Hospitalisation as the Commonoutcome Measure

Declaration of interest T.B. has receivedpayments for lectures and consultancies from Eli Lilly,Janssen and Otsuka inthe past 5 years. The past 25 years have witnessed an explosion in mental health services research. A 1980 review of research in community mental health services (Braun et al, 1981) cited a dozen studies and concluded that there was little evidence that the newer services sustained people longer outside hospitals. Stein & Test’s landmark study of assertive community treatment (ACT) was particularly influential because not only did it demonstrate reduced hospitalisation along with improved clinical outcomes (Stein & Test, 1980), but the accompanying paper indicated that it could achieve this without increased costs (Weisbrod et al, 1980). Not surprisingly these two findings stimulated an enormous interest in developing and evaluating such programmes. When Mueser et al (1998) reviewed the area they were able to cite 75 good-quality studies, and when Catty et al (2002) did the same 4 years later they had over 90 studies to draw on. The vast majority of these studies focused on those with severe mental illness and invariably the samples consisted mainly of people with schizophrenia – over 80% in the UK700 trial and the Department of Veterans Affairs study (Burns et al, 1999; Rosenheck et al, 1995).