Interpersonal Community Psychiatric Treatment: cluster randomized trial into cost effectiveness of a structured outpatient treatment for patients with non-psychotic psychiatric disorders in long-term care

In the Netherlands, as in many other developed countries, many people suffer
from psychiatric disorder during their life. Recent
epidemiological data shows that 43.5% of the Dutch are affected by some form of
mental illness during their life [1]. Depression
(20.1%), anxiety (19.6%), and substance abuse (19.1%) have the highest lifetime
prevalence: the first two appear in the top-4
of diseases with the highest disease burden [2]. Comorbidity with personality
disorders, which have a prevalence of 9.1% in the
US [3] but which are not fully studied in a Dutch community sample, results in
poorer social functioning and limited recovery.
About 80% of all patients receiving mental health services (MHS) have one or
more of the aforementioned non-psychotic
disorders [4]. Particularly for this group long-term treatment or care is
poorly developed.

This study aims for health gain and cost reduction in the care for people with
long-term psychiatric disorders. The research
questions is what the (cost)effectiveness is of Interpersonal Community
Psychiatric Treatment (ICPT), compared to care as
usual (CAU).

HYPOTHESIS
ICPT is more effective in (1) improving patients* quality of life and social
networks, (2) preventing or decreasing professionals*
perception of patients as *difficult*, (3) discharging patients to a lower
level of care, (4) being less costly in reaching these
clinical goals than CAU

Multi-center cluster-randomized clinical trial: participating professionals
will be randomly allocated to either ICPT or CAU for an
intervention period of 12 months, and a follow-up of 6 months.

ICPT is a structured treatment for people with long-term, often difficult to
treat non-psychotic disorders, developed with patients,
professionals, and experts. ICPT uses a number of evidence-based techniques and
was positively evaluated in a controlled
pilot study.

Due to the nature of the patient group, frequent suicide attempts are to be
expected (we think at approximately 40% of this patient group) and therefore is
no specific adverse effects of this research, but the usual symptoms of
patients with this particular long-term psychiatric problems. There might be
expected suicides, but in the same frequency as before the investigation
started. The reason for the ICPT intervention is because in both the
intervention group and the control group suicide attempts occur regularly.

This is a study with no adverse effects. People in both the control group and
the intervention group might become psychotic or suicidal. If this happens
during measurement by the investigators, their professional will be informed.
We don*t assume that the intervention group is more suicidal than the control
group.