Changes in inpatient mental health treatment and related costs before and after flexible assertive community treatment: a naturalistic observational cohort study.

Abstract

Background: Flexible Assertive Community Treatment (FACT) is currently implemented in Norwegian mental health services, aiming to ensure comprehensive and rights-based services for persons with severe mental illness and complex needs, but also motivated by assumed cost-effectiveness. We need knowledge about the consequences of this service innovation. The aim of this study was to investigate changes in total and involuntary inpatient mental health treatment and associated changes in costs of inpatient days before and after enrolment into FACT for persons with severe mental illness and complex needs in Norway.

Methods: In this naturalistic observational cohort study of 397 patients in eight Norwegian FACT teams, we compared total and involuntary admissions, total and involuntary inpatient days, and the costs of total and involuntary inpatient days, for two periods: 24 months before and 24 months after enrolment in FACT. We used paired t-test.

Results: There was a significant reduction in involuntary admissions, involuntary inpatient days, and total inpatient days after enrolment in FACT. We found a slight but non-significant reduction in total admissions to inpatient mental health treatment. There was a significant reduction in the costs of total inpatient days and involuntary inpatient days.

Conclusion: Patients in FACT were admitted to inpatient treatment as frequently as before enrolment in FACT, but involuntary admissions were less frequent. Furthermore, the duration of involuntary and total inpatient treatment was reduced, with a corresponding reduction in costs as expected. Results suggest that targeted and well-timed interventions from FACT may reduce the need for prolonged involuntary inpatient treatment, implying reduced disadvantages for the individual and more efficient allocation of health service funding.