Community based care is superior to conventional care

EDITOR—Tyrer et al's conclusion that aftercare for psychiatric patients with severe mental illness by community teams has a similar outcome to that by hospitals is surprising until one appreciates the rudimentary form of community intervention that they used in the study.1The two methods of follow up they compared seem to have many similarities, except that the community follow up was provided by a team based outside the hospital. This is not really community treatment—two styles of intervention were compared that were not distinct in terms of the care and treatment given to the patients. This may be why Tyrer et al found no substantial difference in outcome between the two approaches. Tyrer himself has recently described this kind of community treatment as profligate and little short of disastrous.2

Community based care is superior to conventional care in cost benefit terms if the treatment is similar to assertive community treatment.34Tyrer et al, however, analysed a type of community treatment that …