ABSTRACT
Severe mental illnesses cause their sufferers dismal functional impairment. The Global Burden of Disease lists schizophrenia among the top 10 contributors to health burden and disability around the world. In the Institute of Mental Health (IMH) of Singapore, 9 out of 10 Class-C beds are occupied by patients whose hospitalisation periods last 300 days on average. Whilst deinstitutionalisation has not seen its expected level of success overseas, the provision of community-based psychiatric care has been shown to be more cost-effective than hospital-based inpatient care. As such, there is a need for increased emphasis on community psychiatric services, both to provide and to effectively utilise available resources to assist patients with severe mental illnesses in living and functioning within the community. In line with several other efforts, a pilot Assertive Community Treatment or ACT Programme was launched by IMH in November 2003. This article details the aims, set-up and services of this pilot project funded by the Health Service Development Programme (HSDP) for 3 years, which receives referrals from IMH psychiatrists. With the services provided by the ACT team including psychosocial rehabilitation, it is hoped that patients will continue to receive adequate psychiatric care as well as maintain sufficient skills for self-care and independent living within the community despite the well-documented deteriorating course of psychotic illnesses like schizophrenia.
It is well known that serious and persistent mental illness can result in diminished ability to function effectively in many life domains, such as the activities of daily living, and the performance of social, cultural and occupational roles. The Global Burden of Disease lists schizophrenia among the top 10 contributors to health burden and disability around the world.1 In the past, most of these patients were locked up in asylums, the living conditions of which often left even the most hardhearted aghast. However, since the 1950s, the movement towards the deinstitutionalisation of mental state hospital patients and the abolishment of mental state hospitals began in many developed nations
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