What is the future of assertive community treatment?

Although the trend towards community care for psychiatric patients has been apparent now for over fifty years, we still do not have a satisfactory model of community care that all can aim for as the target to be achieved. To an outsider this may seem curious. It seems fairly obvious that hospitals are necessary for patients when they are severely ill, that good care given outside hospital when patients have made some improvement is better than continued hospital treatment, and that the more resources there are available in the community to treat patients early in the course of illness or at times of relapse, the better the service. When one learns that by far the largest proportion of costs spent on the treatment of mental illness is concerned with in-patient treatment (around 85% in most countries) (Knapp et al., 1994), it is also easy to see why such a policy is attractive to planners and managers of mental health services as well as governments who have to foot the bills.