Abstract
Background
In Georgia, difficult socioeconomic conditions have resulted in a drastic decrease in government financing for the health sector. State mental hospitals continue to be the main solution for the mentally ill, due to the severe lack of community-based services, and mental health services are inadequate to meet the needs of patients.
Methods
An experimental intervention of assertive community care was implemented with the aim to engage socially isolated patients who lacked contact with outpatient services and to answer their different social and psychological needs. The intervention lasted 10 months and consisted of outpatient visits, visits at home, meetings outside and telephone calls to the services’ facilities; all services were provided by a multidisciplinary team. The intervention was conducted in a psychiatric dispensary in the district of Tbilisi, Georgia.
Results
This pilot study showed the economic sustainability of community care and its effectiveness to facilitate continuity of care and to improve clinical and social outcomes.
Conclusions
High-quality community care costs less than usual treatment and inpatient care and seems to be effective to improve clinical and social outcomes; for these reasons, policymakers should consider, in their future mental health reforms, allocating more resources to community-based care.
Similar content being viewed by others
References
Andreasen NC (1984) Scale for the assessment of negative symptoms (SANS). University of Lowa, Lowa City
Andreasen NC (1984) Scale for the assessment of positive symptoms (SAPS). University of Lowa, Lowa City
Burns T, Catty J, Dash M, Roberts C, Lockwood A, Marshall M (2007) Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. BMJ 335:336–340
Georgian Ministry of Labour, Health and Social Affairs (2008) State Psychiatry care Program 2007. Georgia. www.moh.gov.ge. Accessed July 2008
Johnson S (2008) So what shall we do about assertive community treatment? Epidemiol Psichiatr Soc 17(2):110–114
Killaspy H, Johnson S, Pierce B, Bebbington P, Pilling S, Nolan F, King M (2009) Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial. Soc Psychiatry Psychiatr Epidemiol 44:532–540
Kortrijk HE, Staring AB, van Baars AW, Mulder CL (2009) Involuntary admission may support treatment outcome and motivation in patients receiving assertive community treatment. Soc Psychiatry Psychiatr Epidemiol [Epub ahead of print]
Makhashvili N (2007) Situation appraisal in mental health sector. Statement. Global Initiative on Psychiatry, Tbilisi
Makhashvili N (2007) Towards the new mental health policy: human rights perspective. http://www.crrc.ge/store/files/DI2006Fellows/makhashvili/Makhashvili%20-%20CRRC%20Final%20Analytical%20Report_eng.pdf. Accessed July 2008
Public Defender Office of Georgia (2007) Special report on human rights violations in Georgian psychiatry. PDO, Tbilisi
Ruggeri M, Tansella M (2008) Case management or assertive community treatment: are they really alternative approaches? Epidemiol Psichiatr Soc 17(2):93–98
Saxena S, Thornicroft G, Knapp M, Whiteford H (2007) Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370:878–889
Stata Corporation (2003) Stata statistical software, release 8.0. Stata Corporation, College Station
Statistics in Georgia (2008) http://www.statistics.ge. Accessed July 2008
Thornicroft G, Tansella M (2004) Components of a modern mental health service: a pragmatic balance of community and hospital care. Overview of systematic evidence. Br J Psychiatry 185:283–290
Tomov T (2001) Mental health reforms in eastern Europe. Acta Psychiatr Scand 104(Suppl 410):21–26
World Health Organisation (1992) The ICD-10 classification of mental and behavioural disorders: clinical description and diagnostic guidelines. WHO, Geneva
Zavradashvili N, Makhashvili N (2008) Situation and needs of persons with mental disorders in Georgia. Analytical report. Global Initiative on Psychiatry, Tbilisi
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zavradashvili, N., Donisi, V., Grigoletti, L. et al. Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia. Soc Psychiat Epidemiol 45, 779–783 (2010). https://doi.org/10.1007/s00127-009-0125-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-009-0125-2