Specialisation and marginalisation: how the assertive community treatment debate affects individuals with complex mental health needs

Abstract

was established in England, The Lancet published an article entitled 'Clinical specialism', 1 which explored the tensions between medical generalists and specialists. It suggested that specialisation evolved as an appropriate consequence of 'the growth of knowledge and the mastery of technique', but warned of its potential to limit the cross-fertilisation of ideas and collaborative working, and to generate areas of expertise that were more focused on the self-serving needs of the clinician than on the needs of patients. It advocated more specialised services where needed, with a better balance between generalised and specialised services, while fostering collegial, congenial and collaborative relations between them all. The article probably reflected widely held anxieties about the consequences of the radical reorganisation of health services in the UK at the time and the shift from a private to a publicly funded system. In the current international context of economic turbulence, where health priorities compete for investment within different public/private funding systems, the generalist v. specialist debate remains highly topical.

Advance care planning and palliative medicine in advanced dementia: a literature review

“…In the USA it is associated with improved outcomes and cost-effectiveness; however, these findings have not been replicated in Europe because of differences in the way services are organised. 2 …”

The replacement of assertive outreach services by reinforcing local community teams: a four-year observational study

“…Heated debate and interpretation of these findings continue, both from ardent proponents of the AO model (Rosen et al, 2013) and those calling for the integration of multiple specialisms (Tyrer, 2013). In the meantime, financially stretched providers have gradually and quietly closed AO services over the last eight years.…”

Flexible assertive community treatment (FACT) model in specialist psychosis teams: An evaluation

“…Recent years have seen a widespread disinvestment from assertive community treatment (ACT), with many teams being merged into generic community mental health teams (CMHTs). 1 , 2 Such changes have been criticised for moving away from evidence-based systems, instead adopting untested models of service delivery, with poorer quality care, described in a King's Fund report as ‘a leap in the dark’. 3 In some cases new services have adopted a flexible ACT (FACT) model, with people able to access intensive support delivered in the community using a team case-load and ACT principles, as and when they require it.…”