Community Mental Health Journal

, Volume 48, Issue 4, pp 463–470 | Cite as

Family Support in Assertive Community Treatment: An Analysis of Client Outcomes

  • Tamaki Sono
  • Iwao Oshima
  • Junichiro Ito
  • Masaaki Nishio
  • Yuriko Suzuki
  • Kentaro Horiuchi
  • Nobuyuki Niekawa
  • Masayo Ogawa
  • Yutaro Setoya
  • Kazumi Tsukada
Original Paper


Assertive Community Treatment (ACT) is an outreach-based case management model that assists people with severe mental illness through an intensive and integrated approach. In this program, a multidisciplinary team provides medical and psychosocial services. The purpose of this study was to examine the effectiveness of the following two ACT intervention strategies: “replacement” (supporting the clients) versus “backup” (supporting family members who provide care to clients). Admission days, psychiatric symptoms, quality of life, self-efficacy, and service satisfaction ware evaluated as outcome variables. To identify effective methods of supporting family members, clients living with family were divided into two groups based on the amount and types of services received—the backup group and the replacement group. ANCOVA was used to compare the outcomes between the two groups. The replacement group displayed significantly better psychiatric symptoms, social functioning, self-efficacy, and service satisfaction scores. No differences in admission days or quality of life were found. Clients provided more support directly to clients themselves than to family members was found to have better client outcomes in improving psychiatric symptoms, social functioning, and self-efficacy, resulting in higher levels of service satisfaction. This indicates that society should reduce the responsibility of the family and share responsibility for the care of people with mental illness to effectively improve outcomes for people with mental illnesses.


Assertive community treatment (ACT) Family Process Outcome 



This research was part of a project supported by grant H14-Kokoro-009 and H17-Kokoro-006 from the Ministry of Health, Labor, and Welfare of Japan. I am grateful to the members of the ACT clinical team, research team, and the clients who made the evaluation possible. I would also like to thank Norito Kawakami and Wakate Kai, who were important advisors during the work.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Tamaki Sono
    • 1
  • Iwao Oshima
    • 2
  • Junichiro Ito
    • 3
  • Masaaki Nishio
    • 4
  • Yuriko Suzuki
    • 5
  • Kentaro Horiuchi
    • 6
  • Nobuyuki Niekawa
    • 7
  • Masayo Ogawa
    • 8
  • Yutaro Setoya
    • 3
  • Kazumi Tsukada
    • 6
  1. 1.Psilocybe Inc.ShigaJapan
  2. 2.Graduate School of Social WelfareJapan College of Social WorkKiyose, TokyoJapan
  3. 3.Department of Psychiatric RehabilitationInstitute of Mental Health, National Center of Neurology and Psychiatry JapanKodaira, TokyoJapan
  4. 4.Faculty of Comprehensive WelfareTohoku Fukushi UniversitySendai, MiyagiJapan
  5. 5.Department of Adult Mental HealthNational Center of Neurology and PsychiatryKodaira, TokyoJapan
  6. 6.Kohnodai Hospital, International Medical Center of JapanIchikawa, ChibaJapan
  7. 7.Social Work Research InstituteJapan College of Social WorkKiyose, TokyoJapan
  8. 8.School of NursingUniversity of ShizuokaSuruga-ku, ShizuokaJapan

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