Zusammenfassung der Ressource
Evaluation: Assertive Community
Therapy for Schizophrenia
- ACT is a psycho-social
multidisciplinary, person centred
treatment. 24 hour care is provided to
clients in their natural living
environments, which is either at home
or in a sheltered accommodation in
the community.
- Studies have found that ACT seems to improve the
quality of life for recipients as they feel that they
are able to maintain a normal lifestyle (e.g. Trauer
et al). This is perhaps because the treatment is
carried out in their natural environment, and
hopes to keep the individuals integrated into
society, rather than isolated from it.
- However, although most patients find
living in the community preferable to
being in hospital, others may find that
situation to be more overwhelming and
challenging. Therefore, this form of
treatment may not be successful for
everyone.
- The main aim of the treatment is to
focus on those that need help with
independence, rehabilitation and
recovery to avoid homelessness
and reduce admissions to hospitals
and shorten lengths of stay.
- Social integration has been found to be effective
in reducing symptoms and the severity of these
symptoms. Left found that those suffering from
sz being cared for in the community in sheltered
accommodation showed much lower symptoms
and severity than those hospitalised,
particularly with negative symptoms.
- However, proper integration into society may be found
difficult due to the stigmatisation and prejudice
surrounding sufferers of mental health in society. This is
only exemplified by the media who report on the
extremely rare cases were mentally unwell members of
society have gone on to attack or murder others. This may
make the aim of social integration hard to meet, and may
put strain on both the individual attempting to be
integrated into society and that individual's family.
- Patients are given lifelong
care, even after stabilisation
and outreach is promoted
for those not wishing to
engage with the therapy.
- Gomory argues that ACT is paternalistic and
coercive, and that patients do not always feel
as though they have a choice (particularly
due to the outreach if the individual is not
interested). 11% of patients feel forced to
undertake treatment.
- Bond et al suggested, however, that the
choice of freedom given by ACT, along with
preventing hospitalisation and having an
increased choice of treatment is more
effective than standard community care.
- Medication is self-administered
for many, however extra
support is provided for those
that may need it.
Hospitalisation is given as a last
resort if the individual feels as
though they cannot cope.
- Leshner found that communication was poor
between agencies and that there was no overall
strategy for coordinating patient care. This
suggests that although extra support is
promoted, it may not be of the best quality, and
therefore the treatment may not be as effective
as it is suggested to be.
- Budget cuts make ACT difficult to sustain. Shepherd
found that most programmes are severely
underfunded, and therefore may not be the most
effective form of treatment for an individual.
Furthermore, the reluctance to provide and fund
hospital beds may mean that someone who needs
hospitalisation is not being admitted when needed.