Assertive community treatment - is it the future of community care in the UK?

Assertive community treatment (ACT) is a highly specified, team-based approach to caring for people with severe mental illness in the community. It was originally developed in the US, but is becoming increasingly popular in other countries. Systematic reviews have shown that there is substantial evidence to support the use of ACT for maintaining unstable long-term patients in the community. ACT may be distinguished from less carefully specified varieties of case management (intensive or otherwise), which have failed to deliver any consistent improvements in clinical or social outcome or costs. The failure of case management is particularly clear in research from the UK where six randomized controlled trials have not shown any substantial clinical or social improvements and where the introduction of universal case management for mentally ill people has failed to stem rising admission rates. The failure of case management in the UK is an interesting example of the difficulties that arise when countries attempt to learn new health care practices from abroad. It is proposed that case management in the UK failed because it was practiced in a way that was insufficiently faithful to the principles of ACT.