The future of specialist community teams in the care of those with severe mental illness.

AIMS: Specialist interventions in community psychiatry for severe mental illness are expanding and their place needs to be re-examined.

METHODS: Recent literature is reviewed to evaluate the advantages and disadvantages of specialist teams.

RESULTS: Good community mental health services reduce drop out from care, prevent suicide and unnatural deaths, and reduce admission to hospital. Most of these features have been also demonstrated by assertive community outreach and crisis resolution teams when good community services are not available. In well established community services assertive community teams do not reduce admission but both practitioners and patients prefer this service to other approaches and it leads to better engagement. Crisis resolution teams appear to be more successful than assertive community teams in preventing admission to hospital, although head-to-head comparisons have not yet been made. All specialist teams have the potential of fragmenting services and thereby reducing continuity of care.

CONCLUSIONS: The assets of improved engagement and greater satisfaction with assertive, crisis resolution and home treatment teams are clear from recent evidence, but to improve integration of services they are probably best incorporated into community mental health services rather than standing alone.