Community mental health models of care — structured clinical viva

This viva tests systems psychiatry: can the candidate classify models by intensity and purpose, defend fidelity, cite named evidence, and avoid both institutional nostalgia and anti-bed ideology.^[10]

Architecture. Balanced care after deinstitutionalisation: primary collaborative care for common mental disorders; CMHT for secondary SMI; ICM/ACT for high-need disengaged; FACT as flexible step-up; CRHT for time-limited crisis; EIP for first episode; beds retained for containment and medical complexity.^{[2][5][6][10]}

ACT lineage. Stein and Test comprehensive community programme; Marshall Cochrane on contact and hospitalisation; ACT = small shared caseload, in vivo, assertive, MDT, often time-unlimited — not a rebranded clinic.^[1][2]

ICM context pearl. Dieterich Cochrane package; Burns meta-regression — bed-day reductions larger where baseline hospital use high.^[3][4]

Crisis and early care. Johnson CRT RCT reduced admissions; Glover ecological implementation signal; LEO specialised early psychosis care; EPPIC framework for early detection and phase-specific management.^[5][6][7]

Primary care and social recovery. IMPACT collaborative care; Housing First without sobriety prerequisite; IPS competitive employment first with team integration. Global principles: treatment gap, workforce, rights, continuity (Thornicroft).^[8][9][10]

Pitfalls. ACT-in-name-only; CRHT as bed-closure cover; no step-down; inventing MHA sections; community ideology leaving high risk uncontained.^[10]