Very little experience or evidence is available on how to create effective service models in rural settings. Here, David McAuley and colleagues share their experience of developing an assertive outreach service in Cornwall

Assertive Community Treatment (ACT) is a clinically effective approach to managing the care of people with severe mental health problems living in the community (Marshall and Lockwood 2001). It was developed in the United States in the early 1970s to address the difficulties of caring for people with severe mentally illnesses in the community. The main goals of ACT are to keep this client group in contact with services, reduce hospital admissions and improve outcome, particularly in the areas of social functioning and quality of life. The key components of the ACT model have been outlined in more recent years (Teague et al 1998) in order to encourage services to adhere to the aspects of the service model which have been shown to be effective.