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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00736

Reduction of involuntary admissions in patients with severe psychotic disorders treated in the ACCESS integrated care model including therapeutic assertive community treatment

 Daniel Schöttle1*, Friederike Ruppelt2, Benno Schimmelmann3, Anne Karow2, 4,  Alexandra Bussopulos2, Jürgen Gallinat2, Klaus Wiedemann2,  Daniel Lüdecke2, Anja C. Rohenkohl2, Christian Huber5, Thomas Bock2 and  Martin Lambert2
  • 1University Medical Center Hamburg-Eppendorf, Germany
  • 2Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
  • 3Universitätsklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, Universität Bern, Switzerland
  • 4Klinik für Kinder und Jugendpsychiatrie, psychosomatik und psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Germany
  • 5University Children’s Hospital Basel, Switzerland

Objective: The ACCESS treatment model offers assertive community treatment (ACT) embedded in an integrated care program to patients with severe psychotic disorders. Compared to standard care, it proved to be more effective in terms of service disengagement and other outcomes in patients with psychotic disorders over 12, 24 and 48 months. Many patients with severe mental disorders experience involuntary admissions which can be potentially traumatic. In this study, we assessed the effect of ACT on reducing involuntary admissions over an observation period of 4 years.
Method: 171 patients treated in ACCESS were included in this study. The primary outcome was rate of involuntary admissions during 48 months. Secondary outcomes were differences between those with and without involuntary admissions in the two years prior to ACCESS regarding change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication non-adherence, and service-disengagement.
Results: Of 171 patients, 58 patients (33.9%) were involuntarily admitted to hospital in the past 2 years before entry. During the four years of treatment, 16 patients (9.4%) were involuntarily admitted to hospital which was a significantly lower rate compared to the two years before inclusion in ACCESS (p<.001). Comparing the two groups, larger improvements in severity of illness (p = .004) and functional status (p = .043) were detected in the group with no history of involuntary admissions. At four-year follow-up, of the remaining patients 69.2% (n=81) were full adherent (p < .001), compared to 18.9% (n = 31) at baseline with no differences between the two groups over the study period (p=.25).
Over four years, only 13 patients (13.2 %) were service-disengaged due to non-practical reasons.
Conclusions: In this long-term study, we were able to demonstrate a reduction in involuntary admissions in four treatment years compared to the two years prior to admission to the ACCESS-model in patients with severe and mostly multiphase schizophrenia spectrum disorders and affective disorders with psychotic features. This may help prevent patients from suffering from a potentially traumatic experience during treatment in the psychiatric system.

Keywords: psychosis, Involuntary admission, Coercion, Assertive community treatment, severe mental illness, Integrated Care, Integrated care and clinical outcomes

Received: 25 Apr 2019; Accepted: 13 Sep 2019.

Copyright: © 2019 Schöttle, Ruppelt, Schimmelmann, Karow, Bussopulos, Gallinat, Wiedemann, Lüdecke, Rohenkohl, Huber, Bock and Lambert. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Daniel Schöttle, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, d.schoettle@uke.de