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International Journal of Mental Health Systems
Published in: International Journal of Mental Health Systems 1/2014

Open Access 01-12-2014 | Research

Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use

Authors: Henning Pettersen, Torleif Ruud, Edle Ravndal, Ingrid Havnes, Anne Landheim

Published in: International Journal of Mental Health Systems | Issue 1/2014

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Abstract

Background

Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use.

Methods

Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses.

Results

The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients’ own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment.

Conclusions

The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients’ contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client’s quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment.
Literature
1.
2.
Stein LI, Test MA: Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry. 1980, 37: 392-397. 10.1001/archpsyc.1980.01780170034003.CrossRefPubMed
3.
Dietrich M, Irving CB, Park B, Marshall M: Intensive case management for severe mental illness (review). Cochrane Database Syst Rev. 2010, 10: CD007906
4.
Hasin D, Kilcoyne B: Comorbidity of psychiatric and substance use disorders in the United States: current issues and findings from the NESARC. Curr Opin Psychiatr. 2012, 25: 165-171. 10.1097/YCO.0b013e3283523dcc.CrossRef
5.
Hartz SM, Pato CM, Medeiros H, Cavazos-Rehg P, Sobell JL, Knowles JA, Bierut LJ, Pato MT: Comorbidity of severe Psychotic disorders with measures of substance use. JAMA Psychiat. 2014, 71: 248-254. 10.1001/jamapsychiatry.2013.3726.CrossRef
6.
McHugo GJ, Drake RE, Teague GB, Xie H: Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatr Serv. 1999, 50: 818-824.CrossRefPubMed
7.
Cleary M, Hunt GE, Matheson SL, Siegfried N, Walter G: Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev. 2008, 1: CD001088
8.
O’Brien A, Fahmy R, Singh SP: Disengagement from mental health services: a literature review. Soc Psychiatry Psychiatr Epidemiol. 2009, 44: 558-568. 10.1007/s00127-008-0476-0.CrossRefPubMed
9.
Killaspy H, Johnson S, Pierce B, Bebbington P, Pilling S, Nolan F, King M: Successful engagement: a mixed methods study of the approaches of assertive community treatment and mental health teams in the REACT trial. Soc Psychiatry Psychiatr Epidemiol. 2009, 44: 532-540. 10.1007/s00127-008-0472-4.CrossRefPubMed
10.
Hall M, Meaden A, Smith J, Jones C: Brief report: the development and psychometric properties of an observer-rated measure of engagement with mental health services. J Ment Health. 2001, 10: 457-465. 10.1080/09638230120041227.CrossRef
11.
Drake RE, Essock SM, Shaner A, Carey KB, Minkoff K, Kola L, Lynde D, Osher FC, Clark RE, Rickards L: Implementing dual diagnosis services for clients with severe mental illness. Psychiatr Serv. 2001, 52: 469-476. 10.1176/appi.ps.52.4.469.CrossRefPubMed
12.
Monroe-DeVita M, Teague GB, Moser LL: The TMACT: a new tool for measuring fidelity to assertive community treatment. J Am Psychiatr Nurses Assoc. 2011, 17: 17-29. 10.1177/1078390310394658.CrossRefPubMed
13.
Watts J, Priebe S: A phenomenological account of users’ experiences of assertive community treatment. Bioethics. 2002, 16: 439-454. 10.1111/1467-8519.00301.CrossRefPubMed
14.
Priebe S, Watts J, Chase M, Matanov A: Processes of disengagement and engagement in assertive outreach patients: qualitative study. Br J Psychiatry. 2005, 187: 438-443. 10.1192/bjp.187.5.438.CrossRefPubMed
15.
Appelbaum PS, Le Melle S: Techniques used by assertive community treatment (ACT) teams to encourage adherence: patient and staff perceptions. Community Ment Health J. 2008, 44: 459-464. 10.1007/s10597-008-9149-4.CrossRefPubMed
16.
Wright N, Callaghan P, Bartlett P: Mental health service users’ and practitioners’ experiences of engagement in assertive outreach: a qualitative study. J Psychiatr Ment Health Nurs. 2011, 18: 822-832. 10.1111/j.1365-2850.2011.01733.x.CrossRefPubMed
17.
Chinman M, Allende M, Bailey P, Maust J, Davidson L: Therapeutic agents of assertive community treatment. Psychiatr Q. 1999, 70: 137-162. 10.1023/A:1022101419854.CrossRefPubMed
18.
Leiphart LR, Barnes MG: The client experience of assertive community treatment: a qualitative study. Psychiatr Rehabil J. 2005, 28: 395-397.CrossRefPubMed
19.
Patton MQ: Qualitative Research & Evaluation Methods. 2002, London: Sage Publications
20.
Kvale S, Brinkman S: Interviews. Learning the Craft of Qualitative Research Interviewing. 2009, Thousand Oaks: Sage Publications, 2
21.
Malterud K: Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health. 2012, 40: 795-805. 10.1177/1403494812465030.CrossRefPubMed
22.
Giorgi A: The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure. J Phenomenol Psychol. 1997, 28: 235-260. 10.1163/156916297X00103.CrossRef
23.
Giorgi A: The descriptive phenomenological method in psychology: A modified Husserlian approach. 2009, Pittsburgh: Duquesne University Press
24.
Pettersen H, Ruud T, Ravndal E, Landheim A: Walking the fine line: self-reported reasons for substance use in persons with severe mental illness. Int J Qual Stud Health Well-being. 2013, 8: 21968-CrossRefPubMed
25.
Lincoln YS, Guba EG: Naturalistic Inquiry. 1985, Beverly Hills: Sage
26.
Gillespie M, Meaden A: Psychological processes in engagement. Reaching Out: The Psychology of Assertive Outreach. Edited by: Cupitt C. 2010, London: Routledge, Taylor & Francis, 15-42.
27.
Wharne S, Spilsted K: Service user experience: engagement and recovery. Assertive Outreach in Mental Healthcare. Edited by: Williams C, Firn M, Wharne S, Macpherson R. 2011, Chichester: Blackwell Publishing, 134-152.
28.
Margison F: Integrating approaches to psychotherapy in psychosis. Aust N Z J Psychiat. 2005, 39: 972-981. 10.1080/j.1440-1614.2005.01715.x.CrossRef
29.
Deci PA, Santos AB, Hiott DW, Schoenwald S, Dias JK: Dissemination of assertive community treatment programs. Psychiatr Serv. 1995, 46: 676-678.CrossRefPubMed
30.
Brugha TS, Taub N, Smith J, Morgan Z, Hill T, Meltzer H, Wright C, Burns T, Priebe S, Evans J, Fryers T: Predicting outcome of assertive outreach across England. Soc Psychiatry Psychiatr Epidemiol. 2011, 47: 313-322.CrossRefPubMed
31.
SMCH: Keys to Engagement: Review of Care for People with Severe Mental Illness who are Hard to Engage with Services. 2001, London: Sainsbury Centre for Mental Health
32.
Addis J, Gamble C: Assertive outreach nurses’ experience of engagement. J Psychiatr Ment Health Nurs. 2004, 11: 452-460. 10.1111/j.1365-2850.2004.00742.x.CrossRefPubMed
33.
Aggett P, Goldberg D: Pervasive alienation: on seeing the invisible, meeting the inaccessible and engaging ‘lost to contact’ clients with major mental illness. J Interprof Care. 2005, 19: 83-92. 10.1080/13561820400024092.CrossRefPubMed
34.
Williamson T: Ethics of assertive outreach (assertive community treatment teams). Curr Opin Psychiat. 2002, 15: 543-547. 10.1097/00001504-200209000-00013.CrossRef
35.
Anthony W, Rogers ES, Farkas M: Research on evidence-based practices: future directions in an era of recovery. Community Ment Health J. 2003, 39: 101-114. 10.1023/A:1022601619482.CrossRefPubMed
36.
Rosen A, Mueser KT, Teesson M: Assertive community treatment – Issues from scientific and clinical literature with implications for practice. J Rehabil Res Dev. 2007, 44: 813-826. 10.1682/JRRD.2006.09.0110.CrossRefPubMed
37.
Phillips SD, Burns BJ, Edgar ER, Mueser KT, Linkins KW, Rosenheck RA, Drake RE, Herr EC: Moving assertive community treatment into standard practice. Psychiatr Serv. 2001, 52: 771-779. 10.1176/appi.ps.52.6.771.CrossRefPubMed
38.
Rapp CA, Goscha RJ: The principles of effective case management of mental health services. Psychiatr Rehabil J. 2004, 27: 319-333.CrossRefPubMed
39.
Thøgersen MH, Morthorst B, Nordentoft M: Perceptions of coercion in the community: a qualitative study of patients in a Danish assertive community treatment team. Psychiat Q. 2009, 81: 35-47.CrossRef
40.
Ware NC, Dickey B, Tugenberg T, McHorney CA: CONNECT: a measure of continuity of care in mental health services. Ment Health Serv Res. 2003, 5: 209-221. 10.1023/A:1026276918081.CrossRefPubMed
41.
Ware NC, Tugenberg T, Dickey B, McHorney CA: An ethnographic study of the meaning of continuity of care in mental health services. Psychiatr Serv. 1999, 50: 395-400.CrossRefPubMed
42.
Adshead G: Psychiatric staff as attachment figures. Understanding management problems in psychiatric services in the light of attachment theory. Br J Psychiatry. 1998, 172: 64-69. 10.1192/bjp.172.1.64.CrossRefPubMed
43.
Berry K, Barrowclough C, Wearden A: A review of the role of adult attachment style in psychosis: unexplored issues and questions for further research. Clin Psychol Rev. 2007, 27: 458-475. 10.1016/j.cpr.2006.09.006.CrossRefPubMed
44.
Cupitt C, Gillham A, Law A: The whole team approach: containment or chaos?. Reaching Out: The Psychology of Assertive Outreach. Edited by: Cupitt C. 2010, London: Routledge, Taylor & Francis, 43-63.
45.
Flores PJ: Addiction as an Attachment Disorder. 2004, Lanham: Jason Aronson
46.
Molodynski A, Burns T: What does research tell us about assertive community treatment?. Assertive Outreach in Mental Healthcare. Edited by: Williams C, Firn M, Wharne S, Macpherson R. 2011, Chichester: Blackwell Publishing, 1-14.
47.
Ryan R, Morgan S: Assertive Outreach: A Strengths Approach to Policy and Practice. 2004, Edinburgh: Churchill Livingstone
Metadata
Title
Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use
Authors
Henning Pettersen
Torleif Ruud
Edle Ravndal
Ingrid Havnes
Anne Landheim
Publication date
01-12-2014
Publisher
BioMed Central
Published in
International Journal of Mental Health Systems / Issue 1/2014
Electronic ISSN: 1752-4458
DOI
https://doi.org/10.1186/1752-4458-8-40

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