The assertive community treatment (ACT) model has been shown to successfully reduce hospitalizations and increase quality of life for individuals living with severe mental illness (e.g., psychotic disorders or schizophrenia). Participation in ACT alone, however, does not decrease clients' contact with the criminal justice system. ACT with police integration (ACT-PI), a novel model that entails integrating police officers into existing ACT teams, is viewed by clients and staff as an acceptable method to reduce criminal encounters with unknown police officers. The aim of the study was to examine changes in multiple types of police encounters before and after admission to the program. The authors collected data from 448 unique ACT-PI clients who had at least one police contact between 2008 and 2019. The number of overall police encounters significantly decreased, in particular for non-mental health-related occurrences. The number of mental health-related police encounters increased. These changes were especially evident among clients whom police identified by their race, suggesting that the ACT-PI program may have nuanced effects on outcomes for this group. These findings provide further support for the ACT-PI program as an effective method to reduce the criminalization of persons with severe mental illness and to shift remaining police responses toward mental health-related interventions.

Effective psychosocial interventions help people with schizophrenia live full and productive lives, but these interventions are not available to most people with schizophrenia. To facilitate access, interventions must be adapted and tested for delivery in community practice settings. In this pragmatic effectiveness trial, Cognitive Behavioral Social Skills Training (CBSST) was modified and tested for delivery by Assertive Community Treatment (ACT) teams in community mental health settings. Participants with schizophrenia or schizoaffective disorder (N = 178) were recruited from publicly funded ACT teams operating in community settings and randomized to receive ACT alone or ACT + CBSST. Functioning (primary outcome), CBSST skill learning, symptoms, and defeatist attitudes were assessed every 18 weeks after baseline for 18 months. Significant treatment effects were not found for functioning or any other outcome. CBSST delivery was low, but CBSST skill learning improved significantly more in ACT + CBSST, and post hoc exploratory analyses showed that exposure to more CBSST sessions was associated with greater skill learning, which in turn was associated with greater improvement in experiential negative symptoms and ultimately functioning. The effectiveness of CBSST when delivered by typical community ACT providers may have been compromised by low delivery. Greater delivery of CBSST sessions was associated with greater skill acquisition which improved outcomes. Adapting CBSST to fit into the ACT service delivery creates an opportunity to substantially increase the number of individuals with schizophrenia who could access interventions like CBSST, but implementation research is needed to identify factors to promote session delivery. ClinicalTrials.gov NCT02254733.

Individuals with schizophrenia experience severe impairments in everyday functioning. Cognitive behavioral social skills training (CBSST) has demonstrated moderate effects on functional outcomes in controlled trials. This study examined whether CBSST, when integrated into assertive community treatment (ACT), improves daily-life functioning as assessed by ecological momentary assessment (EMA). This was a secondary analysis of a pragmatic randomized controlled trial involving 155 participants diagnosed with schizophrenia or schizoaffective disorder. Participants were randomized to receive either ACT + CBSST (n= 75) or ACT alone (n= 80). Assessments occurred at baseline, 9months (n= 100), and 18months (n= 67) to capture real-time reports of "productive" and "non-productive" activities. The primary outcome was productive activity. Secondary outcomes included non-productive activity, the productive/non-productive activity ratio, anhedonia, and defeatist beliefs. Linear mixed models were used to test for differential changes over time between groups. Although the groups differed at baseline, the ACT + CBSST group showed significantly greater improvements over time relative to the ACT group in productive activities, the productive/non-productive activity ratio, and in reductions in anhedonia and defeatist beliefs. However, between-group differences at follow-up were not statistically significant. Adding CBSST to ACT may yield greater improvements in daily-life functioning than ACT alone. While these results support the potential added value of integrating CBSST into routine care, further research is needed to confirm its superiority. Together with the companion report from this study, these findings suggest that EMA may offer a sensitive approach for detecting changes in real-world functioning in clinical trials.Trial Registration: ClinicalTrials.gov (NCT02254733; https://clinicaltrials.gov/).

Addressing Complex Needs: Assertive Community Treatment with Afghan Migrant Adolescents in Iran

To address high-cost inpatient utilization for those with severe and persistent mental illness, stakeholders from a County Department of Human Services, a Behavioral Health Managed Care Organization, and mental health providers created a value-based payment (VBP) model to shift funding from inpatient mental health treatment (IPMH) to intensive, evidence-based, community-based mental health treatment, Assertive Community Treatment (ACT). Using a retrospective observational study, individuals who received ACT from providers participating in the VBP (N = 2) were compared to individuals who received ACT from providers (N = 17) not supported through a VBP. Results show decreasing average ACT and IPMH expenditures as well as shorter lengths of stay over time for providers under a VBP compared to those not in a VBP. Access to care was not impacted. These results, including implications for behavioral health, are discussed in the context of quality of care.

This study explores how stigma influences community experiences among individuals with serious mental illness (SMI), using the structural-function-experiential (SFE) model as a guiding framework. Qualitative semi-structured and social network interviews were conducted with 30 participants receiving assertive community treatment (ACT) services in New York state. Modified grounded theory approach guided the analysis. Four themes emerged: (1) "Maybe I'm as crazy as they say I am," (2) avoiding disclosure and relationships, (3) providers or no one, and (4) longing for connection. These themes illustrate how stigma operates in an ecological framework such as the SFE model consisting of structural, functional, and experiential dimensions of community. Stigma disrupts social relationships, inhibits disclosure, and reinforces social isolation. Applying the SFE model highlights community-level mechanisms through which stigma can be mitigated. Findings inform transformative change efforts to enhance social inclusion and recovery for people with SMI.

Factors influencing length of hospital stay among psychiatric inpatients in Montreal, Canada: The role of insulin, IL-6 and TNF-Alpha.

Drug-related deaths (DRDs) remain a global issue, with Scotland reporting the second-highest rate per million population. Although some areas have seen improvements, DRDs continue to rise in parts of the Scottish Highlands. Proactive outreach to those at highest risk is believed to reduce harm. This project tested and implemented a risk identification tool—the Trigger Checklist (TC)—to initiate assertive outreach in a remote Highland area by September 2023.The Model for Improvement was used to structure the improvement process. This included collaborative exploration of the problem and solution, development of the TC, devising a family of measures and Plan, Do, Study, Act cycles to structure interactive learning and refinement of the TC and outreach process. Data were collected on the number of completed TC, the percentage of those outreached within 48 hours and the number of days between incidents of non-fatal overdoses (NFOD). Timely staff experience feedback was gathered using a visual facial analogue scale.A standardised TC was devised and tested. 48 TCs were received over 8 months. Of those 100% (n=48) were assertively outreached within 48 hours of a TC referral. The median number of days between NFOD increased from 6.5 days (January–August 2022) to 23 days (September 2022–August 2023). There was an increase in the number of days between incidents of NFOD locally, with more than 90 days between two events (previously the maximum number reached was 48). For the duration of the project, the locality did not receive a DRD notification.There is a need to further test and standardise the use of the TC in other areas frequented by those most at risk of drug-related harm, such as the remote and rural emergency department.

Young adults (YAs) have high rates of serious mental health conditions and historically low rates of mental health treatment engagement. YAs have historically been understudied within psychiatric rehabilitation, but more recently, multidisciplinary team- and community-based approaches informed by assertive community treatment have become popular. Much can be learned from YAs enrolled in YA-specific teams to understand how YA-specific teams support YA recovery. A research team with several YAs with lived/living mental health experience conducted and analyzed interviews with YAs (n = 22) enrolled in YA-specific team-based services. The research team used reflexive thematic analysis. Self-discovery was central in YA team-based service experiences. The YA team fostered discovery by (a) supporting YA self-reflection within mutually respectful YA client-team member relationships made possible through the YA team; (b) blending and balancing YA development, lived experience, and clinical expertise; and (c) providing flexible, tailored services and activities in the community and clinic. Supporting YAs in building their sense of self is central in engaging YAs. YA mental health providers and policymakers in the field of psychiatric rehabilitation can use discovery practice concepts to describe how and why adult mental health care can successfully be different for YAs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This study presents a preliminary evaluation of the effectiveness of the GUIA Team's flexible Assertive Community Treatment (ACT) program implemented in Spain, designed for adolescents and young adults with complex mental health conditions. The program addresses fragmented care by coordinating multiple service sectors.Retrospective observational pre-post study with 42 participants aged 14-25 years, assessing treatment adherence, clinical symptoms, hospital service utilization and global functioning.Findings demonstrate a significant reduction in psychiatric emergency visits and involuntary hospitalizations, along with objective improvements in clinical symptomatology and overall functioning, particularly with longer intervention. Treatment adherence was high and outcomes were consistent across a heterogeneous sample, irrespective of primary diagnoses or demographic characteristics. These findings suggest that diagnostic categories alone are limited in predicting outcomes in complex cases, underscoring the importance of functional and recovery oriented models.The study supports the feasibility and clinical value of a flexible ACT model adapted for youth, emphasizing sustained, multidisciplinary and individualized interventions in the patient's natural environment.

IntroductionThe objective of this scoping review is to elucidate contexts in which Flexible Assertive Community Treatment (FACT) has been utilised, which populations it has served, how it has been adapted and what outcomes it has achieved. FACT is a model of mental healthcare where patients are transitioned along a continuum of high-intensity outreach-based treatment and lower-intensity case management, according to need. Despite being adopted globally, a review of the evidence on the FACT model has not been conducted since 2014.Methods and analysisThis study will follow the Joanna Briggs Institute’s (JBI) methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A structured search of several electronic databases (MedLine, CINAHL, PsycINFO, Psychology & Behavioural Sciences, Embase, Scopus, Sociological s and ASSIA Social Sciences Index s) will be conducted to locate relevant studies addressing models of care that adhere to the core components of the FACT model and that were published in English or Dutch from 2003 (model conception date) to the present day. To explore the range of populations served by FACT, we will not limit participant populations by age or diagnosis. With respect to FACT adaptations, we will include articles that explore modifications to the structure of FACT such as staffing complement, caseloads or interface with other health and social services. Articles identified from our structured searches will be screened independently by two reviewers. Data from included articles will be extracted, analysed and presented on tables and visual graphs, and summarised in a narrative report.Ethics and disseminationOur scoping review does not require ethics approval as it does not involve human subjects and will draw evidence from published peer-reviewed articles. Our findings will be disseminated through journal publication, presentations at relevant conferences and distribution across our networks and those of our partners, including healthcare providers, researchers and other key stakeholders.

Addressing housing insecurity as a social determinant of health: A systematic review of interventions in healthcare settings.

Deinstitutionalization spawned numerous psychiatric rehabilitation interventions, but only a small number have endured for decades and spread widely. This article identifies a concise set of 10 criteria to examine ethical, scientific, practical, and policy elements of highly successful interventions. Based on 50 years of psychiatric rehabilitation literature, we examined three exemplary, enduring practices-assertive community treatment, Individual Placement and Support, and Housing First-for evidence related to the 10 common criteria. Psychiatric rehabilitation has had a firm grounding in ethics, client-centeredness, implementation science, and outcomes research. Policy and funding have followed. We identified 10 criteria that incorporate these values: recovery, model clarity, fidelity, effectiveness, enduring effects, cost-effectiveness, feasibility, scalability/sustainability, policy/funding, and adaptability. All three practices are guided by validated fidelity scales, have strong evidence for effectiveness, and are feasible to implement, but they vary on other criteria. In varying degrees, assertive community treatment, Individual Placement and Support, and Housing First are practices meeting most of the 10 criteria in a newly developed framework aimed at broadening the criteria for evaluating psychiatric rehabilitation programs to encompass both scientific and pragmatic, real-world considerations. This framework establishes an objective framework to guide the prioritization of services for people with mental health conditions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background There is a gap between the model of Alcohol Assertive Outreach Treatment (AAOT) and its implementation. This study compared the implementation of AAOT in a high-fidelity service and a medium-fidelity service in the North West of England, with a focus on differences in healthcare utilization change and exploring stakeholder views on the fidelity and sustainability of each service’s adaptation of AAOT. Methods A multistage mixed-methods design involving: 1) quantitative assessment and comparison of differences in healthcare utilization and treatment data pre- and post-AAOT implementation between services; and 2) qualitative exploration of the fidelity and sustainability of each service based on semi-structured interviews (n = 48), analyzed using the Framework Approach. Results Both services showed reductions in Emergency Department visits and unplanned ward admissions (p < .001). Interviewees indicated that high-fidelity AAOT was more effective for service users with complex needs who previously struggled to engage with community specialist addiction treatment services, although sustainability challenges persist, reflecting barriers in commissioning processes and continuity of care. Conclusion The AAOT model can be successfully adapted to different local contexts and reduce unplanned healthcare utilization despite sustainability challenges.

BackgroundService users living with severe mental illness are often in need of treatment from different health care professionals. Their family members play an important but underreported role in their treatment and care. Following the implementation of the flexible assertive community treatment (FACT) model in Norway since 2013, FACT teams have been evaluated from different perspectives. The overall aim of this study was to explore how family members of people living with SMI experience their situation and the follow-up provided by FACT teams.MethodsForty-one family members aged 31 to 78 years took part in nine focus groups representing seven FACT teams from both rural and urban areas in Norway. Most of the participants had parental roles. The data was analysed using qualitative content analysis.ResultsThe results revealed the following two main themes and five sub-themes: (1) An all-consuming and demanding role (A life of love, care and despair and A life affecting health and well-being), and (2) A turning point after FACT (From a patchwork to more integration and continuity, Family involvement as a vital part of care and Availability of support outside regular opening hours).ConclusionsBeing family members of service users with SMI are experienced as an all-consuming and demanding role. The family members experience the FACT team as an important support in their day-to-day life. However, they wish to receive more support and inclusion in the treatment than they currently do. Further strengthening the involvement and collaboration between the family members and the FACT teams is recommended. Psychoeducational interventions arranged by the FACT team could support family members’ situations. To share their stories with professionals and/or peers would further contribute to their well-being. Extending the opening hours of FACT is recommended as it might mitigate family members’ everyday challenges and improve their subjective well-being.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13485-z.

Within the context of community care, assertive community treatment (ACT) targeting individuals with severe mental disorders is typically a prolonged endeavor. Despite its extended nature, evidence on the long-term effects of ACT remains limited. This study aimed to assess the long-term effects of ACT services in Japan over 7years by comparing readmission outcomes between the ACT and treatment-as-usual (TAU) groups. This study traced participants from a prior randomized controlled trial (RCT) examining the short-term effects of ACT program in Japan. We assessed their readmission experiences, including the frequency and length (days) of readmissions over 7years through medical record review. Multivariable analyses were conducted to examine outcomes by group. Of the 63 participants tracked for 7years of follow-up (ACT group = 34, TAU group = 29), there were no significant group differences in readmission rate (TAU = 79% vs. ACT = 53%; odds ratio = 0.41, 95% CI = 0.12 to 1.35, p = 0.144) or cumulative days of hospitalization (Β = -75.66, 95% CI = -184.41 to 33.09, p = 0.173). However, the ACT group had significantly fewer hospitalizations (Β = - 1.03, 95% CI = - 1.97 to - 0.10, p = 0.030) than the TAU group. In particular, readmissions in the ACT group substantially decreased at 2years after initial randomization. In the Japanese medical landscape, an ACT program for individuals with severe mental illness might help mitigate the frequency of readmission compared with TAU over the long term. In particular, the pronounced benefits of the ACT program appear to emerge approximately 2years after the start of ACT services. Future research in different countries is needed to confirm the findings of this study, particularly the timing at which the long-term effects of ACT services emerge for various outcomes. The trial was retrospectively registered on 5 August 2025 with the Japan Registry of Clinical Trials (Registration number: jRCT1030250281).

ObjectiveGood Psychiatric Management (GPM) is a structured, evidence-based approach for treating borderline personality disorder (BPD). In this study, we aimed to explore the experiences of using GPM within a multidisciplinary mental health team and to identify factors that promote or impede its implementation and practice.MethodsThe study design was informed by interpretive description methodology. Semi-structured, in-person interviews were conducted with staff based at an assertive community outreach service (ACOS) trained in GPM. Interviews were audio-recorded, transcribed and coded by reflexive thematic analysis.ResultsFrom eleven participants of social work, community support work, nursing, psychology, occupational therapy and managerial backgrounds, we identified three main themes: (1) GPM as complementary to practitioners' values, (2) GPM as empowerment to deliver treatment confidently and consistently and (3) leadership as instrumental for the implementation of a new model.ConclusionsImplementing GPM as a shared model of care has value for health professionals by improving confidence and skills in working with people with BPD and increasing team cohesion. Effective leadership facilitates the introduction of an empirically supported evidence-based model of care, even when there are system constraints. Further research is needed to evaluate the use of GPM in general healthcare settings.

Overcoming mental health crises at home: a qualitative study on the perspectives of people with mental illness Abstract: Background: In recent years, various outreach psychiatric care models have been established in Germany and their effectiveness has been proven. Despite these promising results and evident benefits, these care models have not yet been widely implemented. Aim: This qualitative study investigates the key factors and experiences of psychiatric home treatment from the perspective of people with mental illnesses in Germany. Methods: Episodic, semi-structured interviews were conducted with 18 individuals diagnosed with mental illnesses according to ICD-10 (F2X, F3X, F6X), all of whom were receiving care within outreach mental health services: psychiatric outpatient clinics, community psychiatric nursing, Assertive Community Treatment, and home treatment equivalent to inpatient care. The interviews were analyzed using thematic coding based on Flick's methodology. Results: The study identifies four key factors: role of the caregiver, therapeutic measures, living environment and treatment characteristics. Conclusion: The results emphasize the central role of the caregiver, who has a positive influence on the success of the therapy, particularly through empathy, humanity and professional competence. Individualized measures and support in the living environment strengthen autonomy and stability. The key factors indicate that further development of the home treatment is necessary.

From time to time, tragic cases occur when patients with serious Mental illness commit homicide. We describe two cases which are in the public domain.These cases are not isolated incidents but part of a broader, systemic failure to provide sustained, assertive, and well-resourced community-based mental health care. It is crucial that the techniques of Assertive Outreach we have discussed are not only adopted in principle but also fully integrated into everyday practice, backed by proper funding, staff training, and institutional support. Without this commitment, we risk continuing the tragic cycle of preventable deaths, where both patients with severe mental illness and innocent bystanders pay the price for gaps in the system. By applying assertive outreach models effectively, we have the opportunity to change the trajectory of care, ensuring that vulnerable individuals receive the intensive, proactive support they need to remain stable, safe, and ultimately, to prevent such tragedies from happening again.

International guidelines recommend the provision of community based treatment as an alternative to predominant inpatient stays in psychiatric hospitals for people with severe mental illnesses. Assertive community treatments have been introduced across the globe; however, the development and implementation of such treatment options are still limited in Switzerland in general and were, until recently, not available in Basel-Stadt. We here describe the development and implementation of an assertive community treatment program created specifically for people with previous heavy use of psychiatric inpatient services in the canton of Basel-Stadt. The program offers this patient group a need-centered and recovery-oriented treatment option following an inpatient stay. Primary objectives are a reduction in the likelihood of further inpatient stays and the potential experience of involuntary admissions as well as high participant satisfaction. Results from the three-year pilot study (2019-2022) are reported here on a case-level. We compare objective outcome measures for people participating in the program after an inpatient stay and receiving minimal treatment (ncases = 110) versus people not participating (ncases = 292). Overall, we show that program participation is associated with a lower number of inpatient treatment days, inpatient stays and number of involuntary admissions. Feedback on subjective outcome measures indicates high treatment satisfaction. These findings speak to the feasibility of the program's implementation and provide a first outlook for a new recovery-oriented treatment option for people with a history of frequent hospitalizations.