LAUSR

World Psychiatry 21:2 June 2022 provide a wide range of interventions. Vari­ ations among team practices suggest that it is hard to practice all elements or compo­ nents well, and that sometimes different components can compete, e.g., ensuring rapid response to new referrals vs. provid­ ing intensive care with frequent visits to current service users. Local adaptations are often necessary, and this may add to challenges in comparing complex inter­ ventions across sites and countries. Johnson et al’s overview describes a wide range of acute psychiatric care mod­ els used in various stages and contexts. For most of these models, there is a lack of research­based evidence, and achiev­ ing evidence for all these models may not be possible. However, a possible path may be to use research models currently under development for complex interventions to study individual elements of acute psychi­ atric care. If such research could identify which elements are critical for what types of clinical effect, these elements could be applied and studied within various models and contexts. One dilemma of the increasing special­ ization and differentiation in mental health services, including acute psychiatric care, is the increasing discontinuity of care for service users who need services through several phases of illness. Models with more generic or integrated teams may secure more continuity in the personal relation­ ships between the service user and the service provider. Efficiency requirements focus on management of disorders, but often leave little room for the interaction of providers with persons with these dis­ orders. We need to know more about which out­ comes are most important for service users and what elements of acute psychi­ atric care contribute to the various out­ comes. As a part of this, it is important to better understand how continuity of care and therapeutic relationships contribute to positive patient experiences and out­ comes in acute psychiatric care, and how these two critical elements may be pro­ vided.