Question: In difficult to engage service users in a community setting (street homeless, hostel dwellers, drug/alcohol/substance misusers, those recently discharged from prison), how effective (and cost effective) is assertive community treatment / assertive outreach, compared to any other community treatment, in terms of reducing homelessness, reducing substance misuse, and improving engagement and retention in services?

Answer:

Limited UK based evidence suggests that outcomes for patients with serious mental illness were similar for community mental health teams and ACT teams, but ACT may be better at engaging clients and may lead to greater satisfaction with similar costs of the two treatments. Based on studies conducted among homeless people in the US, ACT appears beneficial on a number of outcomes. However, it is unclear whether these results are generalizable to a UK setting. All included studies had methodological weaknesses and so these results should be interpreted with some caution. There is a need for further UK based studies to evaluate the effectiveness of ACT in this setting.