Patients in Norwegian Assertive Community Treatment teams: Subjective Quality of Life and Inpatient Service Use

Abstract

Assertive Community Treatment teams (ACT) were implemented in Norway to improve services for people with severe mental illness who need long-term and comprehensive services, but whose needs are inadequately met by standard mental health care. This study investigated the subjective quality of life and associations with patient characteristics amongst ACT patients, their inpatient service use in the two years before and after they enrolled into ACT teams, and associations between changes in inpatient service use and patients’ characteristics. Subjective quality of life was positively associated with age, contact with social network, and everyday functioning and negatively associated with the severity of anxiety and depressive symptoms. Satisfaction with specific life domains was positively associated with related areas of functioning. The patients spent fewer days in psychiatric hospitals in the two years with ACT, compared to the two years before ACT. This was mainly due to a reduction of inpatient days amongst patients with high use of inpatient services before ACT. Patients with problematic substance use had significantly fewer total and involuntary inpatient days during ACT than before. The reduction occurred despite ongoing problematic substance use. The positive relationship between subjective quality of life and the level of functioning may suggest that training targeted to increase patients’ practical and social skills may improve their subjective quality of life. Further, the findings may indicate that ACT contributes to a more appropriate use of inpatient care, possibly by reducing the presumably avoidable hospitalisation of high users and increasing the presumably needed inpatient care of low users. Finally, ACT teams seem to successfully support people with complex mental health problems in the community, including those with problematic substance use, and perhaps thereby contribute to less inpatient service use.