maria Cecília de Araújo Carvalho ◽  
Maria Tavares Cavalcanti
Keyword(s):  
Mental Health ◽  
Case Management ◽  
Assertive Community Treatment ◽  
Community Care ◽  
Psychiatric Services ◽  
Community Treatment ◽  
Care Services ◽  
Health Community ◽  
Services Evaluation

OBJETIVO: Realizar uma revisão de estudos sobre programa de tratamento assertivo na comunidade (PACT) e case management para verificar se os resultados demonstram desfechos mais favoráveis quando tais modelos são implementados na rede comunitária de assistência para portadores de doença mental grave e persistente. MÉTODOS: A coleta de artigos - publicados entre 1985 e 2005 - foi realizada em duas etapas: a primeira, na base de dados PubMed, com expressões-chave mental health, community care, services evaluation e seleção de artigos cuja temática era PACT e case management, e a segunda, no banco de dados da revista Psychiatric Services, com palavras-chave assertive community treatment, PACT e case management. Foram desconsiderados estudos que analisavam serviços exclusivos para crianças, idosos e pacientes com diagnóstico único de abuso de álcool/drogas; abordavam unicamente os custos da intervenção e se referiam exclusivamente a serviços hospitalares. RESULTADOS: A partir da leitura dos 73 estudos selecionados, os autores descreveram oito categorias nas quais os artigos foram agrupados, visto que um artigo poderia pertencer a mais de uma categoria. CONCLUSÕES: O PACT e o case management são estratégias importantes e reconhecidamente mais eficazes, quando comparados a outros modelos de cuidado, em trazer evoluções favoráveis para indivíduos com doença mental grave e persistente.

Computers and process description for community mental health care

1997 ◽  
Vol 6 (S1) ◽  
pp. 81-90
Author(s):  
Rob Bale ◽  
Matthew Fiander ◽  
Tom Burns
Keyword(s):  
Mental Health ◽  
United States ◽  
Health Care ◽  
Case Management ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Assertive Community Treatment ◽  
The United States ◽  
Community Treatment ◽  
Practice Characteristics

The focus of mental health care has seen a significant shift from institutional care to community based care and has been well described (Thornicroft & Bebbington, 1989). This shift has necessitated the development of new and flexible models for ensuring that patients' needs are met. Mental health professionals have to operate across a wide range of community contexts dealing with a complex range of needs. Intensive Case Management (ICM) also known as Assertive Community Treatment is a model of service provision to the long term mentally ill in the community. The Programme of Assertive Community Treatment (ACT) developed by Stein & Test (1980) in the United States has a number of Key elements (figure 1).ACT-based ICM is unusual in that it has been extensively researched (principally in the United States of America), and programmes are relatively well described. Such descriptions, especially of programmes outside America, often focus on underlying principals and philosophies and do little to measure practice. Teague et al. (1995), however, devised clear criteria for measuring practice components and McGrew et al. (1994) asked ACT “experts” to rate the “key” elements of PACT and related a number of these to levels of hospital use. In the United Kingdom, Thornicroft (1991) listed twelve axes for describing the central practice characteristics of case management (a broad concept including ICM). These UK ‘practice characteristics’ also focus more on macro-level programme description rather than on the practices of programme staff. There is a pressing need for research into exactly what teams do.

scholarly journals A visitor's view of Madison's Program for Assertive Community Treatment (PACT)

1989 ◽  
Vol 13 (7) ◽  
pp. 352-355 ◽  
Author(s):  
M. Muijen ◽  
G. McNamee
Keyword(s):  
Mental Health ◽  
Assertive Community Treatment ◽  
Community Care ◽  
Research Programme ◽  
Community Treatment ◽  
Positive Research ◽  
Schizophrenic Patients ◽  
Research Findings ◽  
Long Term Prognosis ◽  
The Uk

Before commencing work on the Daily Living Programme at the Maudsley Hospital, in London, to compare the benefits of community care with standard hospital admission for patients with serious mental illness, a visit to Madison was arranged, where some ten years ago a similar study had been carried out (Stein & Test, 1980). We had the impression from the substantial literature which has appeared on the mental health service in Madison (Stein & Test, 1985) that they have implemented in practice their positive research findings on community care. It was felt that their lengthy experience with such a service could be beneficial to the UK, where such services are now being developed. This visit included PACT (Program for Assertive Community Treatment); a research programme investigating the long-term prognosis of mainly schizophrenic patients, and the various units of the mental health services in Madison.

Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness

1999 ◽  
Vol 174 (4) ◽  
pp. 346-352 ◽  
Author(s):  
Anthony F. Lehman ◽  
Lisa Dixon ◽  
Jeffrey S. Hoch ◽  
Bruce Deforge ◽  
Eimer Kernan ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Cost Effectiveness ◽  
Severe Mental Illness ◽  
Usual Care ◽  
Assertive Community Treatment ◽  
Cost Effective ◽  
Homeless Persons ◽  
Community Treatment ◽  
Stable Housing

BackgroundHomelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed.AimsTo evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland.MethodsA total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed.ResultsCompared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0. 58 in favour of ACT. Patterns of care and costs varied according to race.ConclusionACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.

scholarly journals The Greek Hybrid Version of the Assertive Community Treatment Model: A Perspective View between Challenges and Limitations

Psych ◽  
2021 ◽  
Vol 3 (4) ◽  
pp. 792-799
Author(s):  
Vaios Peritogiannis ◽  
Fotini Tsoli
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Health Professionals ◽  
Assertive Community Treatment ◽  
Rural Areas ◽  
Community Treatment ◽  
Community Mental Health Service ◽  
Perspective View

The Assertive Community Treatment (ACT) model of care has been long considered to be effective in the management of patients with severe mental illness (SMI) in most Western countries. The implementation of the original ACT model may be particularly challenging in rural and remote communities with small and dispersed populations and lack of adequate mental health services. Rural programs may have to adapt the model and modify the ACT fidelity standards to accommodate these limitations, and this is the rationale for the introduction of more flexible, hybrid ACT models. In rural Greece, the so called Mobile Mental Health Units (MMHUs) are well-established community mental health services. For patients with SMI that have difficulties engaging with treatment services, the new hybrid ACT model has been recently launched. The objective of this manuscript is to present the recently launched hybrid ACT model in rural areas in Greece and to explore the challenges and limitations in its implementation from the experience of a team of mental health professionals with ACT experience. Referral criteria have not been strictly set, but the number of previous relapses and hospitalizations is taken under consideration, as well as the history of poor treatment adherence and disengagement from mental health services. The main limitation in the implementation of the hybrid ACT service is that it has been introduced in several areas in the absence of a pre-existing community mental health service. This may impact referrals and limit focus on the difficult cases of patients with SMI, thus making the evaluation of the model inapplicable.

Suicide Prevention

1992 ◽  
Vol 160 (2) ◽  
pp. 149-153 ◽  
Author(s):  
H. G. Morgan
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Suicide Prevention ◽  
Mental Hospital ◽  
Community Care ◽  
District General Hospital ◽  
Residential Area ◽  
Psychiatric Services ◽  
Local District ◽  
Health Centres

In 1989 a crisis occurred in a West Country seaside town. Its psychiatric services had been regarded as a vanguard of community care, having been fully established some three years previously when the in-patient facilities which had been based in a mental hospital some 15 miles away were closed. The framework of the new-style service consisted of five mental health centres scattered throughout the residential area and a 60-bed in-patient unit, based in the grounds of the local district general hospital.

scholarly journals So what shall we do about assertive community treatment?

2008 ◽  
Vol 17 (2) ◽  
pp. 110-114 ◽  
Author(s):  
Sonia Johnson
Keyword(s):  
Assertive Community Treatment ◽  
Community Care ◽  
Risk Group ◽  
Full Range ◽  
Relevant Literature ◽  
High Risk Group ◽  
Community Treatment ◽  
Admission Rates ◽  
Recovery Orientation ◽  
Care Systems

AbstractThe usefulness of Assertive Community Treatment (ACT) in European countries with well-developed community care systems has been disputed, despite considerable relevant literature. This paper aims to assess reasons for and against implementing ACT in such countries. ACT may not be useful where generic community mental health teams are not yet well-developed, where admission rates are already low, or where an alternative model based on close integration of a full range of types of care is in place. Good reasons for introducing ACT include listening to patients' preferences, being able to monitor a high risk group of patients more successfully, good staff satisfaction, and the potential for using ACT teams as a platform for delivering interventions for difficult to treat psychosis. The ACT model is more likely to thrive in future if a recovery orientation can be adopted.

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