The evidence is pretty clear that ACT delivers best mental health outcomes and substance misuse problems when, as we were talking earlier, the two are combined. Unfortunately, ACT teams have been disappointing, in terms of reducing re-arrest or re-incarceration of people with serious mental illness and drug abuse problems. The only models showing improvement on ACT ones also have aspects of a community treatment order or some coercive element, in addition to the ACT team, with both mental health and addictions treatment going on for people.
So for that even smaller group—the ones who are the frequent flyers between courts, prisons, mental health facilities and police arrest—none of our services are managing terribly well. We need quite complex responses that have the ACT mental health element, the ACT substance-misuse elements, and some degree of integration with criminal justice to make sure that care is effective and stops those cycles.