Stanley Susanne, Velayudhan Ajay, Hellewell Amanda, Bhatt Mitul, Isaac Mohan
Fremantle Hospital and Health Service / Mental Health Unit, South Metropolitan Health Service, Fiona Stanley Fremantle Hospitals Group, Fremantle, Western Australia.
University of Western Australia, UWA Medical School/Psychiatry, Perth, Western Australia.
Soc Psychiatry Psychiatr Epidemiol. 2025 May 16. doi: 10.1007/s00127-025-02931-2.
This study aimed to objectively assess a long-term Assertive Community Treatment (ACT) programme run by a suburban mental health hospital in Western Australia. The study examined the programme by tracking Emergency Department (ED) presentations, hospital admissions and length of hospital stays (bed days) of people with severe mental illness who entered the programme. Between January 2008 - June 2019, 160 clients who attended the hospital had presentation and admission activities assessed at two time periods (1) PRE - the period from each client's first engagement with the mental health service up to their entering the service's ACT programme, and (2) DURING- which is the time that each client spent engaged in that ACT programme. No difference was found between ED presentations before the ACT programme as compared to during the ACT programme. Voluntary mental health hospital admissions were significantly lower during the programme than before the programme, but no difference was found for involuntary mental health hospital admissions. Both voluntary and involuntary hospital stays, however, showed a significant reduction in bed days for clients during their time in the ACT programme. This data shows the continued use of the ACT programme at suburban mental health services to be beneficial. While the number of ED presentations and involuntary admissions remained the same (although for different reasons), the reduction in voluntary hospital admissions and hospital bed days suggests that the increased provision of outpatient and home care through ACT is still working to support clients in the community keeping them out of more restrictive hospital settings.
本研究旨在客观评估西澳大利亚一家郊区精神卫生医院开展的一项长期的积极社区治疗（ACT）项目。该研究通过追踪进入该项目的严重精神疾病患者的急诊科就诊情况、住院情况以及住院时长（住院天数）来对该项目进行考察。在2008年1月至2019年6月期间，对160名到该医院就诊的患者在两个时间段的就诊和住院活动进行了评估：（1）治疗前——从每位患者首次接触精神卫生服务到其进入该服务机构的ACT项目这段时间；（2）治疗期间——每位患者参与该ACT项目的时间段。结果发现，ACT项目开展前的急诊科就诊情况与项目开展期间相比并无差异。在该项目期间，自愿性精神卫生住院人数显著低于项目开展前，但非自愿性精神卫生住院人数未发现差异。然而，无论是自愿性还是非自愿性住院，患者在参与ACT项目期间的住院天数均显著减少。这些数据表明，在郊区精神卫生服务中持续采用ACT项目是有益的。虽然急诊科就诊人数和非自愿住院人数保持不变（尽管原因不同），但自愿性住院人数和住院天数的减少表明，通过ACT增加门诊和家庭护理的提供，仍有助于支持社区中的患者，使他们避免进入限制更严格的医院环境。
