A pragmatic evaluation of a nationwide mental health outreach service in Japan raises more questions than answers

ABSTRACT FROM: Kayama M, Kido Y, Setoya N, et al . Community outreach for patients who have difficulties in maintaining contact with mental health services: longitudinal retrospective study of the Japanese Outreach Model Project. BMC Psychiatry 2014;14:311. Intensive forms of community treatment for people with severe mental illness include Assertive Community Treatment (ACT) and Assertive Outreach (AO). They are characterised by caseloads of <20 patients per clinician. These interventions can reduce admissions to hospital, increase retention in care and improve social functioning, but the effect on mental state and quality of life is less clear.1 Any benefit is greatest for patients with high rates of hospital admission.1 There is less evidence when comparing less intensive forms of case management with standard care.1 Japan has not had a nationwide implementation of ACT and there are many patients who lose contact with mainstream services.2 Kayama and colleagues evaluated the effectiveness of the nationwide Japanese Outreach Model Project (JOMP), established in 2011 …