A national survey of assertive community treatment services in England

Abstract

Background: Assertive community treatment (ACT) teams have been implemented across England since 1999. Although successful at engaging clients, the model has failed to show the same clinical effectiveness in trials in Europe as in the US and Australia.

Aim: To investigate current ACT provision in England, aims of treatment and team managers' views of the effectiveness of ACT and the most important interventions.

Method: Postal survey of managers of all services in England identifying as ACT teams.

Results: A total of 104/187 (56%) completed questionnaires were received. The majority of teams were in urban or mixed urban/rural areas. One third (36%) of teams had no psychiatrist, one half (48%) had no psychologist and less than a fifth (18%) had designated inpatient admission beds. The areas of intervention rated as most important by team managers could be delivered by non-professionally trained staff (engagement, accommodation, finances). The majority of managers reported positive clinical outcomes but only one third had collected data to support this. One third of teams were undergoing review or being reconfigured or closed.

Conclusion: Successful client engagement is not being used as a vehicle to deliver evidence-based interventions. Many ACTs in England are not adequately staffed to deliver these.

Keywords:

• Assertive Community
• survey
• severe mental illness
• team managers
• service provision

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.