Chapter 6. Community Mental Health Care: Promises and Pitfalls

  1. Norman Sartorius3,
  2. Wolfgang Gaebel4,
  3. Juan José López-Ibor5 and
  4. Mario Maj6
  1. Paul Bebbington1,
  2. Sonia Johnson1 and
  3. Graham Thornicroft2

Published Online: 29 APR 2002

DOI: 10.1002/0470846488.ch6

Psychiatry in Society

Psychiatry in Society

How to Cite

Bebbington, P., Johnson, S. and Thornicroft, G. (2002) Community Mental Health Care: Promises and Pitfalls, in Psychiatry in Society (eds N. Sartorius, W. Gaebel, J. J. López-Ibor and M. Maj), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846488.ch6

Editor Information

  1. 3

    University of Geneva, Switzerland

  2. 4

    University of Düsseldorf, Germany

  3. 5

    Complutense University of Madrid, Spain

  4. 6

    University of Naples, Italy

Author Information

  1. 1

    Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, UCL (University College London), London, UK

  2. 2

    Health Services Research, The David Goldberg Centre Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK

Publication History

  1. Published Online: 29 APR 2002
  2. Published Print: 30 APR 2002

ISBN Information

Print ISBN: 9780471496823

Online ISBN: 9780470846483



  • community care;
  • severe mental illness;
  • service models;
  • assertive community treatments;
  • crisis resolution;
  • psychiatric treatments;
  • dual diagnosis;
  • first episodes


In the last fifty years, the organization of community-based psychiatric services has become increasingly complex and sophisticated in most developed countries. Questions remain about the most effective deployment of services and treatments. The failing that resulted from unthinking policies of decarceration from the large old mental hospitals led to the development of community mental health teams. There is some empirical support for the benefits of these teams, particularly in terms of patient satisfaction, and they provide flexibility and continuity of care. Variations on the basic model include assertive community treatment for difficult-to-engage patients with longstanding disorders who are difficult to engage, and crisis resolution teams able to respond flexibly and intensively to people with acute problems. The evidence for these is reviewed: it remains unclear whether they offer significant advantages over well-resourced generic mental health teams. The debate is not helped by semantic disputes.

Services are mechanisms for delivering treatment and care. We review the evidence for treatments that might be particularly relevant for the maintenance of community tenure. There is little evidence for the effectiveness of social skills training and cognitive remediation, while family interventions and cognitive behaviour therapy seem more hopeful treatments that might be deployed more widely in a community context. Other complex problems may require specific service models. Services for patients with dual diagnoses, and for those early in the course of psychotic disorders are described, and the limited evidence for their effectiveness reviewed. Finally, the potential role of primary care in supporting people with severe psychiatric disorders is outlined.