Modified assertive community treatment program for patients with schizophrenia: Effectiveness and perspectives of service consumers from a South Indian setting

Background: Schizophrenia is a disabling mental illness. Antipsychotic treatment in conjunction with comprehensive psychosocial rehabilitation services is essential in promoting functional recovery. Assertive Community Treatment (ACT) is an evidence-based approach in promoting recovery in schizophrenia. The evidence for the effectiveness and feasibility of such community-based assertive interventions in low and middle-income countries is limited. Aim: To evaluate the effectiveness of modified assertive community treatment in a South Indian setting and evaluate the perspectives of patients and caregivers who participated in the program. Methodology: Socio-demographic details, illness characteristics, course of the illness including the number of relapses and hospitalization, adherence level at baseline, the scores on the Social and Occupational Functioning Assessment Scale (SOFAS), and Global disability score on Indian Disability Evaluation and Assessment Scale (IDEAS) were compared before and after the initiation of the M-CAT program using retrospective file review. The perspectives of the clients were assessed using a 6-item questionnaire. Results: Ten patients (six male and four female) with a diagnosis of schizophrenia were under the Manipal Assertive Community Treatment (M-ACT) program for a median duration of 3 years (IQR 1.25) participated in the study. There was a significant improvement in the overall level of functioning, medication adherence, relapse rates, and disability after the enrolment into the program. The majority of the respondents had a positive attitude towards the M-ACT program. Conclusion: Assertive community interventions with suitable modifications for local resource-limited conditions may be an effective option in promoting functional recovery in Schizophrenia.