Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia.
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.
Zavradashvili
Nana
N
Georgian Association for Mental Health, Tbilisi, Georgia. valeria.donisi@univr.it
Donisi
Valeria
V
Grigoletti
Laura
L
Pertile
Riccardo
R
Gelashvili
Ketevan
K
Eliashvili
Manana
M
Amaddeo
Francesco
F
D000553:Ambulatory Care / Q000191:economics; D003156:Community Mental Health Services / Q000191:economics* / Q000379:methods*; D003266:Continuity of Patient Care / Q000191:economics; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005846:Georgia (Republic) / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000191:economics; D006801:Humans; D008137:Longitudinal Studies; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D010865:Pilot Projects; D011203:Poverty / Q000191:economics / Q000706:statistics & numerical data*