Introduction In 2016 a new form of integrated community treatment for patients with serious mental illnesses was implemented in two neighborhoods in the city of Utrecht (335000 inhabitants) in the Netherlands. Treatment is characterized by close collaboration of psychiatric care, somatic care (i.e. general practitioner, nurse practitioner), supported housing and other facilities, i.e. the police officer, and is provided in the direct neighborhood of the patients. This ‘neighborhood based integrated mental health care’ should not contribute solely to clinical recovery, but also specifically to social and personal recovery. Objectives The aim of this research was to investigate the experience of patients with serious mental illnesses themselves receiving this new form of neighborhood-based integrated mental health care. More specific the question is studied if and how neighborhood-based integrated mental health care supports personal and social recovery. Methods To assess the experience of patients in depth qualitative semi-structured interviews were conducted with 20 patients. Patients were asked to participate in interviews directly by the researchers, by their case managers and by experts by experience. Interview topics included personal and social recovery, resilience and self-efficacy related to the collective effort of caregivers. Qualitative data was analyzed by three independent researches with the qualitative computer program Tarzan. Strategies to enhance quality of data analysis (respondent validation) and validity (attention to negative cases) were used. Results The study will be finished in January 2019. Conclusions The results, a brief description of the collaborative care methodology offered and experiences of patients, and conclusions will be presented at the ENMESH conference.
During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for “difficult to reach” children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient’s motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma. ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions.
Introduction F-ACT is a flexible version of Assertive Community Treatment to deliver care in a changing intensity depending on needs of individuals with severe mental illnesses (Van Veldhuizen, 2007). In 2016 a number of the FACT-teams in the Dutch region of Utrecht moved to locations in neighborhoods and started to work as one network team together with neighborhood based facilities in primary care (GP’s) and in the social domain (supported living, social district teams, etc.). This should create better chances on clinical, social and personal recovery of service users. Objectives This study describes the implementation, obstacles and outcomes for service users. The main question is whether this Collaborative Mental Health Care in the Community produces better outcome than regular FACT. Measures include (met/unmet) needs for care, quality of life, clinical, functional and personal recovery, and hospital admission days. Methods Data on care utilization regarding the innovation are compared to regular FACT. Qualitative interviews are conducted to gain insight in the experiences of service users, their family members and mental health care workers. Changes in outcome measures of service users in pilot areas (N=400) were compared to outcomes of users (matched on gender and level of functioning) in regular FACT teams in the period 2015-2018 (total N=800). Results Data-analyses will take place from January to March 2019. Initial analyses point at a greater feeling of holding and safety for service users in the pilot areas and less hospital admission days. Conclusions Preliminary results support the development from FACT to a community based collaborative care service.
