remmers van veldhuizen2019-12-02T12:27:09+00:00



This website  informs on Flexible Assertive Community Treatment or Flexible ACT (FACT).

Flexible ACT is a Dutch version of outreaching community care for persons with severe mental illness (SMI). FACT is also being adopted in many other countries. In Norway, Sweden, Denmark, Belgium, The Czech Republic, UK, Canada and Australia teams have been started.

As an introduction to the model we provide the MANUAL FLEXIBLE ASSERTIVE COMMUNITY TREATMENT (DOI: 10.13140/RG.2.1.3925.1683).  

The Manual Flexible ACT was published in 2013 by J.R. van Veldhuizen & M. Bähler and is on this website available in different languages.



Deze website informeert internationale lezers over “Flexible Assertive Community Treatment”, ook bekend als FLEXBLE ACT of FACT. FACT is een Nederlands model voor intensieve ambulante behandeling en zorg aan cliënten met ernstige psychiatrische aandoeningen (EPA).

Het Engelstalige “MANUAL ASSERTIVE COMMUNITY TREATMENT “, gepubliceerd in 2013 door J.R. van Veldhuizen en M. Bähler. De officiële verwijzing is: ”  DOI: 10.13140/RG.2.1.3925.1683″ .

Dit manual kan hier zonder kosten  worden gedownload. Inmiddels zijn ook een Chinese, Duitse, Franse, Noorse, Roemeense, Tsjechische en Zweedse vertaling beschikbaar. Toestemming tot vertaling  wordt gegeven onder strikte condities.

Van dit Manual bestaat geen Nederlandse vertaling. Voor Nederlandse teksten wordt verwezen naar het Handboek (Flexible) ACT , Redactie: van Veldhuizen, Polhuis, Bahler, Kroon en Mulder (2015, De Tijdstroom) en voor kortere versie naar het “Zakboek Flexible ACT”  van Veldhuizen (2016, De Tijdstroom). Daarnaast vindt u op deze website actuele Nederlandse en internationale informatie.


Flexible ACT or FACT model

The model is a Dutch version of ACT. ACT (Assertive Community Treatment) was developed in the USA by Stein & Test for the most disabled 20% of the group of SMI, at risk for readmission to the psychiatric hospital. It is a well-researched evidence based intervention.

On average, a multidisciplinary Flexible ACT team of 11–12 FTE monitors 200 clients. The target group is the broad group of all individuals with SMI in a catchment area: both the 20% for whom ACT is indicated and the other 80% of the group, who need at a certain moment less intensive treatment and support. To combine care for these two groups, the FACT team employs a flexible switching system. The group requiring the most intensive care is discussed daily and for this group the team adopts a shared caseload approach. The names of these clients are listed on the digital FACT board. For the clients requiring less intensive care, the same team provides individual case management with multidisciplinary treatment and support. When clients become more stable, they do not have to be transferred (as in ACT, through ‘graduation’) to a different team; they stay with the same FACT team. This flexibility to switch between the two modes of service delivery in the same team enhances continuity of care and reduces drop-out.

In the Netherlands already more than 400 teams started with this model and a further growth of the number of teams to 600-700 on a population of 17 Million, is foreseen.

Together with FACT we introduced also a certifying body: CCAF. More than 400 audits have been completed the last 10 year, see CCAF.NL.

The first English article on FACT was published in 2007, and can be downloaded; click here: van Veldhuizen JR, FACT: A Dutch Version of ACT’ (2007), Community Mental Health Journal vol. 43(4) 421-433.


The Manual Flexible ACT was published in 2013 by J.R. van Veldhuizen & M. Bähler
(DOI: 10.13140/RG.2.1.3925.1683). The Manual is free downloadable in the following languages:

All translations have to be granted by J.R. (Remmers) van Veldhuizen  (as first author and intellectual owner of “FACT” / “Flexible ACT”) under the following standard conditions, which can be downloaded here


  • Veldhuizen, J. R. van, (2007). FACT: A Dutch Version of ACT, Community Mental Health Journal, (43), 4, 421-433
  • Firn, M.,K.Hindhaugh, D.Hubbeling, G. Davies, B.Jones, S.J. White (2012). A dismantling study of assertive outreach services: comparing activity and outcomes following replacement with the FACT model. Soc. Psychiatry Psychiatric Epidemiology 2012 Springer.
  • Veldhuizen, J.R. van & M. Bähler (2013), Manual Flexible Assertive Community Treatment , FACT manual, [DOI: 10.13140/REG.2.1.3925.1683], www.
  • Veldhuizen, J.R. van, Ph. Delespaul, H.Kroon and N. Mulder; 2015, FlexibleACT & Resource-group ACT: Different Working Procedures Which Can Supplement and Strengthen Each Other. A Response. Clinical Practice & Epidemiology in Mental Health, 2015,11, 00-00
  • Nugter,A. F.Engelsbel, M.Bahler, R.Keet, R. van Veldhuizen (2015). Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: a Prospective Real Life Study. Community Ment Health J.,DOI 10.1007/s10597-015-9831-2.


  • Veldhuizen, J.R. van (1986). Het Bed op Recept, GGZ-Gazet, 4, pag.16.
  • Veldhuizen, J.R. van, D. Wiersma & L.M. Ram (1988). Opname Vervangende Dag Behandeling in ontwikkeling. Maandblad geestelijke Volksgezondheid, 1, p.3-18.
  • Veldhuizen, J.R. van (1998). Zorgverlamming. MGV, 53 (12), p.1175 – 1186.
  • Veldhuizen, J.R. van en A. Snijdewind (red).(2006). Almaar Ambulanter , uitg. Mension
  • Veldhuizen, J.R. van, M. Bähler & W.Teer (2006). Fact: de ‘Functie ACT’. Maandblad Geestelijke Volksgezondheid, 61 (6), p.525-534.
  • Veldhuizen, J. R. van, M. Bähler, D. Polhuis en J. van Os (red.) (2008). Handboek FACT, De Tijdstroom Utrecht.
  • Veldhuizen, J.R. van (2015), D. Polhuis, M. Bähler, H. Kroon, N. Mulder (red.) Handboek (Flexible) ACT, de Tijdstroom, Utrecht
  • Regionale Expert Teams (2015) FACT sheet voor optimale FACT-zorg volgens cliënten. Zorgbelang Nederland.
  • Veldhuizen, J.R. van (2016), Zakboek Flexible ACT, de Tijdstroom, Utrecht.


  • J. R. (Remmers) van Veldhuizen (psychiatrist) started FACT in Holland.
  • 1978 Psychiatrist
  • 1985 -1990 : Working with Partial Hospitalization
  • 1990- 1999 : Inspector for Mental Health Care in the Netherlands.
  • 1999 – 2012: Director for Innovation of Care at GGZ Noord Holland Noord
  • 2000- now: promoting new Mental Health ACT (community treatment orders etc)
  • 2003: Co-founder of the FACT model in GGZ NHN
  • 2008: Co-Founder of the CCAF// 1st author of Handbook FACT
  • 2010: Officer in the Dutch Royal Order of Oranje Nassau
  • 2015: F-ACTNederland decides to install the yearly “Remmers van Veldhuizen Lecture”
  • 2016: Honorary Member of the Board of CCAF (Certification Centre for ACT and FACT) Actual Activities
  • Senior Auditor CCAF
  • International Senior Advisor in implementation of FACT and ‘transmural’ care systems
  • Lecturing, Training, Coaching in Mental Health Care
Portret photo of Remmers van Veldhuizen author of the Flexible Assertive Community Treatment Manual


Naast activiteiten rond Flexible ACT ben ik beschikbaar voor advisering, lezingen, training en coaching, werkend vanuit 40 jaar ervaring met professionele en bestuurlijke ontwikkelingen in de sociale psychiatrie en ambulantisering.


Italian version of FACT

INFORM THE NETWORK about the Italian version of FACT We are very proud to be able to disseminate the Italian version of the FACT. This manual might be of interest to most Italian professionals. It has been translated from the original Dutch version taking into account all the specificity of that original version and also adapting the text for the Italian community mental health services. As you might know the FACT manual has been already developed in nine different languages, English, French, Norwegian, Romanian, Swedish, German, Chinese, Czech, and is available as free download from the website of the FACT We will also upload the manual on other websites of associations and institutional bodies that might be interested in developing this kind of rehabilitative model. We hope that the Italian version of the manual will make the FACT approach accessible for Italian colleagues and will be of inspiration for everyday practices. Remmers van Veldhuizen, Alessandra Martinelli, Mirella Ruggeri en Fabrizio Starace Italiaanse versie van MANUAL FACT gereed In meerdere Italiaanse centra, zoals o.a. Verona en Triest bestaat interesse in het Flexible ACT model zoals beschreven in het FACT Manual. Men ziet belangwekkende overeenkomsten tussen het FACT model en Italiaanse [...]

By |december 2nd, 2019|Categories: FACT-FACTS|0 Comments


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