A Qualitative Study on the Implementation of Flexible Assertive Community Treatment - an Integrated Community-based Treatment Model for Patients with Severe Mental Illness.

Merete Nordentoft,Carsten Hjorthøj,Ulla Christensen,Camilla Munch Nielsen

doi:10.5334/ijic.5540

Abstract

Introduction:Flexible Assertive Community Treatment (FACT) is a model of integrated care aiming to increase continuity of care for individuals with severe mental illness. FACT teams have been implemented in many countries by merging Assertive Community Treatment (ACT) and standard care from Community Mental Health teams (CMHTs). However, there has been little research on how practitioners experienced the fusion of these teams.Aim:This study explores how former ACT and CMHT practitioners perceived the implementation of FACT.Method:Perceptions of the FACT model, implementation strategies and adaptations of the model were investigated through 17 semi-structured interviews with FACT practitioners.Results:Perceived positive contributions of FACT included the recognition that FACT addressed a service gap for a group of patients who could benefit from increased support and improved integration of outpatient and hospital care. Perceived disadvantages of FACT included the experience that FACT drew away resources from ACT patients with the highest psychiatric needs. The findings also describe barriers to implementation, such as lack of perceived benefit of FACT, the maintenance of traditional work culture and insufficient organisational capacity. These challenges required the negotiation of local implementation strategies and adaptations.Conclusion:FACT increases access to intensive care for a broader group of patients with severe mental illness. However, findings from this study also suggest that the increased caseload in FACT compared with ACT and a changed mindset may not reflect the needs of the smaller group of patients who find it difficult to engage with mental health care services.

Highlights

Flexible Assertive Community Treatment (FACT) is a model of integrated care aiming to increase continuity of care for individuals with severe mental illness
Findings from this study suggest that the increased caseload compared with ACT and a changed mindset may not reflect the needs of the smaller group of patients who find it difficult to engage with mental health care services
This study showed that practitioners held different perceptions of FACT which required the negotiation of new work practices

Summary

Introduction

Flexible Assertive Community Treatment (FACT) is a model of integrated care aiming to increase continuity of care for individuals with severe mental illness. The ACT and FACT model share common goals such as aiming to meet a wide range of patient needs rather than arranging for help to be provided by external services [5,6,7]. This includes illness management, rehabilitation, housing, and finances. Outreach contacts involve visiting patients who are admitted to inpatient care Both models of care use a teambased approach with shared caseload. During shared caseload team members share responsibility for their patients and several team members work together with the same patient [6, 8]

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