The Hourglass Model: Are There Structural Problems with the Scarcity of Positive Results for Flexible ACT?#

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

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© Norlander and Nordén; 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:,
# A commentary on ‘Flexible ACT & Resource-group ACT: Different working procedures which can supplement and strengthen Each other. A response’ (R. van Veldhuizen, P. Delespaul, H. Kroon, & N. Mulder in Clinical Practice & Epidemiology in Mental Health, 2015: 11, 12-15).


The aim of the present article was to discuss the commentary by van Veldhuizen, Delespaul and Mulder (2015) regarding the review by Nordén and Norlander (2014) based on five empirical articles about Flexible Assertive Community Treatment (FACT). Veldhuizen et al. agree on that there is insufficient evidence for the effectiveness of FACT. However, van Veldhuizen et al. avoid a discussion of the lack of positive results despite extensive research during several years and therefore an analysis of why FACT did not fare better is missing. According to FACT it is an advantage that one single team spans the entire chain of care and rehabilitation, but no evidence is given for such an opinion. Instead there may be difficulties for the staff to shift between psychiatric care and psychiatric rehabilitation and the clients perhaps don’t want to encounter the same professional team during all phases of care and rehabilitation.

Keywords: Assertive community treatment, FACT, fidelity, flexible, psychiatric care, psychiatric rehabilitation, RACT, resource group.