Intended for healthcare professionals

Head To Head

Should youth mental health become a specialty in its own right? Yes

BMJ 2009; 339 doi: (Published 26 August 2009) Cite this as: BMJ 2009;339:b3373

Fragment the Fragmented

In general adult psychosis, three teams have already been created,
namely ACT (assertive community team), EIT (early intervention team) and
CR/HT (crisis resolution and home treatment team). All these teams have
been created by taking up human resources (especially experienced team
members) from the existing CMHT (community mental health teams).

The ACT study [1] which is the follow up of the 2006 REACT study the
authors did not find convincing results except for patient satisfaction.
Similar findings were found by the study by Burns et al [2].

Not going into the specifics of the other two teams, EIT and CR/HT
and quoting articles published to that effect, there are equivocal
findings recorded both by the researchers, the clinical teams and possibly
the patient and their carers (for example the revolving door patients seen
earlier by the inpatient teams are now seen by these teams and the
outcomes are the same whether seen by these specialist teams or the CMHT).

These three studies have important implications to the policy makers
and this is what the authors of the ACT study also recommend.

What patients (chronic patients, whether adolescent or adult) want is
travelling companions and not travel guides [3]. Fragmentation of the well
established teams, creating teams out of existing teams, lack of
continuity in the treatment process, ineffective communication, the need
to create ‘extended family’ as Prof. Woody Cann proposes, in the process
of creating yet another service are some of the factors which makes me
take the side of Peter Birleson and yes I agree that creating Youth Mental
Health as a specialist team is not right , similar to the fact that
creating Women Focused Treatment [4] and various other such teams that
many demand.


1.Killaspy H, Kingett S, Bebbington P, Blizzard R, Johnson S, Nolan
F, Pilling S & King M (2009) Randomised evaluation of assertive
community treatment: 3-year outcomes. British Journal of Psychiatry,
195(1) p81-2

2. T.Burns, F.Creed, T.Fahy, S.Thompson, P.Tyrer. Intensive versus
standard case management for severe psychotic illness: a randomised trial
The Lancet, Volume 353, Issue 9171, Pages 2185-2189

3. Deitchman WS: How many managers does it take to screw in a light bulb?
Hospital and Community Psychiatry 31:788–789, 1980.

4. Shelly F. Greenfield and Christine E.Grella. Alcohol & Drug Abuse:
What is ‘Women –Focused’ Treatment for Substance Use Disorders?
Psychiatric Services 2009; 60:880-882

Competing interests:
None declared

Competing interests: No competing interests

12 October 2009
Devender Singh Yadav
Staff Grade Psychiatrist
ABU University NHS trust. CF31 1RQ