Community Mental Health Journal

, Volume 50, Issue 4, pp 454–459 | Cite as

Can Assertive Community Treatment Remedy Patients Dropping Out of Treatment Due to Fragmented Services?

  • Marjan Drukker
  • Wijnand Laan
  • Fred Dreef
  • Ger Driessen
  • Hugo Smeets
  • Jim Van Os
Original Paper


Previously, many patients with severe mental illness had difficulties to engage with fragmented mental health services, thus not receiving care. In a Dutch city, Assertive Community Treatment (ACT) was introduced to cater specifically for this group of patients. In a pre–post comparison, changes in mental health care consumption were examined. All mental health care contacts, ACT and non-ACT, of patients in the newly started ACT-teams were extracted from the regional Psychiatric Case Register. Analyses of mental health care usage were performed comparing the period before ACT introduction with the period thereafter. After the introduction of ACT, mental health care use increased in this group of patients, although not all patients remained under the care of ACT teams. ACT may succeed in delivering more mental health care to patients with severe mental illness and treatment needs who previously had difficulties engaging with fragmented mental health care services.


Mental health care use Assertive Community Treatment Psychiatry Severity of illness 



We gratefully acknowledge the financial support of the PCR-MN by the Ministry of Health, Welfare and Sport.


  1. Bhugra, D., Ayonrinde, O., Butler, G., Leese, M., & Thornicroft, G. (2011). A randomised controlled trial of assertive outreach vs. treatment as usual for black people with severe mental illness. Epidemiology and Psychiatric Sciences, 20(1), 83–89.PubMedCrossRefGoogle Scholar
  2. Bond, G. R., & Salyers, M. P. (2004). Prediction of outcome from the Dartmouth assertive community treatment fidelity scale. CNS Spectrums, 9(12), 937–942.PubMedGoogle Scholar
  3. CBS (Statistics Netherlands). (2012). StatLine; bevolking kerncijfers. Retrieved May 15, 2012, from
  4. Green, C. E., McGuire, P. K., Ashworth, M., & Valmaggia, L. R. (2011). Outreach and Support in South London (OASIS). Outcomes of non-attenders to a service for people at high risk of psychosis: the case for a more assertive approach to assessment. Psychological Medicine, 41(2), 243–250.PubMedCrossRefGoogle Scholar
  5. Hakkaart-van Roijen, L., Tan, S., & Bouwmans, C. (2011). [Manual for costs research] Handleiding voor kostenonderzoek; methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. Geactualiseerde versie 2010. Diemen: Instituut voor Medical Technology Assessment, Erasmus Universiteit Rotterdam.Google Scholar
  6. Ito, J., Oshima, I., Nishio, M., Sono, T., Suzuki, Y., Horiuchi, K., et al. (2011). The effect of assertive community treatment in Japan. Acta Psychiatrica Scandinavica, 123(5), 398–401.PubMedCrossRefGoogle Scholar
  7. Kortrijk, H. E., Mulder, C., Drukker, M., Wiersma, D., & Duivenvoorden, H. (2012). Duration of assertive community treatment and the interpretation of routine outcome data. Australian and New Zealand Journal of Psychiatry, 46(3), 240–248.PubMedCrossRefGoogle Scholar
  8. Kortrijk, H. E., Mulder, C. L., Roosenschoon, B. J., & Wiersma, D. (2010). Treatment outcome in patients receiving assertive community treatment. Community Mental Health Journal, 46(4), 330–336.PubMedCentralPubMedCrossRefGoogle Scholar
  9. Marshall, M., & Lockwood, A. (2000). Assertive community treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews, 2, CD001089.Google Scholar
  10. Michigan Recovery Centre of Excellence. (2012). Assertive community treatment (ACT/PACT). Retrieved July 11, 2012, from
  11. Mulder, C. L., & Kortrijk, H. E. (2012). [Effects of treatment duration on the interpretation of ROM data in ACT patients] De invloed van de duur van behandeling op het interpreteren van ROM-metingen bij ACT. Tijdschrift voor Psychiatrie, 54(2), 191–196.PubMedGoogle Scholar
  12. National Alliance on Mental Illness. (2012). Treatment and services; assertive community treatment. Retrieved October 3, 2012, from
  13. O’Campo, P., Kirst, M., Schaefer-McDaniel, N., Firestone, M., Scott, A., & McShane, K. (2009). Community-based services for homeless adults experiencing concurrent mental health and substance use disorders: A realist approach to synthesizing evidence. Journal of Urban Health, 86(6), 965–989.PubMedCentralPubMedCrossRefGoogle Scholar
  14. Rosenheck, R. A., & Dennis, D. (2001). Time-limited assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry, 58(11), 1073–1080.PubMedCrossRefGoogle Scholar
  15. Smeets, H. M., Laan, W., Engelhard, I. M., Boks, M. P., Geerlings, M. I., & de Wit, N. J. (2011). The psychiatric case register middle Netherlands. BMC Psychiatry, 11, 106.PubMedCentralPubMedCrossRefGoogle Scholar
  16. Snijders, T., & Bosker, R. (1999). Multilevel analysis, an introduction to basic and advanced modeling. London: Sage.Google Scholar
  17. StataCorp. (2009). Stata Statistical Software (Version 11). College Station, TX: Stata Corporation.Google Scholar
  18. Sytema, S., Wunderink, L., Bloemers, W., Roorda, L., & Wiersma, D. (2007). Assertive community treatment in the Netherlands: A randomized controlled trial. Acta Psychiatrica Scandinavica, 116(2), 105–112.PubMedCrossRefGoogle Scholar
  19. The Iowa Consortium for Mental Health. (2012). ACT (Assertive Community Treatment). Retrieved July 11, 2012, from
  20. Van Vugt, M. D., Kroon, H., Delespaul, P. A., Dreef, F. G., Nugter, A., Roosenschoon, B. J., et al. (2011). Assertive community treatment in the Netherlands: Outcome and model fidelity. Canadian Journal of Psychiatry Revue Canadienne de Psychiatrie, 56(3), 154–160.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Marjan Drukker
    • 1
  • Wijnand Laan
    • 2
  • Fred Dreef
    • 3
  • Ger Driessen
    • 1
  • Hugo Smeets
    • 2
  • Jim Van Os
    • 1
    • 4
  1. 1.Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNSMaastricht UniversityMaastrichtThe Netherlands
  2. 2.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
  3. 3.De Care ExpressUtrechtThe Netherlands
  4. 4.King’s Health Partners, Department of Psychosis Studies, Institute of PsychiatryKing’s College LondonLondonUK

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