Managed cases, drop‐ins, drop‐outs, and other by‐products of mental health care

The assertive case management (ACT) study by Bond and colleagues illustrates the problems of evaluating new mental health service modalities applied to multi-dimensional problems. Both characteristics of large urban areas and increasing consumer self-awareness affect implementation of random assignment and follow-up studies. In the study reviewed here, possible lack of fit between study subjects and the control condition, a drop-in center, may have contributed to a high attrition rate. As most of the controls never received the treatment, neither ACT nor the drop-in center were adequately tested. And without explication of how the control condition relates to other peer-oriented interventions, study findings cannot be generalized to self-help. The authors' conclusions concerning self-help are therefore not supported by their findings.