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A randomised controlled trial of assertive outreach vs. treatment as usual for black people with severe mental illness

Published online by Cambridge University Press:  28 March 2011

D. Bhugra ,
O. Ayonrinde ,
G. Butler ,
M. Leese  and
G. Thornicroft
D. Bhugra*
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
O. Ayonrinde
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK
G. Butler
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
M. Leese
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
G. Thornicroft
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
*
*Address for correspondence: Professor Dinesh Bhugra, Health Service & Population Research Department, Institute of Psychiatry, King's College London, PO Box 25, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected])
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Abstract

Aim.

We aimed at testing whether an assertive outreach team (AOT) run by a Black voluntary organisation is more acceptable to Black people with severe mental illness.

Methods.

A randomised controlled trial (RCT) of 83 Black (African, African Caribbean or Black British) patients with severe mental illness with treatment as usual (TAU) or Assertive Outreach (AO) by a non-statutory sector Black AOT. Frequency of admissions, duration of admissions, symptom severity and client satisfaction with clinical interventions were assessed.

Results.

The mean length of admission at follow-up was not significantly different between the two groups (74.64 v. 64.51; mean difference = 10.13, 95% CI −2.86, 23.11, p = 0.125), neither was the mean number of admissions (1.32 v. 1.20; mean difference = 0.13, 95% CI −0.18, 0.43, p = 0.401). Mean Brief Psychiatric Rating Scale (BPRS) ratings at 1-year follow-up were significantly lower in the AOT group than in the TAU group (56.34 v. 63.62; mean difference = 7.27, 95% CI 0.66, 13.88, p = 0.032), and people were significantly more satisfied with AOT 24/29 (83%) than the generic services: 4/26 (15%), p < 0.001.

Conclusions.

While the AO service was highly culturally acceptable to Black people, there was no evidence that the provision of AOT reduces frequency or duration of hospital admission.

Keywords

Assertive outreachblack patientsrandomised controlled trial (RCT)
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 20 , Issue 1 , March 2011 , pp. 83 - 89
Copyright
Copyright © Cambridge University Press 2011

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References

Bhugra, D, Cochrane, R (2001). Psychiatry in Multicultural Britain. Gaskell: London.Google Scholar
Burns, T, Catty, J, Dash, M, Roberts, C, Lockwood, A, Marshall, M (2007). Use of intensive care management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. British Medical Journal 335 (7615), 311–312.CrossRefGoogle ScholarPubMed
Burns, T, Creed, F, Fahy, T, Thompson, S, Tyrer, P, White, I (1999). Intensive versus standard case management for severe psychotic illness: a randomised trial. UK 700 Group. Lancet 353 (9171), 2185–2189.CrossRefGoogle ScholarPubMed
Burns, T, Firn, M (2002). Assertive Outreach in Mental Health: A Manual for Practitioners. Oxford University Press: New York.CrossRefGoogle Scholar
Department of Health (2004). The National Service Framework for Mental Health: Five Years On, Department of Health (DOH): London.Google Scholar
Heer, B, Woodhead, D (2002). Promoting Health, Preventing Illness: Public Health Perceptions on London's Mental Health. pp. 44–47. King's Fund: London.Google Scholar
Killaspy, H, Bebbington, P, Blizard, R, Johnson, S, Nolan, F, Pilling, S, King, M (2006). The REACT study: randomised evaluation of assertive community treatment in North London. British Medical Journal 332, 815–818.CrossRefGoogle ScholarPubMed
Killaspy, H, Kingett, S, Bebbington, P, Blizard, R, Johnson, S, Nolan, F, Pilling, S, King, M (2009). Radnomised evluations of assertive community treatment: 3 year outcome. British Journal of Psychiatry 195, 81–82.CrossRefGoogle Scholar
Larsen, DL, Attkisson, CC, Hargreaves, WA, Nguyen, TD (1979). Assessment of client/patient Satisfaction: development of a general scale. Evaluation and Programme Planning 2, 197–207.Google ScholarPubMed
McHugo, GJ, Drake, RE, Teague, GB, Xie, H (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services 50 (6), 818–824.CrossRefGoogle ScholarPubMed
Office for National Statistics (2008). http://www.neighbourhood.statistics.gov.uk/dissemination/. Retrieved 8 June, 2008.Google Scholar
Overall, JE, Gorham, DR (1962). The brief psychiatric rating scale. Psychological Reports 10, 799–812.CrossRefGoogle Scholar
Stein, LI, Test, MA (1980). Alternative to mental hospital treatment, I: conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry 37, 392–397.CrossRefGoogle ScholarPubMed
Thornicroft, G, Tansella, M (2005). Growing recognition of the importance of service user involvement in mental health service planning and evaluation. Epidemiologia e Psichiatria Sociale – An International Journal for Epidemiology and Psychiatric Sciences 14 (1), 1–3.CrossRefGoogle ScholarPubMed
WHO (1995). International Classification of Diseases Version 10. WHO: Geneva.Google Scholar