Tottori J. Clin. Res. 7(2), 101-108, 2016

Activities of the Assertive Outreach Team (AOT) at Tottori Medical Center
and The reduction of beds
Toshiyuki Ueta*
Assertive Outreach Team, Tottori Medical Center, National Hospital Organization.
*Correspondence: tori.mhc@gmail.com
Abstract
In 2011, Japanese psychiatry departments had 269 hospital beds per 100 thousand people in the population,
which is an exceptionally high ratio compared to other nations. The reason behind this has been criticized to be
the significant lack of community services for patients with mental disorders which prevents patients withsevere and persistent mental disturbances from sustaining lives in the community. The assertive outreachtreatment (ACT) is known to be an effective method in this type of situation; however, it has not taken root inJapan yet. Given that, we at the Tottori Medical Center launched an assertive outreach team (AOT) under thatname with the goals of promoting the discharge of patients and supporting their ability to adjust to living in thecommunity. The AOT at our center is a multi-professional team, composed of psychiatrist, nurse, psychiatricsocial worker, occupational therapist and clinical psychologist and currently supports the community lives ofeight users. All eight users are diagnosed with schizophrenia, and are thus patients of severe and persistentmental disturbances. The intervention of the AOT has significantly decreased the total time in hospitalization,
the length of the longest hospitalization, and the lengths of single hospitalizations. Furthermore, visits after
discharge allows the AOT staffs to detect psychiatric symptoms early so that patients can be re-hospitalized
promptly before conditions worsen. Therefore, introducing the multi-professional AOT home-visitation service
to the standard clinical approach has a great advantage of allowing efficient use of limited medical resources.
We were able to confirm that in the normal clinical situation in our country, AOT was effective in supportingthe community lives of patients with severe mental disorders, even if the active outreach service AOT does notconform exactly to the ACT model standards for fidelity. Although there are currently not enough funds
allocated to this form of visiting service in Japan, it is essential to introduce an active outreach team to thenormal clinical setting. Tottori J. Clin. Res. 7(2), 101-108, 2016
Key Words: assertive outreach, community support, schizophrenia, discharge management
care in Japan. The population of the Tottori
prefecture Eastern Area is 230 thousand, and there
are four psychiatric hospitals in the area. There area total of 689 beds, which equates to 298 beds per
100 thousand inhabitants. The National Hospital
Organization Tottori Medical Center is one of thepsychiatric hospitals in the region, with 142 beds in
its three psychiatric wards. Many of the wards havelong-term inpatients, many of whom have fallen
into the pattern of institutionalism. As mentioned
above, one of the reasons for this is the lack ofcommunity care services in the Tottori Prefecture
Eastern Area, as well.
As such, the active outreach team (AOT) waslaunched in the Tottori Medical Center. Its founding
goals were to 1) encourage hospitalized patients’Introduction
The number of psychiatry hospital beds in ournation in 2011 was 269 per 100 thousand people in
the population, which is exceptionally highcompared to other OECD countries1) (Fig. 1). Themajority of these beds are used for long-term, rather
than acute care. This is a problem that has been
criticized, and a major reason behind this problem
is the significant lack of community services.
Despite the great efforts that psychiatric hospital
staff has been putting into encouraging discharge, it
is a challenge for patients with severe and persistentmental disorders to continue living in thecommunity. Although the ACT system is named as
one of the effective methods under suchcircumstance, it is not introduced yet into standard
1