[Mental health in Eastern Lille: a future of network-psychiatry?] / De ggz in Oost-Lille: inspiratie voor de praktijk van netwerkzorg in de ggz.

BACKGROUND: For some time now, East Lille has been working with a relatively modern mental health care system that remarkably resembles Dutch health care with the same values and norms that we want to implement in the Netherlands as well.
AIM: Gaining inspiration to further investigate regional cooperation and 'network care' in Dutch psychiatry.
METHOD: A delegation from the board of f-act-Netherlands and ccaf paid a working visit to Lille.
RESULTS: The basis of the East Lille working method is a charter of shared values developed with all parties, clients, relatives, employees and external professionals, which is signed by every professional. In case of doubt, a change of context or the introduction of new working methods, these values are used first. CONCLUSIONS High quality mental health care develops in dialogue, in which working methods, service delivery models and interventions are linked to each other by means of network care. Through reflection, moral deliberation and appreciative auditing, care is progressively improved. These procedures guarantee a modern process of quality improvement.

[Flexible assertive community treatment (FACT) as part of a community (health) network]. / FACT als onderdeel van wijkgerichte zorg in het (zorg)netwerk.

BACKGROUND: Community-based care for people with severe mental illness increasingly requires far-reaching cooperation between different domains. This cooperation must always be unique and local, and at the same time provide an answer to generic and nationally set goals.
AIM: Offering new insights on collaboration within and between domains.
METHOD: Reflection on developments in the social domain and specialist mental healthcare using relevant literature and recent (inter)national experiences.
RESULTS: It seems possible to provide better integral care by allowing FACT-teams to network together with Social Support partners (e.g. by sharing financial and/or human resources). In this process, networks of care for people with serious mental illness (SMI), develop over various phases and realize new partnerships. The model fidelity scale for FACT-teams was adjusted to facilitate that process. CONCLUSIONS The new FACT model fidelity scale is ready to allow FACT-teams to explore flexible local solutions for partnerships to realize the much-needed multi-domain integrated community care for people with SMI.

[Indicating care: quite a challenge]. / Indiceren voor zorg: een hele uitdaging.

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[Decision aid for the treatment of psychotic illness: development of TReatment E-AssisT (TREAT)]. / Beslistool bij de behandeling van psycho-tische aandoeningen: de ontwikkeling van TReatment E-AssisT (TREAT).

BACKGROUND: Use of decision aids in mental health care is increasing and will also be introduced in the Dutch mental healthcare system. We describe the context of this development and discuss how decision aids could facilitate evidence-based psychiatry.
AIM: To describe the development of the decision aid TReatment E-Assist (TREAT) in the Dutch mental healthcare system that aims to optimize treatment of people with a psychotic illness.
METHOD: We describe how the TREAT application works and discuss its potential contribution to the treatment of people with a psychotic illness.
RESULTS: In a pilot study TREAT was judged as user friendly and useful. TREAT seemed to increase the integration of ROM-results in treatment and the advice offered new view points for practioners.
CONCLUSION: TREAT is a novel application which combines routine outcome monitoring results with current treatment guidelines and standards of care in order to generate personalised treatment recommendations in the context of a psychiatric treatment trajectory. A multicentre study is being conducted in different provinces in the Netherlands to investigate the effectiveness of TREAT.

[Development of the renewed Flexible ACT scale: F-ACT fidelity 2017]. / De ontwikkeling van de vernieuwde Flexible ACT-schaal: F-ACT-s 2017.

BACKGROUND: An important model for the organisation of care for people with severe mental illness is flexible assertive community treatment (F-ACT). F-ACT combines case management with assertive crisis intervention. Quality control was implemented in 2008 using a model fidelity scale. Research has shown that the norms used for the F-ACT fidelity scale no longer correspond with current norms concerning restorative and evidence-based care, as established in treatment guidelines.
AIM: To develop a new model fidelity scale for F-ACT teams.
METHOD: Using knowledge of experts, relevant articles and feedback from professionals, researchers, interest groups and family members, a new model fidelity scale was developed: the F-ACTs 2017. The revised scale was tested by trained auditors in 21 F-ACT teams and adjusted in two pilot rounds.
RESULTS: In 2017 the final version was presented to the stakeholders and was approved by the board of auditors; the final version is currently in use. CONCLUSIONS With the availability of F-ACTs 2017, the (research) field has state-of-the-art instrument to monitor the quality of care of persons with severe mental illness. It uses field standards to evaluate the degree of model fidelity of teams that focus on patients with severe mental illness in a rapidly changing context.

[Model fidelity of flexible assertive community treatment (F-ACT) teams: five years of audit results]. / Modelgetrouwheid van flexible assertive community treatment(F-ACT)-teams: resultaten van vijf jaar auditeren.

BACKGROUND: The Flexible act (f-act) has been introduced in the Netherlands since 2004, alongside the Assertive Community Treatment (act) model. An estimate of 400 (f-)act teams concurrently provide care to approximately 70.000 people with serious mental illness. The ccaf has been assessing the model fidelity of act and f-act teams since 2009 to promote the quality and transparency of healthcare for clients with serious mental illness. OBJECTIVE To describe the state of implementation of f-act and associated trends in the Netherlands.
METHOD: Analysis of the ccaf database, which holds the data of audits conducted between 2009 and 2014.
RESULTS: The audits conducted by ccaf between 2009 and 2014 indicated an adequate implementation of f-act. The team foundations were well organized, featuring a multidisciplinary team structure, management of medication, practical support and investment in healthcare continuity, including during an admission. However, the results regarding participation and recovery were unsatisfactory. Furthermore, the results depicted a decline in the scores concerning a number of areas, including outreach and support of participation and recovery. CONCLUSIONS Although the data indicates an on average satisfactory implementation of f-act in the Netherlands, there are signs that the implementation of f-act is under pressure with relatively fewer home visits, a rising caseload and a reduced investment in recovery and participation. The findings are in accordance with the signs and arguments to adjust the emphasis on reducing hospital admissions, prioritizing the consolidation of outpatient care instead.

[A valid quality system for mental health care: from accountability and control in institutionalised settings to co-creation in small areas and a focus on community vital signs]. / Een valide kwaliteitskader voor de ggz: van benchmark-ROM aan de achterkant naar regionale regie en cocreatie aan de voorkant.

BACKGROUND: In a given year, around 25% of the Dutch population may experience significant mental health problems, much more than the mental health service can attend to, given a maximum capacity of 6% of the population per year. Due to the lack of a public mental health system, there is fierce competition over who gets to receive care from mental health services and little control over how the level of needs can be matched with the appropriate intensity of care. As a result, resources are being wasted and both overtreatment and undertreatment are prevalent.
AIM: To propose a valid quality system that benefits the mental health of the entire population and does not simply attend to the symptoms of a strategically selected group.
METHOD: Literature review from an epidemiological and public mental health perspective.
RESULTS: In our view, a valid quality system for mental health care needs to focus on two distinct areas. The first area involves the analysis of about 20 quantitative population parameters or 'Community Vital Signs' (care consumption, pharmaco-epidemiological indicators, mortality, somatic morbidity, social care, housing, work, benefits, involuntary admissions). This analysis will reveal regional variation in the mental health of the entire population rather than in the relatively small, selected group receiving mental health care. The second area to which attention needs to be directed comprises a system of simple qualitative visits to mental health care institutions based on 10 quality parameters that currently remain invisible; these parameters will measure the impact at local community level. The focus of these will be on a transition from accountability and control in large institutions to provision of care in small areas that was co-designed with users and other stakeholders.
CONCLUSION: A valid quality system for mental health care is within reach, provided it is combined with a novel system of public mental health and transition of care to a system of co-design with users in small areas.

[Using resource groups in assertive community treatment; literature review and recommendation]. / De inzet van resourcegroepen voor gedeelde besluitvorming bij assertive community treatment; literatuuroverzicht en aanbevelingen.

BACKGROUND: In psychiatry there is an increasing interest in giving patients and their relatives control over the goals of treatment and the way in which treatment is carried out. A structural method of organising this within assertive community treatment (ACT) is to let patients and their relatives participate in what is known as a resource group (RG).
AIM: To provide a systematic view of the advantages of giving patients control over their treatment and the way in which it is carried out via ACT, particularly if this control is organised in the form of an RG.
METHOD: We reviewed the relevant literature on the basis of search instructions in the databases of PubMed and Cochrane Library. We found nine trials that had a randomised controlled design (RCT). Only one of these RCTs involved the use of an RG in ACT.
RESULTS: The approaches used in ACT, whereby patients with schizophrenia had control over their treatment, led to significant improvements that were considerably greater than those achieved in standard care. Improvements were found in symptomatology, social functioning and in the quality of life. There are indications that treatment satisfaction and social functioning improve still further if patients' control over their treatment is organised in an RG.
CONCLUSION: Research demonstrates that positive results are achieved with ACT whereby patients have control over their treatment and the way in which it is carried out. However, further research is needed to determine whether this addition to ACT in the form of an RG is superior to other approaches used previously in ACT, particularly if it concerns the inclusion of an RG.

[Consensus regarding the definition of persons with severe mental illness and the number of such persons in the Netherlands]. / Consensus over de definitie van mensen met een ernstige psychische aandoening (EPA) en hun aantal in Nederland.

BACKGROUND: Insurance companies and mental health service planners need to have information about the prevalence of severe mental illness (SMI) and about the numbers of persons affected. They require these data in order to be able to develop, implement and evaluate innovative mental health care for such patients. This information lets them draw up their budgets and define their priorities. AIM: To reach a consensus regarding the number of patients with SMI in the Netherlands. METHOD: A consensus was reached regarding the definition of SMI, and the prevalence of SMI was determined on the basis of epidemiological literature and policy papers relating to mental health care in the Netherlands. When figures from the literature were inaccurate or unavailable, estimates were checked by a group of experts. RESULTS: The definition of SMI was adjusted and amended in relation to psychiatric comorbidity. An analysis of the care-loads of all the mental health care providers yielded an estimate of 160,000 SMI patients aged 18-65, including those receiving addiction care and forensic care (1.6% of the adult population). When children and adolescents (< 18 years) and the elderly (> 65 years) were included, the total number of patients came to 216,000 (1.3%). The prevalence among the population was estimated to be 281,000 (1.7%). CONCLUSION: The Consensus group is of the opinion that the consensus document estimates of the number of SMI patients in the Netherlands are as accurate as they can possibly be. Of course, the document contains assumptions and extrapolations which will require further research. The figures will be confirmed or adjusted in the future as soon as new evidence becomes available.

Unveiling patterns of affective responses in daily life may improve outcome prediction in depression: a momentary assessment study.

OBJECTIVE: Daily life affective responses are closely linked to vulnerability and resilience in depression. Prediction of future clinical course may be improved if information on daily life emotional response patterns is taken into account. METHOD: Female subjects with a history of major depression (n=83), recruited from a population twin register, participated in a longitudinal study using momentary assessment technology with 4 follow-up measurements. The effect of baseline daily life emotional response patterns (affect variability, stress-sensitivity and reward experience) on follow-up depressive symptomatology was examined. RESULTS: Both reward experience (B=-0.30, p=0.001) and negative affect variability (B=0.46, p=0.001) predicted future negative affective symptoms independent of all other dynamic emotional patterns and conventional predictors. CONCLUSION: Daily life information on dynamic emotional patterns adds to the prediction of future clinical course, independent of severity of symptoms and neuroticism score. Better prediction of course may improve decision-making regarding quantitative and qualitative aspects of treatment.