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Martinelli A, Pozzan T, Mulder CL, Ruggeri M. Implementing the flexible ACT model in an Italian residential facilities multidisciplinary team. Int J Soc Psychiatry 2024:207640241255586. [PMID: 38840417 DOI: 10.1177/00207640241255586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Alessandra Martinelli
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Tecla Pozzan
- Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy
| | - Cornelis L Mulder
- Epidemiological and Social Psychiatric Research, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Mirella Ruggeri
- Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Tholen MG, Martin A, Stemeseder T, Vikoler T, Wageneder B, Aichhorn W, Kaiser AK. Evaluation of a flexible assertive community treatment (FACT) program for patients with severe mental illness: an observational study in Salzburg, Austria. Int J Ment Health Syst 2024; 18:6. [PMID: 38336693 PMCID: PMC10858489 DOI: 10.1186/s13033-024-00628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Inpatient treatment of severe mentally ill patients binds substantial resources and creates the dilemma of "revolving-door hospitalizations". Evidence suggests that these patients benefit more from an assertive outreach community psychiatric treatment. This descriptive study evaluates the implementation of a new treatment program for severe mentally ill patients provided by a flexible assertive community treatment (FACT) team. METHODS An uncontrolled design with routine data was used to measure the total length of stays, readmission rates and number of contacts one year prior to the implementation of the FACT program and the following first three years of treatment. RESULTS A continuous decrease of hospitalization among patients with severe mental illness was observed with the implementation of the FACT program with declines in total length of stays and readmission rates and accompanied with a decreasing number of contacts per year. CONCLUSION Our findings indicate that this program may create effects in stabilizing patients with severe mental illness and may be highly relevant also for other patient groups.
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Affiliation(s)
- Matthias Gerhard Tholen
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria.
| | - Anna Martin
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Theresa Stemeseder
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Vikoler
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Barbara Wageneder
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Aichhorn
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Kurt Kaiser
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
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van Genk C, Roeg D, van Vugt M, van Weeghel J, Van Regenmortel T. Current insights of community mental healthcare for people with severe mental illness: A scoping review. Front Psychiatry 2023; 14:1156235. [PMID: 37143787 PMCID: PMC10151504 DOI: 10.3389/fpsyt.2023.1156235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
Background For the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare. Methods We conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals. Results The search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships. Conclusion We found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support.
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Affiliation(s)
- Caroline van Genk
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- *Correspondence: Caroline van Genk,
| | - Diana Roeg
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Kwintes Housing and Rehabilitation Services, Zeist, Netherlands
| | - Maaike van Vugt
- Trimbos Institute, Dutch Institute of Mental Health and Addiction, Utrecht, Netherlands
- HVO-Querido, Amsterdam, Netherlands
| | - Jaap van Weeghel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Tine Van Regenmortel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Faculty of Social Sciences – HIVA, University of Leuven, Leuven, Belgium
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Munch Nielsen C, Hjorthøj C, Arnfred BT, Nordentoft M. Patient Outcomes of Flexible Assertive Community Treatment Compared With Assertive Community Treatment. Psychiatr Serv 2022:appips20220235. [PMID: 36475824 DOI: 10.1176/appi.ps.20220235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In many European countries, flexible assertive community treatment (FACT) has replaced assertive community treatment (ACT) despite limited evidence for FACT's effectiveness in improving functional and patient-reported outcomes. This study evaluated the effectiveness of FACT relative to ACT in improving functioning, client satisfaction, and the working alliance. METHODS The authors used a nonblinded, quasi-experimental controlled study design to compare outcomes of patients treated by ACT teams that were reconfigured to FACT teams with those of patients treated by a remaining ACT team. Patients from nine ACT teams in the Capital Region of Denmark were included. Six of the nine ACT teams were reconfigured to FACT in 2018 and 2019 by integrating them with community mental health teams. The remaining three ACT teams were used as control groups. Assignment to treatment was based solely on administrative considerations. RESULTS The study included 131 patients (FACT, N=74; ACT, N=57). Patients treated by FACT teams had poorer personal and social functioning than patients assigned to ACT teams (adjusted difference in means=-2.9, 95% CI=-5.8 to -0.1). No between-group differences were found in client satisfaction or working alliance. CONCLUSIONS Patients treated by FACT teams had significantly lower functioning than patients treated by ACT teams, but the clinical relevance or causality of this finding remains unclear. Given the reconfiguration of the FACT teams during follow-up, along with substantial drop-out rates and baseline differences between the two groups, these results must be interpreted with caution. The findings require further examination in a randomized controlled trial that includes fidelity measures of the treatment models.
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Affiliation(s)
- Camilla Munch Nielsen
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Benjamin Thorup Arnfred
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
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The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study. Lancet Psychiatry 2021; 8:27-35. [PMID: 33091344 DOI: 10.1016/s2215-0366(20)30424-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/12/2020] [Accepted: 08/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Flexible assertive community treatment (FACT) is a community-based treatment model for patients with severe mental illness that has been widely implemented despite little evidence for its effectiveness. We aimed to evaluate the effect of FACT on mental health care outcomes compared with treatment from standard community mental health teams (CMHTs) or assertive community treatment (ACT) teams in Denmark. METHODS We did a quasi-experimental, propensity-score matched, controlled study in five FACT teams, four ACT teams, and five CMHTs in the Capital Region of Denmark. The FACT teams were established on May 1, 2016 (the index date). Patients were identified through the Danish Psychiatric Register and the study population consisted of all patients receiving care from any of these teams on the index date. Assignment to treatment was based on administrative considerations and was not done by the researchers. Patient data were collected from Danish registers. The primary outcome was analysed in the intention-to-treat population and compared mental health care outcomes (psychiatric admissions and bed days, outpatient contacts, self-harm, coercion, and death by any cause) for patients under the care of CMHTs or ACT teams that were reconfigured to FACT teams (CMHT-FACT or ACT-FACT) with patients who remained under the care of CMHTs and ACT teams. Patients who received FACT were matched using propensity scores with control patients from CMHTs and ACT teams to balance differences in baseline characteristics. FINDINGS On May 1, 2016, 2034 individuals (887 in the CMHT-FACT group, 887 in the matched CMHT group, 130 in the ACT-FACT group, 130 in the matched ACT group) were enrolled and were followed up from Nov 1, 2016, to Nov 1, 2018. The number of outpatient contacts was higher for patients receiving FACT than for those in the control groups (CMHT-FACT vs CMHT: incidence rate ratio 1·15; 95 % CI 1·10-1·20; ACT-FACT vs ACT: 1·15; 1·03-1·29). Patients receiving FACT had fewer admissions than those in the control groups (CMHT-FACT vs CMHT: 0·84; 0·76-0·92; ACT-FACT vs ACT: 0·71; 0·59-0·85). However, there were no significant differences in total inpatient days, use of coercion, episodes of self-harm, or deaths. INTERPRETATION To our knowledge, this is the first study to investigate the effect of FACT compared with treatment from a CMHT or ACT team. Our results suggest that FACT can provide a more intensive approach in terms of increased outpatient contacts than CMHT care or ACT. FACT requires further evaluation through randomised controlled trials that include a cost-effectiveness component before wider implementation. FUNDING Mental Health Services in the Capital Region of Denmark.
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Henderson P, Fisher NR, Ball J, Sellwood W. Mental health practitioner experiences of engaging with service users in community mental health settings: A systematic review and thematic synthesis of qualitative evidence. J Psychiatr Ment Health Nurs 2020; 27:807-820. [PMID: 32171046 DOI: 10.1111/jpm.12628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Engagement is regarded as important and beneficial for service users and mental health services A universal definition of engagement is not yet fully agreed upon. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Based upon their experience, mental health staff use varied engagement approaches to fit with the changeable and unique needs of people who use services (service users). Mental health staff demonstrate qualities such as persistence and adaptability to successfully engage with service users. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Irrespective of professional background, the role of community mental health staff is not restricted to any single approach. Practical help and social support are as seen as important as clinical treatment to establish successful engagement. Little is known about the engagement experiences of mental health staff working in early intervention settings as most studies in this review focused on the perspectives of staff based in assertive outreach or community mental health teams. There is a need to further understand staff experiences of engagement with service users in early intervention settings. Role descriptions and expectations of community mental health workers should account for the wide-ranging flexible approach required in order to deliver appropriate interventions. This may involve a focus on engagement in training programmes. ABSTRACT: Introduction Effective mental health care is dependent on engaging service users, but some individuals do not actively attend appointments, and may stop engaging with mental health services. Quantitative studies reveal some salient factors that seem to predict engagement, but these studies miss the nuances of good clinical practice in this area. A number of qualitative studies of health professionals' experiences and understanding of effective engagement have been published. Aim This review aimed to systematically identify, evaluate and synthesize results from these studies with a view to informing effective practice in this area. Methods Electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (www.crd.york.ac.uk/prospero/; ID CRD42017083976). Of 799 records, ten papers met the inclusion criteria. All papers were subjected to quality appraisal based on the CASP checklist and data systematically extracted. A thematic synthesis of included studies examining mental health practitioners' experiences of engagement in community mental health settings was conducted. Results Mental health practitioners see engaging service users as depending upon complex, multi-dimensional phenomena which should include individualized person-centred approaches as well as practical, social and clinical support. Mental health practitioners demonstrate qualities such as determination and adaptability to establish and maintain engagement with service users. Implications for practice As a core aspect of nurse education, registered mental health nurses and other professionals would benefit from systematic guidance regarding engagement strategies. Most studies in this review focused on assertive outreach or community mental health teams, more clarification is needed of practitioner's engagement experiences in early intervention settings.
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Affiliation(s)
- Paul Henderson
- Division of Health Research, Lancaster University, Lancaster, UK.,Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | | | - Judith Ball
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | - William Sellwood
- Division of Health Research, Lancaster University, Lancaster, UK
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Broersen M, Creemers DHM, Frieswijk N, Vermulst AA, Kroon H. Investigating the critical elements and psychosocial outcomes of Youth Flexible Assertive Community Treatment: a study protocol for an observational prospective cohort study. BMJ Open 2020; 10:e035146. [PMID: 32265243 PMCID: PMC7245379 DOI: 10.1136/bmjopen-2019-035146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION When adolescents experience complex psychiatric and social problems, numerous healthcare services usually become involved. In these cases, fragmentation of care services is a risk that often results in both ineffective care and in patients disengaging from care services. To address these issues, Youth Flexible Assertive Community Treatment (Youth Flexible ACT) was developed in the Netherlands. This client-centred service delivery model aims to tackle the fragmented care system by providing psychiatric treatment and support in a flexible and integrated manner. While Youth Flexible ACT is gaining in popularity, the effectiveness of the care model remains largely unexamined. METHODS AND ANALYSIS Here, we present an observational prospective cohort (2017-2021) in which a broad range of treatment outcomes will be monitored. The primary aim of the study is to examine change in treatment outcomes over the course of the Flexible ACT care. The secondary aim is to examine the association between (elements of) Youth Flexible ACT model fidelity and treatment outcomes. An estimated total number of 200 adolescents who receive care from one of the 16 participating Youth Flexible ACT teams will be included in the study. Participants will be asked to complete assessments at four time points in 6-month intervals, resulting in a study duration of 18 months. Latent growth curve analysis will be conducted to examine change in psychosocial functioning over time and its relation to model fidelity. ETHICS AND DISSEMINATION This study received ethical approval from Trimbos Ethics Committee (201607_75-FACT2). This approval applies for all participating institutions. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be disseminated via peer-reviewed academic journals and presentations at conferences. In addition, results will be made available for participating sites, funders and researchers.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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Keet R, de Vetten-Mc Mahon M, Shields-Zeeman L, Ruud T, van Weeghel J, Bahler M, Mulder CL, van Zelst C, Murphy B, Westen K, Nas C, Petrea I, Pieters G. Recovery for all in the community; position paper on principles and key elements of community-based mental health care. BMC Psychiatry 2019; 19:174. [PMID: 31182058 PMCID: PMC6558752 DOI: 10.1186/s12888-019-2162-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/23/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Service providers throughout Europe have identified the need to define how high-quality community-based mental health care looks to organize their own services and to inform governments, commissioners and funders. In 2016, representatives of mental health care service providers, networks, umbrella organizations and knowledge institutes in Europe came together to establish the European Community Mental Health Services Provider (EUCOMS) Network. This network developed a shared vision on the principles and key elements of community mental health care in different contexts. The result is a comprehensive consensus paper, of which this position paper is an outline. With this paper the network wants to contribute to the discussion on how to improve structures in mental healthcare, and to narrow the gap between evidence, policy and practice in Europe. MAIN TEXT The development of the consensus paper started with an expert workshop in April 2016. An assigned writing group representing the workshop participants built upon the outcomes of this meeting and developed the consensus paper with the input from 100 European counterparts through two additional work groups, and two structured feedback rounds via email. High quality community-based mental health care: 1) protects human rights; 2) has a public health focus; 3) supports service users in their recovery journey; 4) makes use of effective interventions based on evidence and client goals; 5) promotes a wide network of support in the community and; 6) makes use of peer expertise in service design and delivery. Each principle is illustrated with good practices from European service providers that are members of the EUCOMS Network. CONCLUSIONS Discussion among EUCOMS network members resulted in a blueprint for a regional model of integrated mental health care based upon six principles.
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Affiliation(s)
- René Keet
- GGZ NHN, Stationsplein 138, Heerhugowaard, The Netherlands
| | | | - Laura Shields-Zeeman
- Department Trimbos International, Trimbos Institute, Da Costakade 45, Utrecht, The Netherlands
| | - Torleif Ruud
- Clinical of Health Services Research and Psychiatry, Institute of Clinical Medicine, Medical Faculty, University of Oslo, Blindern, 0318 Oslo, Norway
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Jaap van Weeghel
- Kenniscentrum Phrenos, Da Costakade 45, Utrecht, The Netherlands
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Michiel Bahler
- GGZ NHN, Stationsplein 138, Heerhugowaard, The Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, The Netherlands
| | - Catherine van Zelst
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Billy Murphy
- Inspire Mental Health, 10-20 Lombard Street, Belfast, Northern Ireland
| | - Koen Westen
- Nursing Department, Avans Hogeschool, Onderwijsboulevard 215, ‘s-Hertogenbosch, The Netherlands
| | - Chris Nas
- Zilveren Kruis Achmea, Dellaertweg 1, 2316 WZ Leiden, The Netherlands
| | - Ionela Petrea
- Department Trimbos International, Trimbos Institute, Da Costakade 45, Utrecht, The Netherlands
| | - Guido Pieters
- Department of Psychiatry, KU Leuven, UZ Herestraat 49, Leuven, Belgium
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Tjaden CD, Mulder CL, van Weeghel J, Delespaul P, Keet R, Castelein S, Boumans J, Leeman E, Malm U, Kroon H. The resource group method in severe mental illness: study protocol for a randomized controlled trial and a qualitative multiple case study. Int J Ment Health Syst 2019; 13:15. [PMID: 30949233 PMCID: PMC6429834 DOI: 10.1186/s13033-019-0270-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The resource group method provides a structure to facilitate patients' empowerment and recovery processes, and to systematically engage significant others in treatment and care. A patient chooses members of a resource group (RG) that will work together on fulfilling patients' recovery plan. By adopting shared decision-making processes and stimulating collaboration of different support systems, a broad and continuous support of patients' chosen goals and wishes is preserved and problem solving and communication skills of the RG members are addressed. OBJECTIVE The objectives of this study are (1) to establish the effectiveness of the RG method in increasing empowerment in patients with severe mental illnesses (SMI) in the Netherlands; (2) to investigate the cost-effectiveness and cost utility of the RG method; and (3) to qualitatively explore its dynamics and processes. METHODS/DESIGN This multisite randomized controlled trial will compare the effects of the RG-method integrated in Flexible Assertive Community Treatment (FACT) (90 patients) with those of standard FACT (90 patients). Baseline assessments and 9-month and 18-month follow-up assessments will be conducted in face-to-face home visits. The primary outcome measure, empowerment, will be assessed using the Netherlands Empowerment List (NEL). The secondary outcomes will be quality of life (MANSA); personal, community and clinical recovery (I.ROC); general, social and community functioning (WHODAS 2.0); general psychopathological signs and symptoms (BSI-18); and societal costs (TiC-P). An economic evaluation of the cost-effectiveness and cost utility of the RG method will also be conducted. A qualitative multiple case-study will be added to collect patients', RG members' and professionals' perspectives by in-depth interviews, observations and focus groups. DISCUSSION This trial will be the first to study the effects of the RG method on empowerment in patients with SMI. By combining clinical-effectiveness data with an economic evaluation and in-depth qualitative information from primary stakeholders, it will provide a detailed overview of the RG method as a mean of improving care for patients with SMI.Trial registration The study has been registered in the Dutch Trial Register, identifier: NTR6737, September 2017.
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Affiliation(s)
- Cathelijn D. Tjaden
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- Antes, Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
- Phrenos Centre of Expertise, Utrecht, The Netherlands
| | - Philippe Delespaul
- School of Mental Health and NeuroSciences, Maastricht University, Maastricht, The Netherlands
- Mondriaan Mental Health Trust, Maastricht/Heerlen, The Netherlands
| | - Rene Keet
- Department of Community Mental Health, GGZ Noord-Holland-Noord, Heiloo, The Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jenny Boumans
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | - Eva Leeman
- Antes, Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Ulf Malm
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Kroon
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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Mustafa FA. High mortality rate in people with severe mental disorders after discharge from assertive community treatment. Perspect Psychiatr Care 2019; 55:40-41. [PMID: 29687458 DOI: 10.1111/ppc.12281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/18/2018] [Accepted: 03/25/2018] [Indexed: 11/30/2022] Open
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Svensson B, Hansson L, Lexén A. Outcomes of clients in need of intensive team care in Flexible Assertive Community Treatment in Sweden. Nord J Psychiatry 2018; 72:226-231. [PMID: 29373933 DOI: 10.1080/08039488.2018.1430168] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Flexible Assertive Community Treatment (Flexible ACT) has been implemented in Sweden during recent years due to increasing interest in integrated services for people with severe mental illness. To date, few studies have been done on Flexible ACT effectiveness. AIMS The overall aim of this study was to explore the extent to which clients assigned to the Flexible ACT board for ACT intensive care were stabilized with improved everyday functioning, social outcomes, and changes in healthcare use. METHODS Ninety-three participants with psychosis, in need of ACT from six newly started Flexible ACT teams, were included. Data were collected using the Social Outcome Index scale (SIX), Practical and Social Functioning Scale, and a healthcare usage questionnaire. RESULTS There was a significant positive change in everyday functioning and in the SIX-item 'friendship' at 18-months follow-up. A positive correlation was also found between everyday functioning and the SIX-item 'friendship' and a negative correlation between duration of ACT and everyday functioning. A significant increase in number of inpatient hospital days and psychiatric outpatient visits also occurred. CONCLUSION Clients with psychosis who need ACT may benefit from Flexible ACT through improved social functioning. Being involved in meaningful activities and supported by others are key aspects of recovering from mental illness and are enhanced by Flexible ACT.
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Affiliation(s)
- Bengt Svensson
- a Department of Health Sciences/Mental Health and Mental Health Services Research , Lund University , Lund , Sweden
| | - Lars Hansson
- a Department of Health Sciences/Mental Health and Mental Health Services Research , Lund University , Lund , Sweden
| | - Annika Lexén
- a Department of Health Sciences/Mental Health and Mental Health Services Research , Lund University , Lund , Sweden
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Decision-Making Behaviour under the Mental Health Act 1983 and Its Impact on Mental Health Tribunals: An English Perspective. LAWS 2018. [DOI: 10.3390/laws7020012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stergiopoulos V, Saab D, Francombe Pridham K, Aery A, Nakhost A. Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre. BMC Psychiatry 2018; 18:20. [PMID: 29368586 PMCID: PMC5784615 DOI: 10.1186/s12888-018-1597-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. METHODS We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. RESULTS Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. CONCLUSIONS Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.
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Affiliation(s)
- Vicky Stergiopoulos
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J 1H4 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada
| | - Dima Saab
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Kate Francombe Pridham
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Anjana Aery
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Arash Nakhost
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada
- Mental Health Services, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
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Newberry K, Terrington C. Engaging the hard to engage: What contribution could occupational therapy make to an interdisciplinary approach? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.8.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Karen Newberry
- Senior lecturer in occupational therapy, College of Health and Social Care, University of Derby, UK
| | - Claire Terrington
- Senior occupational therapist in assertive outreach, Birmingham and Solihull Mental Health Foundation Trust, UK
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Sood L, Owen A, Onyon R, Sharma A, Nigriello J, Markham D, Seabrook H. Flexible assertive community treatment (FACT) model in specialist psychosis teams: an evaluation. BJPsych Bull 2017; 41:192-196. [PMID: 28811912 PMCID: PMC5537572 DOI: 10.1192/pb.bp.116.053967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method The impact of flexible assertive community treatment (FACT) has been observed in people previously supported by assertive community treatment (ACT) teams, but its effect on those previously with a community mental health team (CMHT) has not been studied in the UK. An observational study was conducted of 380 people from 3 CMHTs and 95 people from an ACT team, all with a history of psychosis, following service reconfiguration to 3 FACT teams. Results People previously with a CMHT required less time in hospital when the FACT model was introduced. A smaller reduction was observed in people coming from the ACT team. Both groups required less crisis resolution home treatment (CRHT) team input. Clinical implications FACT may be a better model than standard CMHT care for people with a history of psychosis, as a result of reduced need for acute (CRHT and in-patient) services.
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Affiliation(s)
- Loopinder Sood
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | - Andy Owen
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | - Richard Onyon
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | - Aarohi Sharma
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | | | - Dominic Markham
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | - Hannah Seabrook
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
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Firn M, Alonso-Vicente M, Hubbeling D, Holley J, White SJ, Jones B. The replacement of assertive outreach services by reinforcing local community teams: a replication study reporting comparative outcomes and patient reported experience. J Ment Health 2017. [PMID: 28648100 DOI: 10.1080/09638237.2017.1340601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This is the third in a series of papers on patient outcomes and other consequences of the withdrawal of specialist assertive outreach (AO) teams. We previously reported positive outcomes for patients receiving a less intensive service at up to four years, but had not systematically interviewed patients. AIMS To test the generalizability of earlier findings through replication in another service. To complement the analysis of service utilisation with patient reported experience between the two treatment models. METHODS Service level evaluation 12 months pre and post service change for 55 eligible AO patients. Thirty three consenting patients answered validated questionnaires. RESULTS There were no statistically significant changes in hospital bed use comparing the year before and the year after the change (850-712 bed days, median 34-20). No significant change in crisis activity occurred despite a highly significant reduction in face to face contacts from a mean of 90-40. There were no significant changes in patient reported experience. CONCLUSIONS Results are consistent with earlier studies. Reinforcing community mental health teams can provide an integrated service model that is clinically effective and equally acceptable to patients, making this a viable and affordable alternative to orthodox AO teams.
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Affiliation(s)
- Mike Firn
- a Of South West London & St. George's Mental Health NHS Trust , London , UK
| | | | - Dieneke Hubbeling
- a Of South West London & St. George's Mental Health NHS Trust , London , UK
| | - Jess Holley
- b Department of Mental Health , Middlesex University , London , UK , and
| | - Sarah Jane White
- c Of Population Health Research Institute, St Georges University of London , London , UK
| | - Ben Jones
- a Of South West London & St. George's Mental Health NHS Trust , London , UK
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17
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Iliffe S, Wilcock J, Synek M, Carboch R, Hradcová D, Holmerová I. Case Management for People with Dementia and its Translations: A Discussion Paper. DEMENTIA 2017; 18:951-969. [DOI: 10.1177/1471301217697802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, University College London, UK
| | - Michal Synek
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic; Department of Sociology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Radek Carboch
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic; Department of Sociology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Dana Hradcová
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic
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Nugter MA, Engelsbel F, Bähler M, Keet R, van Veldhuizen R. Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study. Community Ment Health J 2016; 52:898-907. [PMID: 25648552 PMCID: PMC5108818 DOI: 10.1007/s10597-015-9831-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 01/17/2015] [Indexed: 11/30/2022]
Abstract
This study aimed to investigate social and clinical outcomes and use of care during and after implementation of FLEXIBLE Assertive Community Treatment (ACT). Three teams and 372 patients were involved. Model fidelity, clinical and social assessments were performed at baseline and after 1 and 2 years. Use of care was registered continuously. Model fidelity was good at the end of the study. Data showed much variation between patients in number and duration of ACT periods. Statistically significant improvements were found in compliance, unmet needs and quality of life. Improvement of quality of life and functioning was related to duration of ACT. The percentage of remissions increased with 9 %. The number of admissions, admission days and face to face contacts differed between ACT and non-ACT patients, but generally decreased. Findings suggest that implementation of FACT results in a more flexible adaptation of care to the needs of the patients.
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Affiliation(s)
- M Annet Nugter
- Department of Research and Monitoring, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands.
| | - Fabiana Engelsbel
- Department of Research and Monitoring, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - Michiel Bähler
- Department of Community Mental Health, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - René Keet
- Department of Community Mental Health, Mental Health Service Organization GGZ Noord-Holland-Noord, PO Box 18, 1850 BA, Heiloo, The Netherlands
| | - Remmers van Veldhuizen
- Centre for Certification ACT and FACT (CCAF), Praediniussingel 20/9, 9711 AG, Groningen, The Netherlands
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Lexén A, Svensson B. Mental health professional experiences of the flexible assertive community treatment model: a grounded theory study. J Ment Health 2016; 25:379-384. [DOI: 10.1080/09638237.2016.1207236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Firn M, White SJ, Hubbeling D, Jones B. The replacement of assertive outreach services by reinforcing local community teams: a four-year observational study. J Ment Health 2016; 27:4-9. [PMID: 26850124 DOI: 10.3109/09638237.2016.1139073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mike Firn
- South West London & St. George’s Mental Health NHS Trust, London, UK, and
| | - Sarah Jane White
- Population Health Research Institute, St Georges University of London, London, UK
| | - Dieneke Hubbeling
- South West London & St. George’s Mental Health NHS Trust, London, UK, and
| | - Ben Jones
- South West London & St. George’s Mental Health NHS Trust, London, UK, and
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Norlander T, Nordén T. The Hourglass Model: Are There Structural Problems with the Scarcity of Positive Results for Flexible ACT? Clin Pract Epidemiol Ment Health 2015; 11:155-7. [PMID: 26464577 PMCID: PMC4598425 DOI: 10.2174/1745017901511010155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/22/2022]
Abstract
The aim of the present article was to discuss the commentary by van Veldhuizen, Delespaul and Mulder (2015) regarding the review by Nordén and Norlander (2014) based on five empirical articles about Flexible Assertive Community Treatment (FACT). Veldhuizen et al. agree on that there is insufficient evidence for the effectiveness of FACT. However, van Veldhuizen et al. avoid a discussion of the lack of positive results despite extensive research during several years and therefore an analysis of why FACT did not fare better is missing. According to FACT it is an advantage that one single team spans the entire chain of care and rehabilitation, but no evidence is given for such an opinion. Instead there may be difficulties for the staff to shift between psychiatric care and psychiatric rehabilitation and the clients perhaps don’t want to encounter the same professional team during all phases of care and rehabilitation.
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Affiliation(s)
- Torsten Norlander
- Center for Research and Development, Evidens University College, Göteborg, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Tommy Nordén
- Center for Research and Development, Evidens University College, Göteborg, Sweden
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van Veldhuizen R, Delespaul P, Kroon H, Mulder N. Flexible ACT & Resource-group ACT: Different Working Procedures Which Can Supplement and Strengthen Each Other. A Response. Clin Pract Epidemiol Ment Health 2015; 11:12-5. [PMID: 25767558 PMCID: PMC4353123 DOI: 10.2174/1745017901511010012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 12/22/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022]
Abstract
This article is a response to Nordén and Norlander’s ‘Absence of Positive Results for Flexible Assertive Community
Treatment. What is the next approach?’[1], in which they assert that ‘at present [there is] no evidence for Flexible
ACT and… that RACT might be able to provide new impulses and new vitality to the treatment mode of ACT’. We question
their analyses and conclusions. We clarify Flexible ACT, referring to the Flexible Assertive Community Treatment
Manual (van Veldhuizen, 2013) [2] to rectify misconceptions. We discuss Nordén and Norlander’s interpretation of research
on Flexible ACT. The fact that too little research has been done and that there are insufficient positive results cannot
serve as a reason to propagate RACT. However, the Resource Group method does provide inspiration for working
with clients to involve their networks more effectively in Flexible ACT.
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Affiliation(s)
| | - Philippe Delespaul
- Innovations in Mental Health Care, Maastricht University and Mondriaan (Mental Health Service), The Netherlands
| | - Hans Kroon
- Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
| | - Niels Mulder
- Public Mental Health, Epidemiological and Social Psychiatric Research institute, Erasmus MC; Parnassia Psychiatric Institute, The Netherlands
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Kayama M, Kido Y, Setoya N, Tsunoda A, Matsunaga A, Kikkawa T, Fukuda T, Noguchi M, Mishina K, Nishio M, Ito J. 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. [PMID: 25403680 PMCID: PMC4251924 DOI: 10.1186/s12888-014-0311-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Japan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP. METHOD This longitudinal retrospective study used survey data collected from 32 outreach teams of 21 prefectures in Japan during September 2011 to July 2013. The outcome variables were assessed at baseline, 6-month and 12-month as to whether or not participants had been admitted to the hospital. Data from 162 participants with mental illness who had difficulties in maintaining contact with mental health services were analyzed. Repeated measures analysis of variance provided a significant effect of the intervention over time. RESULTS The rate of hospital admission of JOMP participants was 24.1% at 6-months and 27.2% at the 12-month follow-up. The average length of hospital-stay at baseline and 12-months was 38.7 days (SD 84.7). Compared with the baseline, the average score of the Global Assessment Functioning and the Social Behavioral Schedule were significantly improved after the 6-month and 12-month follow-up. The activity log showed that among the most often delivered JOMP services were to "prevent exacerbation of somatic symptoms" and "care for families". CONCLUSION These results suggest that JOMP has a strong potential to both reduce readmission rates and the length of hospital stay compared with the Japanese regular outpatient care by public insurance, and improve social function and problematic behavior. The JOMP teams provided long-term support for families. As of April 2014 JOMP was included in the National Health Insurance program in a limited way therefore an evaluation of JOMP team fidelity on readmissions must be examined.
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Affiliation(s)
- Mami Kayama
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
| | - Yoshifumi Kido
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
- />Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan
| | - Nozomi Setoya
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
| | - Aki Tsunoda
- />Psychiatric and Mental Health Nursing, College of Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044 Japan
| | - Asami Matsunaga
- />Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan
| | - Takahiro Kikkawa
- />Department of Nursing, School of Health Sciences, Tokai University, Kanagawa, Japan
| | | | | | - Keiko Mishina
- />Hanazono University, Clinical Psychology, Faculty of Social Welfare, Kyoto, Japan
| | - Masaaki Nishio
- />Tohoku Fukushi University, Social Welfare, Faculty of General Welfare, Miyagi, Japan
| | - Junichiro Ito
- />National Center of Neurology and Psychiatry, National Institute of Mental Health, Psychiatric Rehabilitation, Tokyo, Japan
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Nordén T, Norlander T. Absence of Positive Results for Flexible Assertive Community Treatment. What is the next Approach? Clin Pract Epidemiol Ment Health 2014; 10:87-91. [PMID: 25320634 PMCID: PMC4197527 DOI: 10.2174/1745017901410010087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/03/2014] [Accepted: 07/13/2014] [Indexed: 11/22/2022]
Abstract
Aims were to review results of the five psychiatric studies on Flexible Assertive Community Treatment (FACT) published during 2007-2013, and to compare FACT with Resource-group Assertive Community Treatment (RACT) which specifically focuses on empowerment and rehabilitation of clients in the stable phase. During 2007 articles appeared in scientific journals arguing in favor of the need for the development of the treatment method Assertive Community Treatment (ACT). A particularly notable article was one that featured a Dutch version of ACT, namely FACT. The initiative received great sympathy given that clinical practice and research showed that both American and British versions of ACT were in need of new impulses to be able to maintain an optimal level of care. Seven years have passed since the Dutch model was international presented and five empirical studies about FACT have been published and therefore a first critical examination of FACT was conducted. The review indicated that the five empirical studies failed to show that FACT involves improvement of the clients in terms of symptoms, functioning, or well-being. The conclusions were that at present there is no evidence for FACT and that RACT with its small, flexible ACT teams, where the client him/herself is included and decides on the treatment goals, might be able to provide new impulses and a new vitality to the treatment mode of an assertive community treatment.
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Affiliation(s)
- Tommy Nordén
- Center for Research and Development, Evidens University College, Göteborg, Sweden
| | - Torsten Norlander
- Center for Research and Development, Evidens University College, Göteborg, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
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Rathod S, Lloyd A, Asher C, Baird J, Mateus E, Cyhlarova E, Cameron J, Lieshman J, Elnazer H, Kingdon D. Lessons from an evaluation of major change in adult mental health services: effects on quality. J Ment Health 2014; 23:271-5. [PMID: 25222371 DOI: 10.3109/09638237.2014.951487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The move from inpatient to community services in mental health has sparked debate internationally but the evidence base for successful service models is sparse. AIM To evaluate the impact of bed reduction on quality of services when accompanied by redesign of community services. METHODS Qualitative and quantitative data were collected 6 months before and 6 months after the redesign was implemented. RESULTS Bed numbers reduced by 35%. Number of admissions and occupied bed days (OBD) reduced; bed occupancy and proportion of detained patients increased. Access to community services improved but quality of assessments did not. Transitions across pathways were rated as difficult by clinicians. There was an overall reduction in staff numbers; staff sickness levels and dissatisfaction with working conditions increased. Service users were generally positive about the redesign but GPs and staff were not. CONCLUSIONS Multi-faceted evaluation of change in cost-pressured services is feasible and should guide developments to minimise negative effects on quality of care.
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Affiliation(s)
- Shanaya Rathod
- Southern Health NHS Foundation Trust in collaboration with the Princess Royal Trust for Carers , Southampton , UK
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Sood L, Owen A. A 10-year service evaluation of an assertive community treatment team: trends in hospital bed use. J Ment Health 2014; 23:323-7. [PMID: 25222169 DOI: 10.3109/09638237.2014.954694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Studies of assertive community treatment (ACT) have shown various benefits, including reduced hospital bed use. In the UK, this finding was not replicated by randomised controlled trials (RCTs), which lacked fidelity to the model. Conversely, observational studies, while limited by their inherent weakness in implying causality, have shown lower bed use. Against this background many ACT teams are being disestablished in the UK. AIMS To observe the long-term effect of ACT on bed use, incorporating methods of analysis which mitigate against some weaknesses of observational design. METHODS Bed use was compared for equal periods of time either side of starting support from an ACT team. RESULTS Ninety-three people were followed for up to 10.5 years after starting ACT. Hospital bed use was compared for each person, showing a reduction from a mean of 72 d per year prior to ACT to 44 d per year during ACT (p = 0.0018). CONCLUSIONS The results demonstrate that ACT is associated with reduced bed use in the UK and that it is possible to use an observational design with enhanced analysis techniques to increase evidence for causality. These techniques may have value in other service evaluations.
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Affiliation(s)
- Loopinder Sood
- Coventry and Warwickshire NHS Partnership Trust, St Michaels Hospital , Warwick , UK
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Drukker M, Visser E, Sytema S, van Os J. Flexible Assertive Community Treatment, Severity of Symptoms and Psychiatric Health Service Use, a Real life Observational Study. Clin Pract Epidemiol Ment Health 2013; 9:202-9. [PMID: 24358050 PMCID: PMC3866708 DOI: 10.2174/1745017901309010202] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 11/22/2022]
Abstract
Background: Introduction of Flexible Assertive Community Treatment (FACT) may be associated with increased remission rates and changes in patterns of care. The present paper reports on differences in psychosocial functioning and health care use between patients in FACT and two groups of patients not currently provided with a specific model of community service.
Methods: The ongoing "Pharmacotherapy Monitoring and Outcome Survey" provided routine outcome measures of patients using antipsychotics in the north of the Netherlands. Level of psychosocial functioning was assessed using the Health of the Nations Outcome Scales (HoNOS) and matched with psychiatric health care consumption obtained from the Psychiatric Case Register. Patients who never received FACT, patients ever in FACT but not at assessment date, and patients in FACT were identified. Data were subjected to multilevel linear regression analysis.
Results: Data showed that most patients in FACT also had non-FACT episodes after the start of FACT. Furthermore, patients in FACT displayed higher levels of psychosocial functioning and used more outpatient care than the other two groups.
Conclusions: Patients in FACT receive more outpatient care and have better psychosocial functioning. However, causal inferences cannot be derived from these data. In addition, membership of a FACT-team in this setting did not last indefinitely.
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Affiliation(s)
- Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, p.o. box 616, Location Vijverdal, 6200 MD, Maastricht, the Netherlands
| | - Ellen Visser
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Rob Giel Centre, p.o. box 30.001, 9700 RB Groningen, the Netherlands
| | - Sjoerd Sytema
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Rob Giel Centre, p.o. box 30.001, 9700 RB Groningen, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, p.o. box 616, Location Vijverdal, 6200 MD, Maastricht, the Netherlands ; King's College London, King's Health Partners Department of Psychosis Studies; Institute of Psychiatry, London, UK
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