Chandler‐California1 1991.

Methods	Allocation: randomised. Design: multicentre, 2 sites*** (site A: Long Beach, urban site; site B: Stanislaus County, rural site). Duration: 36 months. Country: California, USA.
Participants	Diagnosis: serious and persistent mental illness (DSM‐III‐R).* N = 516. Setting: 1 urban, 1 rural but integrated service agencies. Age: 30% > 45 years. Sex: 52% M. Ethnicity: 26% non‐white. History**: i. functional impairment due to mental disorder, ii. eligibility for public assistance, iii. not a primary diagnosis of substance abuse, iv. informed consent given.
Interventions	1. ICM***: ACT provided by integrated service agencies, according to Training in Community Living Programme (Stein and Test). Caseload: 1:10. N = 252. 2. Standard care: usual mental health service (i.e. outpatients: day treatment, case management; inpatients: minimal rehabilitation services). N = 264.
Outcomes	Service use: average number of days in hospital per month Following outcomes available for single centre. Service use: not remaining in contact with psychiatric services, admitted to hospital. Global state: leaving the study early. Social functioning: employment, arrested, imprisoned, accomodation status. Costs: cost of psychiatric hospital care. Unable to use ‐ Mental state: general symptoms: Colorado Symptom Index (no data reported). Self esteem: New York Self Esteem Scale (no data reported). Quality of life: Lehman's Quality of Life Instrument (no data reported). Social functioning: level of social activities (scale not peer reviewed). Family burden: subscales adapted from Tessler's Family Burden Interview (not peer reviewed, attrition > 50%). Participant satisfaction: scale for overall satisfaction with mental health services (scale not peer reviewed). Costs: direct costs of health care and of all care (no SD), all mental health care (not listed as review outcome of interest).
Notes	*61% schizophrenia **28% admitted in previous year ***Intervention programme in 2 sites slightly different: Site A puts more emphasis on employment services and social and therapeutic activities. Site B emphasises avoiding hospitalisation through use of crisis house.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Randomised for single centre. No further details.
Allocation concealment (selection bias)	Unclear risk	No details
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Primary outcome: clinician/participant mediated ‐ rating ‐ Unclear. Secondary outcomes: clinician/participant mediated ‐ rating ‐ Unclear.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Problematic to blind participants and those providing the intervention in studies comparing ICM intervention with standard care.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Employment, arrest, conviction, homelessness, and service use (hospitalisation) were compiled from state and local databases. Blinding not reported. For mental state (symptomology), independent research staff conducted interviews. Blinding not reported. Quality of life and personal safety self reported. Not blinded.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Number of lost to follow‐up reported, but reasons for missing data not provided. LOCF for continuous data.
Selective reporting (reporting bias)	High risk	Listed outcomes of interest not reported (continuous data from scales not reported; days in hospital reported only for site A, no SD).
Other bias	Low risk	Publicly funded (California Department of Mental Health, NIMH). No details. No evidence of the presence of other bias.