Patients with severe psychotic disorders exhibit a severely reduced quality of life (QoL) at all stages of the disease. Integrated care often led to an improvement in QoL. However, the specific mediators of QoL change are not yet well understood.

The ACCESS II study is a prospective, long-term study investigating the effectiveness of an integrated care program for people with severe psychotic disorders (IC-TACT) that includes Therapeutic Assertive Community Treatment within a care network of in- and outpatient services at the University Medical Center Hamburg-Eppendorf, Germany. We examined longitudinal associations between QoL and the hypothesized mediators of change (i.e., negative symptoms, depression, and anxiety), using cross-lagged panel models.

The sample includes 418 severely ill patients treated in IC-TACT for at least 1 year. QoL increased, whereas symptom severity decreased significantly from baseline to 6-month follow-up (p-values ≤ 0.001), and remained stable until 12-month follow-up. QoL and symptom severity demonstrated significant auto-correlated effects and significant cross-lagged effects from QoL at baseline to negative symptoms (6 months, β = −0.20, p < 0.001) to QoL (12 months, β = −0.19, p < 0.01) resulting in a significant indirect, mediated effect. Additionally, negative symptoms after 6 months had a significant effect on the severity of depression after 12 months (β = 0.13, p < 0.05).

Negative symptoms appear to represent an important mechanism of change in IC-TACT indicating that improvement of QoL could potentially be achieved through optimized intervention on negative symptoms. Moreover, this may lead to a reduction in the severity of depression after 12 months.

A mental health (MH) assertive community treatment (ACT) is always designed expecting for a decrease in the pressure (visits and readmissions) in inpatient services and to increase care quality. An appropriate management of ACT provision can be crucial to develop a balanced community-based MH ecosystems.

To assess the impact of the ACT on the performance of the MH ecosystem of Bizkaia (Basque Country, Spain).

The ecosystem is structured by 19 MH areas, supported by 5 ACT teams. Here ACT provides high intensity mobile outpatient care to people suffering from severe mental disorders. The impact of these teams on the ecosystem performance was assessed by Monte-Carlo simulation, the Data Envelopment Analysis (DEA) and fuzzy inference. The input variables were the availability, number of psychiatrics, nurses and total of professionals of ACT services in each area. The outputs were: frequentation, incidence and prevalence of ACT services in each MH area. Performance indicators were: relative technical efficiency (RTE), statistical stability and entropy.

The global ecosystem performance was high (RTE on average=0.799 -input DEA orientation- and 0.825 -output orientation- up to 1, the maximum), the stability was medium-low (respectively 38,67% and 13.64% up to 100%, the maximum) and the entropy was medium-high (respectively 70,41% and 65.9% up to 100%, the maximum).

Results highlighted a positive impact of ACT in Bizkaia. Nevertheless, stability and entropy levels showed the existence of a high structural variability in ACT services due to the necessity of adjusting them to the user’s specific needs.

No significant relationships.

Patients with severe mental illness experience physical health inequities. They are less likely to receive preventative care and adequate treatment for physical illnesses. Physical health screening of patients receiving antipsychotics is usually carried out every six months. This comprises screening bloodwork and ECGs, and the sharing of results with family physicians.

We sought to investigate whether the pandemic affected the receipt of routine physical health screening in patients managed by an Assertive Community Treatment (ACT) Service.

A comprehensive chart review was performed on 62 ACT patients. We compared the receipt of screening bloodwork and ECGs from March—December 2020 to the same period in 2019. Results were analyzed using McNemar’s Chi square test with Yates’ correction.

Patients were less likely to have received an ECG during the pandemic period. 69% received an ECG from March—December 2019 versus 42% from March—December 2020 (χ2= 7.76, p<0.01). Similarly, patients were less likely to have received screening bloodwork during the pandemic period (69% vs. 50%, Χ2= 4.32, p<0.05). Qualitative discussion with ACT staff regarding the 39 patients who had not received an ECG and/or bloodwork during the pandemic period revealed system-related (8%), patient-related (23%), and Covid-related (69%) barriers to screening. Covid-related barriers included transport concerns and lab closures.

ACT patients were less likely to have received routine health screening during the Covid-19 pandemic. Thus, the pandemic may have exacerbated physical health inequities for patients with severe mental illness. Covid-related barriers to screening represent an important target for intervention.

No significant relationships.

Personal agency is a variable which potentially facilitates personal recovery in people with serious mental illness. This study aimed to develop a new brief measure for subjective personal agency that can be completed by people with serious mental illness.

Two focus group interviews were first conducted with 11 people with schizophrenia to understand the fundamental components of subjective personal agency for people with serious mental illness living in the community. One group comprised six people with schizophrenia living in the community, while the other consisted of five people with schizophrenia working as peer-support workers. We then developed scale items through collaboration with people with schizophrenia and qualitative analysis (stage 1). A cross-sectional survey was then conducted to test the psychometric properties of the new scale among service users with schizophrenia in 18 assertive community treatment teams (stage 2). Factor validity was tested via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We evaluated convergent validity with the Boston University Empowerment Scale (BUES), divergent validity with the global assessment of functioning (GAF), internal consistency, and test–retest reliability.

Seven items were included in the scale at stage 1. In stage 2, 195 participants completed this scale. EFA revealed a one-factor model with five items. CFA indicated good model fit (χ2 statistics [CMIN] = 8.445, df = 5 (CMIN/df = 1.689), p = 0.133, comparative fit index = 0.974, Tucker–Lewis fit index = 0.949, root mean square error of approximation = 0.077 and standardised root mean squared residual = 0.042). The new scale was significantly correlated with total BUES score (r = 0.526, p < 0.001), but not with GAF score. Cronbach's α for internal consistency was 0.79, and intra-class correlation coefficient for test–retest reliability was 0.70.

We developed a new, five-item Subjective Personal Agency scale (SPA-5) that can be completed by people with serious mental illness. Further studies are needed to confirm the results outside Japan.

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.