[Study of the impact of an assertive community program on the families of patients with severe mental disorders].
OBJECTIVE
Assertive Community Treatment (ACT) is known to have a positive impact on the number and length of inpatient stays. Yet, research is needed in order to help understand how ACT programs may ease off families' burden, e.g. in terms of economic expenditures. Indeed, many families with siblings suffering from chronic mental illness, who disengaged from psychiatric services, report needs related to ACT. This paper aims to describe the impact of a new ACT program in Geneva on patients and their families' burden.


METHODS
Out of 91 patients consecutively treated by the ACT program for at least 3 months, 55 consented to participate in the research. Twenty-one allowed us to contact their families (out of 37 who had relatives in the area). Data were gathered on patients and families before and after a 6-month-follow-up.


RESULTS
For the patients, after adjustment for the time spent during follow-up, most of the studied variables evolved favorably, particularly for their symptoms. At baseline, most of the family members felt overburdened by the financial cost (59.1%) related to their relatives with severe mental disorder and experienced inconvenience at having to give them assistance in daily life (68.2%) and to supervise them in daily activities (54.5%). Several variables evolved favorably during follow-up. Notably the best changes were observed for the inconvenience relating to assistance in daily life and relatives' emotional distress. Families of patients with delusional disorder featured less or no improvement during the ACT follow-up. The best correlate of improvement in familial burdens was improvement in patient's positives symptoms. Among those patients, being a female and suffering from a schizo-affective disorder was known to have had a higher impact on the number of interventions provided by families.


CONCLUSIONS
ACT should be recommended for patients who feature a poor outcome when treated in other settings. In addition, our results suggest that their families can also improve considerably, particularly those confronted with patients with persistent and enduring disturbing behaviors related to positive symptoms which do not, however, warrant hospitalization. Clinicians should pay particular attention to patients suffering from delusional disorder and their families, as this disorder does not appear to be associated with improvement in family burdens. These data do not allow definitely disentangling whether the improvement of families' burden is directly related to ACT interventions with them, to the implementation of support by other structures (such as peer support groups) or to an indirect effect related to patients' improvement. To our knowledge no similar study on the effect of ACT on family burden exists. Hence, such research needs to be replicated in other areas with different clinical and cultural backgrounds.
Service de psychiatrie générale, département de santé mentale et de psychiatrie, hôpitaux universitaires de Genève, rue du 31-Décembre-36, secteur 1, Eaux-Vives, 1207 Genève, Suisse. philippe.huguelet@hcuge.ch
P
P
Huguelet
V
V
Koellner
S
S
Boulguy
K
K
Nagalingum
S
S
Amani
L
L
Borras
N
N
Perroud
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000328:Adult; D001714:Bipolar Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*; D017028:Caregivers / Q000191:economics / Q000523:psychology*; D002908:Chronic Disease; D003156:Community Mental Health Services / Q000191:economics; D015897:Comorbidity; D017046:Cost Savings / Q000706:statistics & numerical data; D017281:Cost of Illness; D003702:Delusions / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units / Q000191:economics; D010348:Patient Care Team / Q000191:economics; D010359:Patient Readmission; D011618:Psychotic Disorders / Q000191:economics / Q000523:psychology / Q000628:therapy*; D012559:Schizophrenia / Q000191:economics / Q000628:therapy*; D012565:Schizophrenic Psychology; D012648:Self Care; D012737:Sex Factors; D013557:Switzerland; D016896:Treatment Outcome