Developing mental health services in response to research evidence.
Over the last thirty to forty years, psychiatric care in England has relocated from hospital-based settings to community mental health teams (CMHTs) and supported accommodation. Since the 1980s, two forms of intensive home based treatment have evolved in addition to CMHTS, assertive community treatment (ACT) and crisis resolution teams (CRTs). On the basis of evidence for their efficacy in the US and other countries, they have been implemented across England through the Government's National Service Framework for Mental Health. This paper describes this evidence and the first UK studies that were carried out to evaluate these newly implemented services.


METHODS
Descriptions of the evaluations of ACT and CRTs in the inner London boroughs of Camden and Islington.


RESULTS
The implementation of CRTs in North London were associated with reduced use of inpatient services, but the ACT teams were not. Both types of team were associated with greater patient satisfaction with services and the ACTs were better able to engage patients than CMHTs.


CONCLUSIONS
The authors comment on the implications of the findings for service planners in terms of the difficulties in implementing innovative approaches based on the best available evidence when it originates outside the local context.
Killaspy
Helen
H
UCL, Department of Mental Health Sciences, 67-73 Riding House Street, 2nd Floor, Charles Bell House, London WIW 7EJ, United Kingdom. h.killaspy@medsch.ucl.ac.uk
Johnson
Sonia
S
King
Michael
M
Bebbington
Paul
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D035843:Biomedical Research; D003419:Crisis Intervention; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged