The Impact of the Covid-19 Pandemic on Assertive Community Treatment Team Functions, Clinical Services, and Observable Outcomes—A Provincial Survey in Ontario, Canada
Publication: Canadian Journal of Community Mental Health
7 September 2023
Abstract
Assertive Community Treatment (ACT) teams provide the most intensive care for patients with serious mental illness. This online study surveyed the 88 ACT and Flexible ACT (FACT) teams in Ontario, Canada (144/232 surveys, 62.1%) during the height of Covid-19 in 2021, and qualitative thematic analysis on impact of team function and patient outcome showed challenges of teams switching to virtual care, reduced psychosocial services, division to smaller groups, staff redeployment, having unequal compensations, and exacerbated regional differences; there were also increased patient stress, loneliness, hospital and ER visits, substance use and related deaths, and police/crisis team involvement. There was limited morbidity related to actual Covid-19; and positive adaptations included observed independence and resilience, increased interdependence with community partners, and new communication formats.
Résumé
Les équipes de traitement communautaire assertif (ACT) fournissent les soins les plus intensifs aux patients atteints de maladies mentales graves. Cette étude en ligne a interrogé les 88 équipes ACT et ACT flexible (FACT) de l’Ontario, au Canada (144/232 enquêtes, 62,1 %) au plus fort de la Covid-19 en 2021. L’analyse thématique qualitative a montré des rapports faisant état d’une augmentation du stress des patients, de la solitude, des visites à l’hôpital, de la consommation de substances et les décès qui y sont liés, de l’implication de la police/équipe de crise et d’une morbidité limitée liée à la Covid-19. Les défis de l’équipe comprenaient les différences régionales, la division en petits groupes, le redéploiement du personnel, les soins virtuels, la réduction des services psychosociaux et les compensations inégales. Les adaptations positives comprenaient l’observation d’indépendance et de résilience, une interdépendance accrue avec les partenaires communautaires et de nouveaux modes de communication.
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References
Adalja A. A., Toner E., and Inglesby T. V. 2020 Priorities for the US health community responding to COVID-19 JAMA 323 14 1343 -1344
Barry K. L., Zeber J. E., Blow F. C., and Valenstein M. 2003 Effect of strengths model versus assertive community treatment model on participant outcomes and utilization: Two-year follow-up Psychiatric Rehabilitation Journal 26 3 268
Bozdağ F. and Ergün N. 2020 Psychological resilience of healthcare professionals during COVID-19 pandemic Psychological Reports 0033294120965477
Bommersbach T., Dube L., and Li L. 2021 Mental health staff perceptions of improvement opportunities around COVID-19: A mixed-methods analysis Psychiatric Quarterly 1 -14
Bond G. R. and Drake R. E. 2015 The critical ingredients of assertive community treatment World Psychiatry 14 2 240
Clarke, V., & Braun, V. (2014). Thematic analysis. In Encyclopedia of critical psychology (pp. 1947–1952). Springer, New York, NY.
Couser G. P., Taylor-Desir M., Lewis S., and Griesbach T. J. 2021 Further adaptations and reflections by an assertive community treatment team to serve clients with severe mental illness during Covid-19 Community Mental Health Journal 57 7 1217 -1226
Czeisler M. É., Lane R. I., Petrosky E., Wiley J. F., Christensen A., Njai R., and Rajaratnam S. M. 2020 Mental health, substance use, and suicidal ideation during the Covid-19 pandemic—United States, June 24–30, 2020 Morbidity and Mortality Weekly Report 69 32 1049
Dieterich M., Irving C. B., Bergman H., Khokhar M. A., Park B., and Marshall M. 2017 Intensive case management for severe mental illness The Cochrane Database of Systematic Reviews 1 CD007906 https://doi.org/10.1002/14651858.CD007906.pub3
Dixon L. 2000 Assertive community treatment: Twenty-five years of gold Psychiatric Services 51 6 759 -765
Drake R. E. and Deegan P. E. 2008 Are assertive community treatment and recovery compatible? Commentary on “ACT and recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams.” Community Mental Health Journal 44 1 75 -77
Druss B. G. 2020 Addressing the Covid-19 pandemic in populations with serious mental illness JAMA Psychiatry 77 9 891 -892
Galea S. and Ettman C. K. 2021 Mental health and mortality in a time of Covid-19 American Journal of Public Health 111 S2 S73 -S74
Gomes T., Kitchen S. A., and Murray R. 2021 Measuring the burden of opioid-related mortality in Ontario, Canada, during the Covid-19 pandemic JAMA Network Open 4 5 e2112865 -e2112865
Guan I., Kirwan N., Beder M., Levy M., and Law S. 2021 Adaptations and innovations to minimize service disruption for patients with severe mental illness during Covid-19: Perspectives and reflections from an assertive community psychiatry program Community Mental Health Journal 57 1 10 -17
Joannette J. A., Lawson J. S., Eastabrook S. J., and Krupa T. 2005 Community tenure of people with serious mental illness in assertive community treatment in Canada Psychiatric Services 56 11 1387 -1393
Kahl K. G. and Correll C. U. 2020 Management of patients with severe mental illness during the coronavirus disease 2019 pandemic JAMA Psychiatry 77 9 977 -978
Kidd S. A., George L., O’Connell M., Sylvestre J., Kirkpatrick H., Browne G., Odueyungbo A. O., and Davidson L. 2011 Recovery-oriented service provision and clinical outcomes in assertive community treatment Psychiatric Rehabilitation Journal 34 3 194 -201
Laufs J. and Waseem Z. 2020 Policing in pandemics: A systematic review and best practices for police response to Covid-19 International Journal of Disaster Risk Reduction 101812
McGrew J. H. and Bond G. R. 1995 Critical ingredients of assertive community treatment: Judgments of the experts The Journal of Mental Health Administration 22 2 113 -125
McGrew J. H., Pescosolido B., and Wright E. 2003 Case managers’ perspectives on critical ingredients of assertive community treatment and on its implementation Psychiatric Services 54 3 370 -376
Nakhost A., Law S. F., Francombe Pridham K. M., and Stergiopoulos V. 2017 Addressing complexity and improving access in community mental health services: An inner-city adaptation of flexible ACT Psychiatric Services 68 9 867 -869
Nemani K., Li C., Olfson M., Blessing E. M., Razavian N., Chen J., and Goff D. C. 2021 Association of psychiatric disorders with mortality among patients with Covid-19 JAMA Psychiatry 78 4 380 -386
O’Campo P., Stergiopoulos V., Nir P., Levy M., Misir V., Chum A., and Hwang S. W. 2016 How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial BMJ Open 6 9 e010581
Ontario Association for ACT and FACT (OAAF). (2022). Directory. https://ontarioactassociation.com
Rosenheck R., Johnson B., Deegan D., and Stefanovics E. 2021 Impact of Covid-19–related social distancing on delivery of intensive case management The Journal of Nervous and Mental Disease 209 8 543 -546
Sachs R. E. 2022 Encouraging interagency collaboration: Learning from Covid-19 Journal of Law & Innovation 4 1 71
Santarone K., McKenney M., and Elkbuli A. 2020 Preserving mental health and resilience in frontline healthcare workers during Covid-19 The American Journal of Emergency Medicine 38 7 1530 -1531
Sklar M., Ehrhart M. G., and Aarons G. A. 2021 Covid-related work changes, burnout, and turnover intentions in mental health providers: A moderated mediation analysis Psychiatric Rehabilitation Journal 44 3 219 -228
Smaldone A. and Cullen-Drill M. 2010 Mental health parity legislation: Understanding the pros and cons Journal of Psychosocial Nursing and Mental Health Services 48 9 26 -34
Spivak S., Mojtabai R., Green C., Firth T., Sater H., and Cullen B. A. 2019 Distribution and correlates of assertive community treatment (ACT) and ACT-like programs: Results from the 2015 N-MHSS Psychiatric Services 70 4 271 -278
Stefancic A., Henwood B. F., Melton H., Shin S. M., Lawrence-Gomez R., and Tsemberis S. 2013 Implementing housing first in rural areas: Pathways Vermont American Journal of Public Health 103 S2 S206 -S209
Stein L. I. and Test M. A. 1980 Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation Archives of General Psychiatry 37 4 392 -397
Tamiolaki A. and Kalaitzaki A. E. 2020 “That which does not kill us, makes us stronger”: Covid-19 and posttraumatic growth Psychiatry Research 289 113044
Tse J., LaStella D., Chow E., Kingman E., Pearlman S., Valeri L., and Dixon L. B. 2021 Telehealth acceptability and feasibility among people served in a community behavioral health system during the Covid-19 pandemic Psychiatric Services 72 6 654 -660
Yao H., Chen J.H., and Xu Y.F. 2020 Patients with mental health disorders in the Covid-19 epidemic The Lancet Psychiatry 7 4 e21 https://doi.org/10.1016/S2215-0366(20)30090-0
Zulfic Z., Liu D., Lloyd C., Rowan J., and Schubert K. O. 2020 Is telepsychiatry care a realistic option for community mental health services during the Covid-19 pandemic? Australian & New Zealand Journal of Psychiatry 54 12 1228 -1228
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Canadian Journal of Community Mental Health
Volume 42 • Number 2 • August 2023
Pages: 53 - 65
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Version of record online: 7 September 2023
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Aly Kassam, Michaela Beder, John Maher, Saadia Sediqzadah, Nicole Kirwan, Madeleine Ritts, Matthew Levy, and Samuel Law. 2023. The Impact of the Covid-19 Pandemic on Assertive Community Treatment Team Functions, Clinical Services, and Observable Outcomes—A Provincial Survey in Ontario, Canada. Canadian Journal of Community Mental Health.
42(2): 53-65. https://doi.org/10.7870/cjcmh-2023-016
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