The HCOL Compass: Preliminary Development and Evaluation of a Systems-Oriented Leadership Tool for Organizational Learning in Small-to-Medium Healthcare Organizations.

Severe mental illness (SMI) encompasses serious, persistent, and often long-term psychiatric conditions with a profound impact on individual functioning, including schizoaffective disorders, major depressive disorder with psychotic features, certain highly disabling personality disorders, and schizophrenia, which affects approximately one in every 200 adults (National Institute of Mental Health [NIMH], ; World Health Organization [WHO], , ). Although SMI is frequently operationalized using diagnosis-based criteria, contemporary frameworks also emphasize the role of functional impairment, disability, and service needs, which may vary across settings and health care systems (Pina et al., ). SMI has been identified as one of the leading causes of disability worldwide (WHO, , c). Individuals living with SMI have a life expectancy that is 10 to 20 years shorter than that of the general population, primarily due to untreated physical comorbidities and barriers in accessing health care services (WHO, ). From an economic perspective, its burden is substantial, driven by indirect costs related to productivity loss, health care expenditures, and social security (WHO, c; OECD & European Union, ). Importantly, recovery-oriented approaches recognize that people living with SMI can pursue and achieve meaningful recovery, autonomy, and social participation, and recommend avoiding language that implies hopelessness or permanence (Mental Health Coordinating Council, ; Psychiatric Rehabilitation Association [PRA], ). This scenario highlights the urgent need for effective interventions that not only reduce healthcare system costs but also promote psychosocial recovery and community integration among patients (WHO, c). Assertive Community Treatment (ACT), developed as the Program of Assertive Community Treatment (PACT), is an intensive, team-based community mental health model intended to support people with SMI in living in the community as an alternative to long-term inpatient treatment. (Marx et al., ; Stein & Test, ). Over time, ACT evolved from primarily facilitating community living following deinstitutionalization to sustaining community tenure by preventing avoidable hospitalizations, ensuring continuity of support, and advancing recovery-oriented goals (Stein & Test, ). This model is characterized by intensive, community-based services delivered by multidisciplinary teams with shared caseload responsibility, low staff-to-patient ratios, assertive outreach and in vivo service delivery, frequent high-intensity contacts, continuity of care, and 24/7 crisis availability, providing proactive, flexible, and individualized treatment, support, and rehabilitation tailored to each patient’s needs (Marx et al., ; Stein & Test, ).