FACT model - any experience?

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nettyb
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FACT model - any experience?

Post by nettyb » Tue May 02, 2017 10:26 pm

Once again, we're going through significant change within my service in an effort to make CRES savings and avoid redundancy. The trust have decided that best way to do this is to create a generic mental health service by combining 2 secondary care adult CMHTS, the primary care mental health team and the assertive outreach team. It is my understanding that the FACT model will be applied for all referrals taken on in this new service and all clients will be worked assertively with a team of people being responsible for the care of the clients allocated to them, with identified needs being met by interventions from appropriately trained and skilled staff members.

For those who don't know me, I am a qualified CP. I work in a generic CMHT and am responsible for the personality disorder pathway in my locality.

I have read that some teams in the midlands region have adopted FACT, particularly in psychosis teams. Does anyone have experience of this model, either in generic AMH or in as a psychosis team? I'm interested to see what people think about it and what the benefits/challenges (if any) have been encountered. Thanks in advance!

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Gilly
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Re: FACT model - any experience?

Post by Gilly » Fri May 05, 2017 8:55 am

We use the FACT model in our service ('stable' psychosis and personality disorder). In my experience it doesn't really work - the idea being that if someone is placed into FACT then we should have a more assertive, team-informed approach to better support that person and stabilise them.

In practice it is used as a way of people flagging up those they are concerned about in regards to relapse/deterioration in mental health, but because of wider systemic issues - staff shortages, high caseloads, staff burn-out and other service priorities, nothing else happens. Noone is able to put in more support because we don't have additional support to go in, so people can sit on FACT for weeks just being talked about ('yeah they're still risky..' 'yeah they're still experiencing command hallucinations) and recorded on the minutes. So for us its just about flagging up who is struggling at the moment.

Hope your implementation is better
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BlueCat
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Re: FACT model - any experience?

Post by BlueCat » Tue May 09, 2017 1:14 pm

Sorry, I don't have any experience of that.

Also...two acronyms there that meant nothing to me. So I looked them up. Google is my friend, and yours too :) So, for other people who, like me, read the posts above and thought "eh, what?" here's what I dug up.

CRES - Cash Releasing Efficiency Saving. So basically, fancy talk for budget cut.

FACT - Flexible Assertive Community Treatment. The manual for this is here http://www.eaof.org/factmanual.pdf. As a Child and Family clinician, it sounds a little like our Tier 3.5/Community Outreach Team role, although I haven't read much past the introduction. It has come out of The Netherlands. I tend to like the mental health and psychological wellbeing practices that come out of The Netherlands. Interestingly, the manual starts with outlining the sort of wte (whole time equivalent) staff required to operate the model; 11-12 wte clinicians for 200 people with SMI (severe and enduring mental illness) on the assumption that at any one time, about 20% of those people will be in a position of high need, with the remaining 80% either stable, or topped out in hospital. Their numbers suggest this would represent an overall population of 40-50, 000 individuals.

Doctoral candidates - the above would be a great starting point for discussion of NHS issues.....
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nettyb
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Re: FACT model - any experience?

Post by nettyb » Thu May 18, 2017 8:32 pm

Gilly, thank you for your response. I imagine that the implementation of our model will be very similar to yours and that things will continue in very much the same way as before. The more for less model doesn't seem to fit with FACT, as I think most implementation sites in the UK have found.

Bluecat, thanks for clarifying the acronyms!

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