A diverse group walking from a maze to an open field, symbolizing accessible mental healthcare.

Beyond Traditional ACT: How Flexible ACT is Revolutionizing Mental Healthcare Access

Reese Marlowe in Health & Wellness August 2025 • 4 min read.

"Discover how the Flexible Assertive Community Treatment (FACT) model is improving mental health services by addressing complexity and enhancing accessibility."

For years, mental health services have been evolving, particularly since the shift from hospital-centric to community-based care in the 1960s. The goal was simple: empower individuals with serious mental illnesses to live independently, avoiding frequent hospitalizations. However, the reality has been more complex.

Assertive Community Treatment (ACT) emerged as a beacon of hope – an evidence-based model that reduces hospitalization rates and improves housing stability. Yet, even ACT has its limitations. The promise of 'time-unlimited' services sometimes translates to long waiting lists and a struggle to transition stable patients to less intensive care.

Enter Flexible ACT (FACT), an innovative approach developed in the Netherlands and now adapted for North America. FACT merges the strengths of ACT and intensive case management (ICM), offering a more adaptable and accessible solution for individuals with complex needs. Let's explore how FACT is changing the landscape of community mental health services.

FACT: Building a More Flexible and Inclusive System

A diverse group walking from a maze to an open field, symbolizing accessible mental healthcare.

The core innovation of FACT lies in its flexibility. Unlike traditional ACT, which can be rigid in its service delivery, FACT teams can seamlessly transition patients between intensive ACT-level support and less intensive ICM services based on their evolving needs. This ensures continuous care and a stronger patient-clinician relationship.

Here's how FACT is innovating community mental health services:

Integrated ACT and ICM: Combines the strengths of both models within a single team, allowing for seamless transitions in service intensity.
Expanded Access: Serves a broader range of patients with more inclusive admission criteria compared to traditional ACT.
Recovery-Focused Approach: Emphasizes peer support, vocational assistance, and collaborative goal setting.

By integrating these elements, FACT aims to address the unmet needs of individuals who may be underserved by traditional ACT or ICM models, including those with substance use disorders, developmental disabilities, and personality disorders.

The Future of Community Mental Healthcare

The adaptation of FACT in Toronto represents a significant step forward in the evolution of community mental healthcare. By embracing flexibility, inclusivity, and a recovery-focused approach, FACT has the potential to transform the lives of individuals with serious mental illness.

While further research is needed to fully evaluate the effectiveness of FACT, preliminary findings and clinical experience suggest that it holds great promise. Ongoing studies are underway to assess patient wellness, substance use, forensic involvement, and healthcare utilization. Qualitative interviews will also provide valuable insights into the experiences of both staff and service users.

As the mental healthcare landscape continues to evolve, innovative models like FACT will play a crucial role in ensuring that everyone has access to the support they need to thrive. With continued evaluation and refinement, FACT could pave the way for a more responsive and effective community mental health system.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1176/appi.ps.201700195, Alternate LINK

Title: Addressing Complexity And Improving Access In Community Mental Health Services: An Inner-City Adaptation Of Flexible Act

Subject: Psychiatry and Mental health

Journal: Psychiatric Services

Publisher: American Psychiatric Association Publishing

Authors: Arash Nakhost, Samuel F. Law, Katherine M. Francombe Pridham, Vicky Stergiopoulos

Published: 2017-09-01

Everything You Need To Know

What is Flexible Assertive Community Treatment (FACT) and how does it differ from traditional Assertive Community Treatment (ACT)?

Flexible Assertive Community Treatment (FACT) is an innovative approach to mental healthcare that combines the strengths of traditional Assertive Community Treatment (ACT) and intensive case management (ICM). Unlike ACT, which can be rigid, FACT allows for seamless transitions between intensive support and less intensive services based on the individual's evolving needs. This flexibility ensures continuous care and a stronger patient-clinician relationship. FACT uses more inclusive admission criteria compared to traditional ACT.

How does Flexible Assertive Community Treatment (FACT) provide flexibility in mental health service delivery?

The core innovation of Flexible Assertive Community Treatment (FACT) lies in its adaptability. FACT teams integrate Assertive Community Treatment (ACT) and intensive case management (ICM), enabling them to transition patients between intensive ACT-level support and less intensive ICM services seamlessly. This ensures that patients receive the appropriate level of care as their needs change, providing a more responsive and efficient service delivery model.

Who benefits most from the Flexible Assertive Community Treatment (FACT) model?

Flexible Assertive Community Treatment (FACT) aims to address the unmet needs of individuals who may be underserved by traditional Assertive Community Treatment (ACT) or intensive case management (ICM) models. This includes those with co-occurring substance use disorders, developmental disabilities, and personality disorders. By offering a more inclusive and adaptable approach, FACT seeks to provide comprehensive support to a broader range of individuals with complex needs.

In what ways is Flexible Assertive Community Treatment (FACT) changing community mental health services?

Flexible Assertive Community Treatment (FACT) is transforming community mental health services by integrating Assertive Community Treatment (ACT) and intensive case management (ICM) into a single, adaptable framework. This approach ensures that patients receive the right level of support at the right time, improving care coordination and outcomes. The recovery-focused approach, peer support, vocational assistance, and collaborative goal setting all contribute to a more holistic and effective treatment experience. This ensures continuous care and a stronger patient-clinician relationship.

What are the implications of adopting Flexible Assertive Community Treatment (FACT) for the future of community mental healthcare?

The adaptation of Flexible Assertive Community Treatment (FACT) in places like Toronto marks a significant advancement in community mental healthcare. By emphasizing flexibility, inclusivity, and a recovery-focused approach, FACT has the potential to greatly improve the lives of individuals with serious mental illness. The integration of Assertive Community Treatment (ACT) and intensive case management (ICM) allows for a more responsive and tailored approach to care, ultimately leading to better outcomes and a more supportive environment for recovery.