Two big ideas have dominated reform in mental health care in recent years and underpin the widespread enhancement of services that is being attempted in England. These are that people with mental disorders should have treatment in the community, and that young people with early psychosis should receive timely and comprehensive intervention during the critical years following onset. Two large, high quality studies in this issue report much needed evidence on the impact and feasibility of these drivers for reform.1 2 Both studies are large and well designed and report positive results in support of the present reforms.

Johnson and colleagues (p 599) show elegantly that providing, in a disadvantaged inner city community, intensive treatment at home for acutely ill people with severe mental disorder substantially reduces the use of inpatient care.1 The number needed to treat attests to …