Community treatment model effective for individuals with severe mental illness

A specific version of a community-based treatment model appeared more effective than other models for individuals with severe mental illness, according to study results published in The Lancet Psychiatry.

“Flexible assertive community treatment (FACT) is a Dutch model of community-based mental health care that provides flexible, multidisciplinary support to people with severe mental illness,” Camilla Munch Nielsen, MSC, of the Copenhagen Research Center for Mental Health in Denmark, and colleagues wrote. “The model allows staff to provide more intensive support to patients when needed through the use of principles from the assertive community treatment (ACT) approach. When the patient has stabilized, their level of care is downgraded back to standard individual case management.”

In the current quasi-experimental controlled study, the investigators sought to assess FACT’s effects on mental health care outcomes vs. treatment from standard community mental health teams, which serve a broader group of patients than who are more stable than those supported by ACT, or ACT teams. They compared five FACT teams, four ACT teams and five CMHTs in the Capital Region of Denmark and identified patients via the Danish Psychiatric Register. Participants included patients who received care from any of these teams on the index date of May 1, 2016. The researchers analyzed the primary outcome in the intention-to-treat population and compared mental health care outcomes, including psychiatric admissions and bed days, outpatient contacts, self-harm, coercion and death by any cause, for patients receiving care from CMHTs or ACT teams that were reconfigured to FACT teams (CMHT-FACT or ACT-FACT) with those receiving care from CMHTs and ACT teams. They balanced differences in baseline characteristics by using propensity scores to match patients who received FACT with control patients from CMHTs and ACT teams.

Data were available of 887 individuals in the CMHT-FACT group, 887 in the matched CMHT group, 130 in the ACT-FACT group and 130 in the matched ACT group. Results showed a higher number of outpatient contacts for patients who received FACT vs. those in the control group. Further, those who received FACT had few admissions vs. those in the control groups; however, the researchers observed no significant differences in deaths, episodes of self-harm, total inpatient days or use of coercion.

“Future studies should also assess engagement with services and the relative costs and benefits of FACT, ideally through randomized controlled trials with fidelity assessments of the teams,” Nielsen and colleagues wrote.