[The Open-Doors Policy in Oslo: both the starting point and the final chord].

Background: The Lovisenberg Diakonal Hospital recently introduced an Open-Door Policy in their (formerly) closed psychiatric admission wards for people with a forced admission to an acute psychiatric crisis. Their modern mental health care system is remarkably similar to the Dutch healthcare organization, with shared values and standards, and provides good grounds for an implementation of an Open-Doors Policy in the Netherlands.

Aim: Gaining inspiration to reduce seclusion and create a new quality development and assessment process for closed admission departments in the Dutch mental health care system.

[Patient with a long history of disease in whom service dog contributed to recovery].

We describe a patient who reached recovery, after purchasing a dog and training it into an assistance dog. The patient has a long lasting (over 30 years) history in mental health care and was diagnosed with autism spectrum disorder, posttraumatic stress disorder and borderline personality disorder. All these years the patient did not reach symptomatic improvement or personal or social recovery.

[Daily practice of a FACT-team: results of an experience sampling study].

Background: Flexible assertive community treatment (FACT) teams are widespread in the Netherlands. Despite the presence of a model description and model fidelity scale, it is unclear what FACT workers actually do daily.

Aim: Examination of the daily activities of FACT workers on weekdays in relation to the intended activities from the theoretical FACT framework.

The Importance of Context: An ESM Study in Forensic Psychiatry.

Experience Sampling Method (ESM) is a structured diary technique assessing variations in thoughts, mood, and psychiatric symptoms in everyday life. Research has provided ample evidence for the efficacy of the use of ESM in general psychiatry but its use in forensic psychiatry has been limited. Twenty forensic psychiatric patients participated.

[Mental health in Eastern Lille: a future of network-psychiatry?].

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.

[Flexible assertive community treatment (FACT) as part of a community (health) network].

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.

Digital assessment of working memory and processing speed in everyday life: Feasibility, validation, and lessons-learned.

Objectives: Cognitive functioning is often impaired in mental and neurological conditions and might fluctuate throughout the day. An existing experience-sampling tool was upgraded to assess individual's cognition in everyday life. The objectives were to test the feasibility and validity of two momentary cognition tasks.

[Development of the renewed Flexible ACT scale: F-ACT fidelity 2017].

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.

[Decision aid for the treatment of psychotic illness: development of TReatment E-AssisT (TREAT)].

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.

[Model fidelity of flexible assertive community treatment (F-ACT) teams: five years of audit results].

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.

[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].

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.

[Using resource groups in assertive community treatment; literature review and recommendation].

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.

[Cost-effectiveness in Dutch mental health care: future because of ROM?].

Background: The document reporting Dutch mental health care negotiations for 2014-2017 calls for a cost decrease based on cost-effectiveness. Thanks to ROM, the Dutch mental health care seems well prepared for cost-effectiveness research.

Aim: Evaluate how valid cost-effectiveness research should be established in mental health care and the role of rom therein.

[Consensus regarding the definition of persons with severe mental illness and the number of such persons in the Netherlands].

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.

The use of a Cumulative Needs for Care Monitor for individual treatment v. care as usual for patients diagnosed with severe mental illness, a cost-effectiveness analysis from the health care perspective.

Aims: To study the systematic assessment of need for care and clinical parameters for use in treatment plans in patients diagnosed with severe mental illness.

Methods: The Cumulative Needs for Care Monitor (CNCM) includes various validated instruments, such as the Camberwell Assessment of Need. A Markov-type cost-effectiveness model (health care perspective, 5-year time horizon) was used to compare CNCM with care as usual (CAU).

[Behavioural standard or coercive measure? Some considerations regarding the special issue on ROM].

Background: The cost of mental health care has possibly risen more than costs in other sectors of health care in the Netherlands. In an attempt to control the rising costs, new policies have been implemented that include the introduction of selective financial penalties for those in need of mental health care as well as the start of performance-based mental health care reimbursement. In order to achieve the latter goal, a nation-wide large-scale data collection was introduced based on clinical routine outcome monitoring (ROM) data, with a view to using these data for benchmarking.

Momentary assessment technology as a tool to help patients with depression help themselves.

Objective: Given high relapse rates and residual symptoms in depression, new strategies to increase treatment effectiveness are required. A promising avenue is to investigate how electronic momentary assessment technology may contribute to clinical assessment and interventions in depression.

Method: A literature search was conducted focusing on the potential contribution of momentary assessments to clinical applications in depression.

[Development of a fidelity scale for function assertive community treatment (FACT)].

Background: Assertive community treatment (ACT) is one of the most important models for the care and treatment, in the community, of people with severe mental illness (SMI). ACT is concerned primarily with smi-patients who have the most complex problems and it provides care by means of intensive assertive outreach. Function act (FACT) provides care for the entire group of SMI - patients and combines the principles of case management and ACT.

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.

[A psychosis proneness-persistence-impairment model of psychotic disorders].

There is evidence that the normally transitory developmental expression of psychosis (psychosisproneness) may first of all become abnormally persistent (persistence) and later on become clinically relevant (impairment), depending on the amount of environmental risk to which the person is exposed. According to the psychosis-proneness-persistence impairment model, genetic background factors can impact on a transitory expression of psychosis. Whether or not this will lead to a poor prognosis in terms of persistence and clinical need will depend on the interaction between environmental exposure and genetic risk.

Mechanisms of gene-environment interactions in depression: evidence that genes potentiate multiple sources of adversity.

Background: Previous work suggests that daily life stress-sensitivity may be an intermediary phenotype associated with both genetic risk for depression and developmental stress exposures. In the current analysis we hypothesized that genetic risk for depression and three environmental exposures over the course of development [prenatal stress, childhood adversity and adult negative life events (NLEs)] combine synergistically to produce the phenotype of stress-sensitivity.

Method: Twin pairs (n=279) participated in a momentary assessment study using the Experience Sampling Method (ESM), collecting appraisals of stress and negative affect (NA) in the flow of daily life.