Search

Scales initially developed to measure coercion in inpatient psychiatric settings were adapted to the assertive community treatment (ACT) team setting and administered to consenting clients of a high-fidelity team in Montreal (38/68). More than 75% of respondents scored 5 out of 6 or above on the client-centredness scale. The remaining respondents, who scored below 5, also tended to report more negative pressures (threat or constraint) and more perceived coercion, and they tended to be lower functioning and to have personality disorders. A simple measure of client-centredness could help ACT teams identify clients who might benefit from a different clinical approach. [ABSTRACT FROM AUTHOR]

This pilot study assessed the feasibility of a randomized controlled trial of an intervention for major depression among seniors in Canadian family practice. The intervention involved care by a family physician augmented by a Depression Care Practitioner, the latter working under the supervision of a psychiatrist. Treatments included family doctors' prescriptions of antidepressants according to an evidence-based study algorithm and/or brief problem-solving therapy. Eligible patients aged 60+ were identified in a 2-step screening process: 68 patients from 29 Montreal family practices were randomized, and 66 completed the 2-month follow-up. Results support the feasibility of a multisite trial of this intervention. [ABSTRACT FROM AUTHOR]

This study examines the differences between older patients with major depression who significantly improved or remitted and those who did not, in terms of baseline depression severity, social network, and social support. Participants (n = 66), aged 60 or over, were evaluated at a 2-month follow-up on depression symptomatology, diagnosis, and social network and support. Patients were less likely to improve if, at the onset of the study, depressive symptoms, in particular somatic ones, were more severe and if they viewed their social support as inadequate. This research underlines the importance of depression severity, and emotional and instrumental social support, for depression outcome with depressed older adults. [ABSTRACT FROM AUTHOR]

Background: Most persons with severe mental illness prefer competitive to sheltered vocational settings. Supported employment (SE) has become a clearly defined model for helping people with severe mental illness to find and maintain competitive jobs. It involves individualized and rapid placement, ongoing support and assessment, and integration of vocational and mental health staff within a single clinical team. Previous studies show that SE secures competitive employment much more effectively than do other approaches. This review focuses on its economic impacts.Methods: Studies reporting some service use or monetary outcomes of adding SE programs were identified. These outcomes were tabulated and are discussed in narrative form.Results: Five nonrandomized and 3 randomized studies compare SE programs with day treatment or transitional employment programs. The introduction of SE services can result in anything from an increase to a decrease in vocational service costs, depending on the extent to which they substitute for previous vocational or day treatment services. Overall service costs tend to be lower, but differences are not significant. Earnings increase only slightly on average.Conclusions: Converting day treatment or other less effective vocational programs into SE programs can be cost-saving or cost-neutral from the hospital, community centre, and government points of view. Investments of new money into SE programs are unlikely to be materially offset by reductions in other health care costs, by reductions in government benefit payments, or by increased tax revenues. Such investments must be motivated by the value of increasing the community integration of persons with severe mental illness. [ABSTRACT FROM AUTHOR]

This article describes the critical ingredients of the assertive community treatment (ACT) model for people with severe mental illness and then reviews the evidence regarding its effectiveness and cost effectiveness. ACT is an intensive mental health program model in which a multidisciplinary team of professionals serves patients who do not readily use clinic-based services, but who are often at high risk for psychiatric hospitalization. Most ACT contacts occur in community settings. ACT teams have a holistic approach to services, helping with medications, housing, finances and everyday problems in living. ACT differs conceptually and empirically from traditional case management approaches. ACT is one of the best-researched mental health treatment models, with 25 randomized controlled trials evaluating its effectiveness. ACT substantially reduces psychiatric hospital use, increases housing stability, and moderately improves symptoms and subjective quality of life. In addition, ACT is highly successful in engaging patients in treatment. Research also suggests that the more closely case management programs follow ACT principles, the better the outcomes. ACT services are costly. However, studies have shown the costs of ACT services to be offset by a reduction in hospital use in patients with a history of extensive hospital use. The ACT model has been hugely influential in the mental health services field. ACT is significant because it offers a clearly defined model, and is clinically appealing to practitioners, financially appealing to administrators and scientifically appealing to researchers. [ABSTRACT FROM AUTHOR]