The excellent editorial by Rosen et al ^{Reference Rosen, Killaspy and Harvey1} highlights the dilution of assertive community treatment (ACT) research in European settings, leading to a failure to demonstrate reductions in bed use in efficacy studies. Effectiveness studies in the UK have shown that ACT leads to reductions in bed use. ^{Reference Mortimer, Shepherd, Fadahunsi, Jones, Kumar and Gangaram2,Reference Rana and Commander3} Furthermore, our experience of 93 patients followed up for a mean of 6.5 years after starting ACTshowed a reduction from a mean of 72 days per year prior to ACT to 44 days per year during ACT (P=0.002). Repeated measures using the Dartmouth Assertive Outreach Fidelity Scale ^{Reference Teague, Bond and Drake4} demonstrated the team had high fidelity to the assertive outreach model.

The evidence supports the importance of trying to incorporate the effective components of ACT into new services. Despite these benefits, ACT teams continue to be dismantled.