Assertive community treatment versus standard treatment for severely mentally ill patients in Denmark: a quasi-experimental trial.

BACKGROUND

The future of assertive community treatment is uncertain, and studies have questioned whether it continues to provide a more effective treatment model for severely mentally ill patients in a modern mental health context. Studies conducted in new settings can contribute to the debate.

METHODS

This Danish study compares treatment from assertive community treatment with treatment by standard community mental health teams, using a non-blinded quasi-experimental multi-center trial. Outcomes included contact with mental health services, days of admission, days of involuntary admission, number of outpatient contacts, adherence to antipsychotic medication, social functioning, user satisfaction, and psychopathology.

RESULTS

A total of 366 patients receiving treatment from assertive community treatment (n = 213) or continuation of care from community mental health teams (n = 153) were included in the trial. Assertive community treatment was significantly better in sustaining contact with patients. At 2-year follow-up, 16 (8%) of patients receiving assertive community treatment versus 22(14%) receiving care from standard treatment had lost contact with treatment. Patients who received assertive community treatment had a larger reduction in inpatient service-use, increased adherence to antipsychotic medication, improved social functioning, and higher user satisfaction. No differences in days of involuntary admission and psychopathology were found.

CONCLUSIONS

The results suggest that a high fidelity assertive community treatment may be a valuable tool to strengthen contact between severely mentally ill patients and the treatment staff and may contribute to improving outcomes in a modern Danish mental health context.