Patients with severe mental illness who received care from a flexible assertive community treatment (ACT) team exhibited lower levels of personal and social functioning after one year compared with those who received standard ACT, according to a study in Psychiatric Services in Advance. Whereas ACT teams offer intensive support, including frequent home visits, to patients who have a hard time engaging in traditional mental health services, flexible ACT (FACT) teams adjust the intensity of the treatment. Such flexibility allows the FACT teams to take on higher caseloads.
“One of the main goals of the ACT model is to improve functioning with an approach that goes beyond medication management, such as supporting a patient’s social activities and helping with practical matters,” wrote Camilla Munch Nielsen, Ph.D., of Copenhagen University Hospital and colleagues. The researchers noted that FACT has replaced ACT in many European countries despite limited evidence for FACT’s effectiveness relative to ACT.
To compare outcomes in patients who received care from one of the two models, Nielsen and colleagues recruited patients who received care from nine ACT teams in the Copenhagen region from 2018 to 2019; during this period, six teams were reconfigured to the FACT model. The researchers evaluated 74 patients who were treated by a FACT team and 57 who were treated by an ACT team using the Personal and Social Performance (PSP) scale. The PSP measures functioning in four domains: social activities, relationships, self-care, and aggressive behaviors. Each patient received a score on a scale of 1 to 100 based on their verbal reports of their daily living during the assessment.
Thirty-eight FACT patients and 33 ACT patients were available at a one-year follow-up. After one year, the ACT patients’ functioning scores were about three points higher on average than the FACT patients, after adjusting for differences in baseline scores and substance use between the groups. Patients in both groups reported similar satisfaction and working alliance with their care teams.
“When we consider the results of this study together with the few previous studies on mental health care use, whether FACT is a beneficial alternative to ACT remains uncertain,” Nielsen and colleagues wrote.
For related information, see the Psychiatric Services article “Integrating Primary Care Into Assertive Community Treatment.”
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