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  • Epidemiology and Psychiatric Sciences, Volume 20, Issue 3
  • September 2011, pp. 273-278

Function assertive community treatment (FACT) and psychiatric service use in patients diagnosed with severe mental illness

  • M. Drukker (a1), J. Van Os (a1) (a2), S. Sytema (a3), G. Driessen (a1), E. Visser (a3) and Ph. Delespaul (a1) (a4)
  • DOI:
  • Published online: 01 April 2011

Previous work suggests that the Dutch variant of assertive community treatment (ACT), known as Function ACT (FACT), may be effective in increasing symptomatic remission rates when replacing a system of hospital-based care and separate community-based facilities. FACT guidelines propose a different pattern of psychiatric service consumption compared to traditional services, which should result in different costing parameters than care as usual (CAU).


South-Limburg FACT patients, identified through the local psychiatric case register, were matched with patients from a non-FACT control region in the North of the Netherlands (NN). Matching was accomplished using propensity scoring including, among others, total and outpatient care consumption. Assessment, as an important ingredient of FACT, was the point of departure of the present analysis.


FACT patients, compared to CAU, had five more outpatient contacts after the index date. Cost-effectiveness was difficult to assess.


Implementation of FACT results in measurable changes in mental health care use.

Corresponding author
*Address for correspondence: Dr Marjan Drukker, Department of Psychiatry and Psychology, School for Mental Health and NeuroScience MHeNS, Maastricht University, P.O. Box 616, Vijverdal, 6200 MD Maastricht, The Netherlands. (Email:
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M Bak , J Van Os , PAEG Delespaul , A De Bie , Campo , G Poddighe , M Drukker (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. Social Psychiatry and Psychiatric Epidemiology 42, 125130.

GR Bond , RE Drake (2007). Should we adopt the Dutch version of ACT? Commentary on “FACT: a Dutch version of ACT”. Community Mental Health Journal 43, 435438.

AS Detsky , G Naglie , MD Krahn , D Naimark , DA Redelmeier (1997). Primer on medical decision analysis: Part 1 – Getting started. Medical Decision Making 17, 123125.

M Drukker , MLFJ Bak , Campo , G Driessen , J Van Os , PAEG Delespaul (2010). The cumulative needs for care monitor (CNCM), a unique monitoring system in the South of The Netherlands. Social Psychiatry and Psychiatric Epidemiology 45, 475485.

M Drukker , M Maarschalkerweerd , MLFJ Bak , G Driessen , Campo , A De Bie , G Poddighe , J Van Os , PAEG Delespaul (2008 a). A real-life observational study to the effectiveness of F-ACT in a Dutch mental health region. BMC Psychiatry 8, 93.

M Drukker , K Van Dillen , MLFJ Bak , R Mengelers , J Van Os , PAEG Delespaul (2008 b). The use of the Camberwell Assessment of Need in treatment: what unmet needs can be met? Social Psychiatry and Psychiatric Epidemiology 43, 410417.

M Drukker , J Van Os , M Dietvorst , S Sytema , G Driessen , PAEG Delespaul (2011). Does monitoring need for care in patients diagnosed with severe mental illness impact on psychiatric service use? Comparison of monitored patients with matched controls. BMC Psychiatry 11, 45.

A Lora , R Bezzi , A Erlicher (2007). Estimating the prevalence of severe mental illness in mental health services in Lombardy (Italy). Community Mental Health Journal 43, 341357.

D Naimark , MD Krahn , G Naglie , DA Redelmeier , AS Detsky (1997). Primer on medical decision analysis: Part 5 – Working with Markov processes. Medical Decision Making 17, 152159.

FA Sonnenberg , JR Beck (1993). Markov models in medical decision making: a practical guide. Medical Decision Making 13, 322338.

JR Van Veldhuizen (2007). FACT: a Dutch version of ACT. Community Mental Health Journal 43, 421433.

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Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
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