Absence of Positive Results for Flexible Assertive Community Treatment. What is the next Approach?

Tommy Nordén1, Torsten Norlander1, 2, *
1 Center for Research and Development, Evidens University College, Göteborg, Sweden
2 Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden

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© Nordén and Norlander; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Evidens University College, Packhusplatsen 2, SE-411 13 Göteborg, Sweden; Tel: +46 70 662 11 89; Fax: +46 31 711 04 42; E-mail:


Aims were to review results of the five psychiatric studies on Flexible Assertive Community Treatment (FACT) published during 2007-2013, and to compare FACT with Resource-group Assertive Community Treatment (RACT) which specifically focuses on empowerment and rehabilitation of clients in the stable phase. During 2007 articles appeared in scientific journals arguing in favor of the need for the development of the treatment method Assertive Community Treatment (ACT). A particularly notable article was one that featured a Dutch version of ACT, namely FACT. The initiative received great sympathy given that clinical practice and research showed that both American and British versions of ACT were in need of new impulses to be able to maintain an optimal level of care. Seven years have passed since the Dutch model was international presented and five empirical studies about FACT have been published and therefore a first critical examination of FACT was conducted. The review indicated that the five empirical studies failed to show that FACT involves improvement of the clients in terms of symptoms, functioning, or well-being. The conclusions were that at present there is no evidence for FACT and that RACT with its small, flexible ACT teams, where the client him/herself is included and decides on the treatment goals, might be able to provide new impulses and a new vitality to the treatment mode of an assertive community treatment.

Keywords: Assertive community treatment, assertive outreach, FACT, optimal treatment, RACT, resource group..