HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS Psychiatric Bulletin Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Tyrer, P. Articles by Joseph, P. Search for Related Content PubMed PubMed Citation Articles by Tyrer, P. Articles by Joseph, P.

A defence of community mental health teams

Imperial College School of Medicine, Paterson Centre, 20 South Wharf Road, London W2 IPD, UK

S. Simmonds

Department of Public Health, BKCW Health Authority, London, UK

J. Coid

Forensic Psychiatry Research Unit, St Bartholomew's Hospital, London, UK

S. Mariott and P. Joseph

Paterson Centre, London, UK

EDITED BY MATTHEW HOTOPF

Dr Holloway's (2001) stimulating, if ever so slightly mischievous, commentary on our paper (Simmonds et al, 2001) adds substance to the debate on this subject but leaves the reader with the unfair impression that community mental health teams are now out of date and have been replaced by ‘more exotic fruit’. Indeed, our labours have borne much more fruit than we expected, as Dr Holloway identifies our study as a mélange from a variety of species. We accept that the studies in our review showed great heterogeneity of service provision but all possessed the key central feature in the experimental group, a team-based community service. The fact that we were able to identify only five studies that satisfied the criteria for such a comparison, despite the widespread use of such teams, illustrates the consequences of deciding on policy in the absence of evidence. Once this is done, the subject cannot be researched through adequate randomised studies since policy makes the interventions statutory. Dr Holloway is right in concluding that community mental health teams have become the focus of mental health care in the UK and, although they are now universal here, it is still possible to carry out further randomised controlled trials elsewhere. We are in the process of developing similar studies in Eastern Europe, which should help to provide a stronger evidence base for our conclusions if they replicate the findings in the five studies we reported.

What would be most unfortunate at this stage of development of a community mental health team would be to move on to a new model based on the North Birmingham approach (Peck, 1999) without further evidence. The North Birmingham model has not been tested by any form of controlled comparison and there is now a strong body of evidence, to which Dr Holloway himself is a major contributor (Holloway & Carson, 1998; Burns, 2000; Tyrer, 2000), which shows the standard community mental health team to be a robust and effective service model that is at least as effective as the new specialist approaches.

To return to the fruit metaphor, our review, and the work of others, seems to have established firmly that apples, grapes and oranges are good for your health when compared with other non-fruit diets. Recently, mangos, paw-paws and persimmons, have also been introduced and have attracted considerable numbers of devotees. To date, these exotic fruits have not proved in any way to be superior in their health-giving properties than the older fruits; until they do so we should not change our fruit policy. So we should stick with the community mental health team. James Lind, the originator of the first ever controlled trial — of citrus fruit juice for scurvy — would not have expected anything less.

REFERENCES

Burns, T. (2000) Models of community treatment in schizophrenia; do they travel? Acta Psychiatrica Scandinavica, 102 (suppl. 402), 11-14.[CrossRef]

Holloway, F. (2001) Invited commentary on: Community mental health team management in severe mental illness. British Journal of Psychiatry, 178, 503-509[Free Full Text]

Holloway, F. & Carson, J. (1998) Intensive case management for the severely mentally ill. Controlled trial. British Journal of Psychiatry, 172, 19-22.[Abstract/Free Full Text]

Peck, E. (1999) Introduction to special section on community mental health teams. Journal of Mental Health, 8, 215-216.

Simmonds, S., Coid, J., Joseph, P., et al (2001) Community mental health team management in severe mental illness: a systematic review. British Journal of Psychiatry, 178, 497-502.[Abstract/Free Full Text]

Tyrer, P. (2000) The future of the community mental health team. International Review of Psychiatry, 12, 219-225.

This Article Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Tyrer, P. Articles by Joseph, P. Search for Related Content PubMed PubMed Citation Articles by Tyrer, P. Articles by Joseph, P.