Doing More Than Act: The Dutch Fact Model, Flexible Assertive Community Treatment

Abstract

Background/objectives

Assertive community treatment (ACT) has become the standard for integrated care for people with severe mental illnesses. Limitations of ACT are the lack of flexibility, the limited feasibility in rural areas, the limited population and the time-unlimited nature. These limitations can be overcome by flexible assertive community treatment (Flexible ACT), developed in the Netherlands and introduced in several European countries.

Methods

Three studies were done between 2006 and 2015 on the results of the introduction of Flexible ACT, two in The Netherlands and one in the UK.

Results

The outcomes in the Netherlands data show the effectiveness of Flexible ACT. Remission of schizophrenia increased form 19% to 31%. Bed use was reduced and quality of life increased. Effectiveness of FACT was also shown in the UK, where total patient time in hospital declined by half, even though the average time service providers spent with patients also declined. Collected data of the digitalized boards show that the board is used in accordance with the FACT model. Transition rate to primary care is 5–10% per year.

Discussion/conclusion

The introduction of Flexible ACT has been shown to benefit patients with severe mental illness and indicate the ability of to allocate human resources in mental health care more efficiently. Introduction to other countries will be accompanied by research on the effectiveness and feasibility within other cultures.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.