Assessing the efficacy of a modified assertive community-based treatment programme in a developing country
Date
2010-09
Authors
Botha, Ulla A.
Koen, Liezl
Joska, John A.
Hering, Linda M.
Oosthuizen, Piet P.
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: A number of recently published randomized controlled trials conducted in developed countries have
reported no advantage for assertive interventions over standard care models. One possible explanation could be
that so-called “standard care” has become more comprehensive in recent years, incorporating some of the salient
aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial
assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome
in a developing country.
Methods: High frequency service users were randomized into an intervention (n = 34) and a control (n = 26)
group. The control group received standard community care and the active group an assertive intervention based
on a modified version of the international model of assertive community treatment. Study visits were conducted at
baseline and 12 months with demographic and illness information collected at visit 1 and readmission rates
documented at study end. Symptomatology and functioning were measured at both visits using the PANSS, CDSS,
ESRS, WHO-QOL and SOFAS.
Results: At 12 month follow-up subjects receiving the assertive intervention had significantly lower total PANSS
(p = 0.02) as well as positive (p < 0.01) and general psychopathology (p = 0.01) subscales’ scores. The mean SOFAS
score was also significantly higher (p = 0.02) and the mean number of psychiatric admissions significantly lower
(p < 0.01) in the intervention group.
Conclusions: Our results indicate that assertive interventions in a developing setting where standard community
mental services are often under resourced can produce significant outcomes. Furthermore, these interventions
need not be as expensive and comprehensive as international, first-world models in order to reduce inpatient days,
improve psychopathology and overall levels of functioning in patients with severe mental illness.
Description
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at http://www.biomedcentral.com/1471-244X/10/73
The original publication is available at http://www.biomedcentral.com/1471-244X/10/73
Keywords
Community mental health services -- South Africa -- Cape Town
Citation
Botha, U. A. et al. 2010. Assessing the efficacy of a modified assertive community-based treatment programme in a developing country. BMC Psychiatry, 10(73):1-8, doi:10.1186/1471-244X-10-73.