Abstract
Purpose
Financial constraints and some disappointing research evaluations have seen English assertive outreach (AO) teams subject to remodelling, decommissioning and integration into standard care. We tested a specific alternative model of integrating the AO function from two AO teams into six standard community mental health teams (CMHT). The Flexible Assertive Community Treatment model (FACT) was adopted from the Netherlands (Van Veldhuizen, Commun Mental Health J 43(4):421–433, 2007; Bond and Drake, Commun Mental Health J 43(4):435–438, 2007). We aimed to demonstrate non-inferiority in clinical effectiveness and thereby show cost efficiencies associated with FACT.
Methods
Outcomes were compared in a mirror-image study of the 12 months periods pre- and post-service change with eligible individuals from the AO teams’ caseloads (n = 112) acting as their own controls. We also conducted a cost-consequence analysis of the changes. Outcome data regarding admissions, use of crisis and home treatment, frequency of contact and DNA rate were extracted from the electronic patient record.
Results
The results show AO patients (n = 112) transferred to standard CMHTs with FACT had significantly fewer admissions and a halving of bed use (21 fewer admission and 2,394 fewer occupied bed days) whilst being in receipt of a less intensive service (2,979 fewer contacts). This was offset by significantly poorer engagement but not by increased use of crisis and home treatment services.
Conclusions
Enhancing multi-disciplinary CMHTs with FACT provides a clinically effective alternative to AO teams. FACT offers a cost-effective model compared to AO.
Similar content being viewed by others
References
Van Veldhuizen JR (2007) FACT: a Dutch version of ACT. Commun Ment Health J 43(4):421–433
Bond GR, Drake RE (2007) Should we adopt the Dutch version of ACT? Commentary on “FACT: a Dutch version of ACT”. Commun Ment Health J 43(4):435–438
Firn M (2007) Assertive Outreach: has the tide turned against the approach. Mental Health Practice 10(7):24–27
Killaspy H, Bebbington P, Blizard R, Johnson S, Nolan F, Pilling S, King M (2006) The REACT study: randomized evaluation of assertive community treatment in north London. BMJ 332:815–820
Killaspy H, Kingett S, Bebbington P, Blizard R, Johnson S, Nolan F, Pilling S, King M (2009) Randomised evaluation of assertive community treatment: 3-year outcomes. Br J Psychiatry 195:81–82
Priebe S, Watts J, Chase M, Matanov A (2005) Processes of disengagement and engagement in assertive outreach patients: qualitative study. Br J Psychiatry 187:438–443
Killaspy H, Johnson S, Pierce B, Bebbington P, Pilling S, Nolan F, King M (2009) Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial. Soc Psychiatry Psychiatr Epidemiol 44:532–540
Brugha TS, Taub N, Smith J, Morgan T, Hill T, Meltzer H, Wright C, Burns T, Priebe S, Evans J, Fryers T (2012) Predicting outcome of assertive outreach across England. Soc Psychiatry Psychiatr Epidemiol 47(2):313–322
Bak M, van Os J, Delespaul P, de Bie A., Campo J., Poddighe G et al (2007) An observational, ‘“real life”’ trial of the introduction of assertive community treatment in a geographically defined area using clinical rather than service use outcome criteria. Soc Psychiatry Psychiatr Epidemiol 42:125–130
Van Os J, Kapur S (2009) Schizophrenia. Lancet 374:635–645
Stein LI, Test MA (1980) Alternative to mental hospital treatment I. Conceptual model, treatment program and clinical evaluation. Arch Gen Psychiatry 37:392–397
Personal Social Service Research Unit (2011). Unit costs of health and social care. University of Kent, England
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Firn, M., Hindhaugh, K., Hubbeling, D. et al. A dismantling study of assertive outreach services: comparing activity and outcomes following replacement with the FACT model. Soc Psychiatry Psychiatr Epidemiol 48, 997–1003 (2013). https://doi.org/10.1007/s00127-012-0602-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-012-0602-x