Iwao Oshima

The effect of Assertive Community Treatment in Japan

Ito J, Oshima I, Nishio M, Sono T, Suzuki Y, Horiuchi K, Niekawa N, Ogawa M, Setoya Y, Hisanaga F, Kouda M, Tsukada K. The effect of Assertive Community Treatment in Japan.

A randomized controlled trial of individual placement and support in Japan.

OBJECTIVE The individual placement and support (IPS) model of supported employment has been implemented throughout North America and Europe, with multiple randomized controlled trials documenting its effectiveness, but it has not been widely implemented in Asia. To date, no rigorous evaluations of IPS have been conducted in Japan. We sought to evaluate whether IPS could be implemented in Japan and produce superior competitive employment outcomes compared with conventional vocational services. METHOD We employed a randomized controlled trial with a 6-month follow-up; 18 participants were randomly assigned to IPS and 19 to conventional vocational services. We assessed competitive employment rates, hours and weeks worked, and wages earned. RESULTS Over the 6-month follow-up period, IPS participants were more likely than those in usual care to work competitively (44.4% for IPS vs. 10.5% for controls, p = .022), work more hours (mean of 168 hr for IPS vs. 41 hr for controls, p = .002), and work more weeks (mean of 6.4 weeks for IPS vs. 1.8 weeks for controls, p = .003). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE IPS can be implemented in Japan and yield better competitive employment outcomes than conventional vocational services. Adoption of the IPS model might have a dramatic impact on the mental health service system in Japan where psychiatric hospitals play a central role in mental health care.

Family needs and related factors in caring for a family member with mental illness: adopting assertive community treatment in Japan where family caregivers play a large role in community care.

Aim:  In Japan the family plays a large role in community care for persons with mental illness; therefore the aim of the present study was to describe the needs of family caregivers related to assertive community treatment (ACT) and to analyze the relationship of these needs to underlying factors.

Family Support in Assertive Community Treatment: An Analysis of Client Outcomes

Assertive Community Treatment (ACT) is an outreach-based case management model that assists people with severe mental illness through an intensive and integrated approach. In this program, a multidisciplinary team provides medical and psychosocial services. The purpose of this study was to examine the effectiveness of the following two ACT intervention strategies: “replacement” (supporting the clients) versus “backup” (supporting family members who provide care to clients). Admission days, psychiatric symptoms, quality of life, self-efficacy, and service satisfaction ware evaluated as outcome variables. To identify effective methods of supporting family members, clients living with family were divided into two groups based on the amount and types of services received—the backup group and the replacement group. ANCOVA was used to compare the outcomes between the two groups. The replacement group displayed significantly better psychiatric symptoms, social functioning, self-efficacy, and service satisfaction scores. No differences in admission days or quality of life were found. Clients provided more support directly to clients themselves than to family members was found to have better client outcomes in improving psychiatric symptoms, social functioning, and self-efficacy, resulting in higher levels of service satisfaction. This indicates that society should reduce the responsibility of the family and share responsibility for the care of people with mental illness to effectively improve outcomes for people with mental illnesses.

Initiative to Build a Community-Based Mental Health System Including Assertive Community Treatment for People With Severe Mental Illness in Japan

In Japan, although the locus of care is still predominantly in psychiatric hospitals, a growing number of mental health service providers have become engaged in promoting community integration of people with severe mental illness. This paper describes an ongoing initiative to build a mental health and social services system, which is viewed as a model for other Japanese communities in creating support for people with severe mental illness. This initiative consists of two projects: development and evaluation of an assertive community treatment (ACT) team located in a suburb of Tokyo and a broader community support project in this same community. A pilot evaluation of consumer outcomes for the ACT team demonstrated that ACT is feasible and effective in the Japanese social and cultural context. The community support project was successful in start-up demonstration programs of case management, residential, and supported employment services. Challenges to the expansion of ACT and other community-based services in Japan are discussed.

Preliminary outcome study on assertive community treatment in Japan

Aims:  The beneficial effects of assertive community treatment (ACT), which has been widely acclaimed as being successful in several foreign countries, must also be objectively evaluated with respect to the transition from inpatient to community‐based mental health treatment in Japan. This was the first study that examined effects of the ACT program in Japan using pre/post design data of the pilot trial of the ACT program in Japan project.

Association between feasibility of discharge, clinical state, and patient attitude among inpatients with schizophrenia in Japan.

Aim:  There have been some studies on the feasibility of discharging mentally ill inpatients from mental hospitals. The purpose of the present study was to investigate how a psychiatrist judges whether an inpatient can be discharged.