Assertive community treatment

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.