Epidemiology and Psychiatric Sciences

Original Articles

A comparison of the implementation of Assertive Community Treatment in Melbourne, Australia and London, England

C. Harveya1 c1, H. Killaspya2, S. Martinoa3, S. Whitea4, S. Priebea5, C. Wrighta6 and S. Johnsona2

a1 Department of Psychiatry, The University of Melbourne and North Western Mental Health, Melbourne, Australia

a2 University College London and Camden and Islington NHS Foundation Trust, London, UK

a3 South West Area Mental Health Service, Melbourne, Australia

a4 Division of Mental Health, St George's University of London, London, UK

a5 Barts and The London School of Medicine, London, UK

a6 Division of Mental Health, St George's University of London and South West London and St George's NHS Mental Health Trust, London, UK


Aims. The efficacy of Assertive Community Treatment (ACT) is well established in the USA, and to a lesser extent in Australia, whereas UK studies suggest little advantage for ACT over usual care. Implementation of ACT varies and these differences may explain variability in reported efficacy. We aimed to investigate differences in ACT implementation between Melbourne, Australia and London, UK.

Methods. In a cross-sectional survey, we investigated team organisation, staff and client characteristics from four Melbourne ACT teams using almost identical methods to the Pan London Assertive Outreach studies of 24 ACT teams.

Results. Client characteristics, staff satisfaction and burnout were very similar. Three of four Melbourne teams made over 70% of client contacts ‘in vivo’ compared to only one-third of comparable London teams, although all teams were rated as ‘ACT-like’. Melbourne teams scored more highly on team approach. Three quarters of clients were admitted in the preceding 2 years but Melbourne clients had shorter stays.

Conclusions. Differences in the implementation of ‘active components’ of home treatment models that have been associated with better client outcomes (home visiting, team approach) may explain international differences in ACT efficacy. Existing fidelity measures may not adequately weight these important elements of the model.

(Received November 27 2009)

(Revised June 20 2010)

(Accepted July 23 2010)

(Online publication March 18 2011)


c1 Address for correspondence: Dr Carol Harvey, Associate Professor in Psychiatry, Department of Psychiatry, University of Melbourne, Psychosocial Research Centre, 130 Bell St, Coburg, Victoria 3058, Australia. (Email: c.harvey@unimelb.edu.au)