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Assertive community treatment

Department Psychiatry, University of Wisconsin, 6001 Research Park Blvd, Madison, Wisconsin 53719 USA

Ronald J. Diamond

Department of Psychiatry, University of Wisconsin

Alan Rosen

Royal North Shore Hospital and Community Mental Health Services, Department of Psychological Medicine, University of Sydney, Sydney, Australia

We are grateful to T. Burns and J Catty for calling attention to the importance of ‘Defining the comparator and identifying active ingredients’ of the conditions being studied (Psychiatric Bulletin, September 2002, 26, 324-327). We agree on the importance of the accurate use of the terms used to describe treatment models when making comparisons. We applaud their call to be more rigorous in this regard and want to point out an example of how difficult this seems to be. In their paper, they assert that the impressive advantages of assertive community treatment (ACT) reported in earlier studies are not being repeated in later studies. To support their assertion, they then reference two UK studies (Thornicroft et al, 1998, UK 700 group, 1999). Unfortunately neither of these are studies of ACT.

This error is particularly egregious because it has been pointed out previously in the literature that these are not studies of ACT (Marshall et al, 2000; Rosen & Teesson, 2001). It is clearly misleading to label these as ACT studies, and yet they continue to perpetuate this misrepresentation. By mis-labelling studies as ACT, even though clear criteria have been developed to identify and measure ACT's essential elements (Teague et al, 1998), the authors demonstrate that it is difficult for them to practise what they so rightly preach. As they point out, these kinds of errors cloud rather than clarify our understanding of the role various models could play in a system of care.

References

MARSHALL, M., BOND, G., STEIN, L. I., et al (1999) PRiSM Psychosis Study. Design limitations, questionable conclusions. British Journal of Psychiatry, 175, 501-503.[Free Full Text]

ROSEN, A. & TEESSON, M. Does case management work? The evidence and the abuse of evidence based medicine. Australian and New Zealand Journal of Psychiatry, 35, 731-746.

TEAGUE, G. B., BOND, G. R. & DRAKE, R. E. (1998) Program fidelity in assertive community treatment. American Journal of Orthopsychiatry, 68, 216-232.[Medline]

THORNICROFT, G., WYKES, T., HOLLOWAY, F., et al (1998) From efficacy to effectiveness in community mental health services. PRiSM psychosis study, 10. British Journal of Psychiatry, 173, 423-427.[Abstract/Free Full Text]

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Stein, L. I. Articles by Rosen, A. Search for Related Content PubMed Articles by Stein, L. I. Articles by Rosen, A.