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Chapter 19 Assertive outreach, crisis resolution and intensive home treatment teams, and early intervention services

• Assertive outreach [link]
• Crisis resolution and intensive home treatment teams [link]
• Early intervention services [link]

• • The specialist psychiatric services described in this chapter represent developments which, in the UK, have supplemented community mental health teams, which themselves followed the move to more community-based mental health services from the old asylums. They are sometimes referred to as Modernization Teams, as described in the UK Department of Health Mental Health Policy Implementation Guide of 2001. Although the new services are clearly defined in this document, there is much variation in terminology and practice.
• • In the USA assertive outreach is referred to as assertive community treatment (ACT). Such services of high standard in the USA are sometimes referred to as Programme for ACT (PACT).
• • In Europe services that followed this model but often lacked features of its structure, such as shared caseloads and extended hours, are referred to as Intensive Case Management Teams. In the USA, the work of The Department of Veterans' Affairs ACT teams are also called Intensive Psychiatric Community Care.
• • ACT crossed the Atlantic to the UK following demonstrated effectiveness in early studies. The original model programme was a community follow-up service which attempted to sustain life outside hospital through skills training and was referred to as Training in Community Living. The effect of training, however, was demonstrated to wear off.
• • A classic randomized control trial ¹ showed that a community follow-up service reduced hospitalization, symptomatology, and improved social outcomes, including social stability and housing.

1. 1 Stein LI, Test MA (1980). Alternative to mental hospital treatment, 1. Conceptual model, treatment progress and clinical evaluations. Archives of General Psychiatry 37: 392–7.[Abstract]