Flexible Assertive Community Treatment, Severity of Symptoms and Psychiatric Health Service Use, a Real life Observational Study

Marjan Drukker1, , *, Ellen Visser, 2, Sjoerd Sytema2, Jim van Os1, 3
1 Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, p.o. box 616, Location Vijverdal, 6200 MD, Maastricht, the Netherlands
2 Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Rob Giel Centre, p.o. box 30.001, 9700 RB Groningen, the Netherlands
3 King's College London, King's Health Partners Department of Psychosis Studies; Institute of Psychiatry, London, UK

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© Drukker et al.; Licensee Bentham Open.

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* Address correspondence to this author at the Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, p.o. box 616, location Vijverdal, 6200 MD Maastricht, the Netherlands; Tel: +31-(0)43-3883913; Fax: +31-(0)43-3884122 E-mail:
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Introduction of Flexible Assertive Community Treatment (FACT) may be associated with increased remission rates and changes in patterns of care. The present paper reports on differences in psychosocial functioning and health care use between patients in FACT and two groups of patients not currently provided with a specific model of community service.


The ongoing "Pharmacotherapy Monitoring and Outcome Survey" provided routine outcome measures of patients using antipsychotics in the north of the Netherlands. Level of psychosocial functioning was assessed using the Health of the Nations Outcome Scales (HoNOS) and matched with psychiatric health care consumption obtained from the Psychiatric Case Register. Patients who never received FACT, patients ever in FACT but not at assessment date, and patients in FACT were identified. Data were subjected to multilevel linear regression analysis.


Data showed that most patients in FACT also had non-FACT episodes after the start of FACT. Furthermore, patients in FACT displayed higher levels of psychosocial functioning and used more outpatient care than the other two groups.


Patients in FACT receive more outpatient care and have better psychosocial functioning. However, causal inferences cannot be derived from these data. In addition, membership of a FACT-team in this setting did not last indefinitely.

Keywords: : Assertive Community Treatment, Health Care, Population Register, Psychiatry, Psychosocial Factors, Severity of Illness.