Best Practices: Assertive Community Treatment for Persons With Severe and Persistent Mental Illness in Ethnic Minority Groups

Assertive community treatment is a well-established model for providing intensive treatment and psychosocial rehabilitation services to people with severe and persistent mental illnesses (1). Use of this model has been shown to lead to significant reductions in psychiatric admissions and hospital stays and to improved housing stability, symptoms, and quality of life (2). Although assertive community treatment has been well studied in the general population in North America and parts of Europe, no studies have examined its effectiveness when used with specific populations of persons with serious mental illnesses, such as recent immigrants, refugees, and persons from ethnic minorities with cultural and language barriers.

Patients from ethnic minority groups who have serious and persistent mental illnesses represent one of the most difficult-to-serve populations. Their severe functional impairment is often compounded by stressors related to migration and acculturation, language difficulties, socioeconomic disadvantages, inadequate housing, lack of access to services, and discrimination. Furthermore, many patients may be alone in their new countries—members of their extended family or other supportive persons may not be available. Loss of this support network is critical because research has suggested that family and social support is associated with favorable outcomes in developing countries (3).

Even though patients from ethnic minority groups have many needs, studies have shown that these groups are underserved by the mainstream mental health system, as demonstrated by less access and lower quality of care (4,5). Language and cultural barriers are key reasons for the disparity.

Recognizing this challenge, the Mount Sinai Hospital, funded by the Ontario Ministry of Health, in partnership with Hong Fook Mental Health Association (a community agency), developed an assertive community treatment team with a mandate to serve persons from ethnic minority groups in central Toronto.

Research is needed to examine whether the assertive community treatment model can be adapted for patients from ethnic minority groups who have serious and persistent mental illnesses. In this column we report on the unique and innovative aspects of this ethnoculturally focused team and use data from a one-year outcome study to describe its effectiveness. We hope that this column will help to lay the "best practice" groundwork for assertive community treatment services for these patients.

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Home of the Culturally Adapted Psychoeducation project for families of patients with first-episode psychosis and The Culture and Psychosis Working Group