The article by Rosen et al ^{Reference Rosen, Killaspy and Harvey1} is a thought-provoking piece on the perception of the effectiveness of assertive community treatment in Europe. I write as a psychiatrist who has worked within assertive community teams (ACTs) on both sides of the Atlantic (the UK and Canada). Although the economic downturn and cutbacks are equally shared in both UK and Canadian health systems, the investment in specialist mental health programmes including ACT continues to gather pace in Canada due to the robust and demonstrable effectiveness of the teams. In Canada, there is a stronger fidelity to the original ACT model and a shift from the paternalistic to a more collaborative relationship with patients. There is greater emphasis on relationship building through varieties of psychosocial strategies, easier access to specialist and subsidised housing facilities and vocational opportunities.

The ACT service delivery in Canada is a true representation of the standard originally described in 1973 after 20 years of field testing in the USA. ^{Reference Marx, Test and Stein2} It includes peer support workers who have life experience and can provide expertise that professional training cannot replicate. The peer support workers are fully integrated team members functioning in the team's generalist role. There is a 24-hour on-call service and treatment intervention is intensive with two or three face-to-face visits daily.

Undoubtedly, ACT is a clinically effective approach to managing the care of severely mentally ill people in the community. If aimed at the right patient population and when the model of care is fully adhered to, ACT can substantially reduce the costs of hospital care while improving the outcome and patient satisfaction. ^{Reference Test and Stein3}