The REACT study: randomised evaluation of assertive community treatment in north London.
OBJECTIVE
To compare outcomes of care from assertive community treatment teams with care by community mental health teams for people with serious mental illnesses.


METHODS
Non-blind randomised controlled trial.


METHODS
Two inner London boroughs.


METHODS
251 men and women under the care of adult secondary mental health services with recent high use of inpatient care and difficulties engaging with community services.


METHODS
Treatment from assertive community treatment team (127 participants) or continuation of care from community mental health team (124 participants).


METHODS
Primary outcome was inpatient bed use 18 months after randomisation. Secondary outcomes included symptoms, social function, client satisfaction, and engagement with services.


RESULTS
No significant differences were found in inpatient bed use (median difference 1, 95% confidence interval -16 to 38) or in clinical or social outcomes for the two treatment groups. Clients who received care from the assertive community treatment team seemed better engaged (adapted homeless engagement acceptance schedule: difference in means 1.1, 1.0 to 1.9), and those who agreed to be interviewed were more satisfied with services (adapted client satisfaction questionnaire: difference in means 7.14, 0.9 to 13.4).


CONCLUSIONS
Community mental health teams are able to support people with serious mental illnesses as effectively as assertive community treatment teams, but assertive community treatment may be better at engaging clients and may lead to greater satisfaction with services.
Killaspy
Helen
H
Department of Mental Health Sciences, University College London, London NW3 2PF. h.killaspy@medsch.ucl.ac.uk
Bebbington
Paul
P
Blizard
Robert
R
Johnson
Sonia
S
Nolan
Fiona
F
Pilling
Stephen
S
King
Michael
M
D000328:Adult; D001242:Assertiveness; D001521:Behavior Therapy / Q000379:methods*; D003156:Community Mental Health Services; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D017060:Patient Satisfaction; D016896:Treatment Outcome